If you live in Glasgow, you are more likely to die young. Men there die a full seven years earlier than their counterparts in other UK cities. Until recently, the causes of this excess mortality remained a mystery.
The phenomenon has become known as the Glasgow Effect. But David Walsh, a public health programme manager at the Glasgow Centre for Population Health, who led a study on the excess deaths in 2010, wasn’t satisfied with how the term was being used. “It turned into a Scooby-Doo mystery but it’s not an exciting thing. It’s about people dying young, it’s about grief.”
He wanted to work out why Glaswegians have a 30% higher risk of dying prematurely – that is before the age of 65 – than those living in similar post-industrial British cities. In 2016 his team published a report looking at 40 hypotheses – from vitamin D deficiency to obesity and sectarianism. “The most important reason is high levels of poverty, full stop,” says Walsh. “There’s one in three children who are classed as living in poverty at the moment.”
But even with deprivation accounted for, mortality rates in Glasgow remained inexplicable. Deaths in each income group are about 15% higher than in Manchester or Liverpool. In particular, deaths from “diseases of despair” – drug overdoses, suicides and alcohol-related deaths – are high. In the mid-2000s, after adjusting for sex, age and deprivation, there was almost a 70% higher mortality rate for suicide in Glasgow than in the two English cities.
Walsh’s report revealed that radical urban planning decisions from the 1950s onwards had made the physical and mental health of Glasgow’s population more vulnerable to the consequences of deindustrialisation and poverty.
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Shifting theories of city planning have profoundly altered people’s lives everywhere, and particularly over the past half-century in Glasgow. The city’s population stands at about 600,000 now. In 1951, it was nearly double this. Glasgow’s excess mortality, the report suggests, is the unintended legacy of urban planning that exacerbated the already considerable challenges of living in a city.
Studies have consistently linked city living with poorer mental health. For example, growing up in an urban environment is correlated with twice the risk of developing schizophrenia as growing up in the countryside. By 2050, 68% of the world’s population will live in cities, according to UN figures. The consequences for global health are likely to be significant.
Can we learn from what happened in Glasgow? As an increasing number of people move to or are born in cities, questions of fragmented communities, transient populations, overcrowding, inequality and segregation – and how these affect the wellbeing of residents – will become more acute.
Are urban dwellers doomed to poor mental health or can planners learn from the mistakes of the past and design cities that will keep us healthy and happy?