The Glasgow Effect

This weeks input focused on risk behaviours and how the impact on society and lifestyles. The first aspect we were to take away from this input, was to read the Glasgow Effect Document.  The Glasgow Effect was a study which aimed to look more closely at what has been termed “The Scottish Effect”, the increased levels of poor health and mortality which can be found in Scotland, moreso than can be explained by socio-economic environments. The term “Glasgow Effect” comes from the fact that this seems to be concentrated in the west of Scotland.

The document analysed information taken from 3 similarly deprived cities: Glasgow, Liverpool and Manchester, gathered through income data, mortality data and historical census. Despite their basically identical deprivation profiles, overall mortality rates in Glasgow are 15% higher, and premature death rates are 30% relative to Liverpool and Manchester. This “excess mortality” can be found across almost the whole population – male and female, deprived and non-deprived areas, and across all age groups, with the exception of the very young.

It states that deprivation is a fundamental factor of health and mortality, but stresses that it is only one aspect of a more complex picture, and that it dose not explain the levels of excess mortality encountered in Glasgow, when related to its two counterparts.

The study found that approximately 50% of premature deaths (those under the age of 65) were directly linked to alcohol and drug-related causes. It also found that income-deprived communities in Glasgow which experience significantly different health outcomes, relative to identically income-deprived communities in Liverpool and Manchester. Child mortality rates were actually found to be lower than in Liverpool and Manchester, and mortality rates were found to be generally higher amongst males than females.

An important aspect of the study to note was that while income deprived areas in Glasgow experienced higher rates of mortality than in the comparative cities, so too did more affluent suburbs of Glasgow, with an approximate difference of 15% between Glasgow and it’s comparative cities. Some statistics which linked risk behaviours to premature mortality were:

• 27% Increase in incidences of lung cancer.
• 32% increase in external causes (accident, injury, assault, medical accidents or surgical care)
• ~70% increase in rates of suicide (exception: females in Glasgow 2x higher than in Liverpool and Manchester)
• 2.3 x increase in alcohol-related causes
• 2.5x increase in drug-related poisonings

The question that needs to be asked here is: what impact does society and lifestyles have on rates of mortality? Looking at this document, it cannot be quantitatively stated. However, the fact that increases in causes of mortality are incidences of lung cancer (linked to smoking), external injury (e.g. by assault), suicide (possibly linked to mental health provision and the cultural attitudes surrounding mental health), and drug and alcohol use, it can be seen that the lifestyle choices that people make may have a bearing on future health and mortality rates. The problem now is finding ways to tackle these issues and counteract the problems that are lasting and effective.

 

Are Scottish people healthy?

This question was raised near the end of class, and I am firmly in the ‘maybe’ camp. It is a very broad question, and not one that I feel can be easily answered with a simple yes or a no. Some Scottish people are healthy, and some are not, but to say that all Scottish people are or are not healthy seems to me to speculative and somewhat generalising. Scotland has been described in the past as the “sick man of Europe”, and while we do seem to experience poorer health outcomes and lower life expectancy comparative to other UK cities, and in Europe, it is unfair to judge a whole country of individuals based on speculation.

For me, health is dependent on a myriad of factors: income, a good physical environment, access to healthy food, opportunities for physical activity, good social and emotional health, and mental health, in additional to a good work/life balance and good education. These factors work in conjunction with each other to form a healthy individual, and if enough of these factors are inadequate or not appropriately met, then a person’s health can be impacted adversely. It based in my belief in this complexity of health that I feel that it is unfair to say yes or no to this question.  The World Health Organisation lists some other determinants of health here: http://www.who.int/hia/evidence/doh/en/

As we are a nation of individuals, we all possess individual levels and combinations of the factors I have previously mentioned, and those stipulated by the WHO. Due to this, we all possess individual health backgrounds, and may be healthy or unhealthy in different ways and for different reasons. It is fair to state, and it has been stated in the Glasgow Effect, that Scotland experiences poorer health outcomes than other cities within the UK and other European countries. This document, published in 2003, looks in further detail at Scotlands ranking in Europe in terms of health at the time of the study.

While this is true, it does not enable us to categorically state whether Scottish people as a whole are healthy or not, without breaking the statistics down further and looking at the cultural and socio-economic factors which interlink with health, and the part they play on our health and mortality rates.