October 23, 2019
Is it down to bad planning?
The Glasgow effect, the fact that Glaswegians are 30% more likely to die prematurely (before the age of 65), has confounded researchers for years. The most comprehensive studies point to the most obvious explanation – poverty – but even accounting for that, Glasgow still experiences disproportionately higher rates of mortality than any other UK city. To what extent does responsibility lie with the city’s planners? Is it possible to design a city that actually makes residents healthy and happy rather than vulnerable to the ‘diseases of despair’. Interesting piece in the Guardian that explores the evidence.
The ‘Glasgow effect’ implies cities make us sad. Can the city prove the opposite?
David Walsh of the Glasgow Centre for Population Health set out to understand why Glaswegians have a 30% higher risk of dying prematurely than those living in similar post-industrial British cities.
Life expectancy for Glaswegians has long been notoriously low, but planners are starting to learn how to make citizens healthier – and happier
If you live in Glasgow, you are more likely to die young. Men die a full seven years earlier than their counterparts in other UK cities. Until recently, the causes of this excess mortality remained a mystery.
“Deep-fried Mars bars,” some have speculated. “The weather,” others suggested. For years, those reasons were as good as any. In 2012, the Economist described it thus: “It is as if a malign vapour rises from the Clyde at night and settles in the lungs of sleeping Glaswegians.”
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,” he says. “It’s about people dying young, it’s about grief.”
You have to understand what sort of shape Glasgow was in. They thought the best approach was to start afresh.
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.
In Glasgow, deaths from “diseases of despair” are particularly high.
Walsh’s report strongly suggested a theory: that radical urban planning decisions from the 1950s onwards had made not just the physical but the mental health of Glasgow’s population more vulnerable to the consequences of deindustrialisation and poverty.
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. And the unintended legacy of some urban planning exacerbates the already considerable challenges of living in a city – something 68% of the world’s population will be doing by 2050, according to UN projections.
Are these urban dwellers doomed to poor mental health, or can planners design cities that will keep us healthy and happy? Can we learn from what happened in Glasgow?
New Towns, new problems
Postwar Glasgow was severely overcrowded. The 1945 Bruce report proposed solving this by housing people in high-rises on the periphery, while the following year’s Clyde Valley report suggested encouraging workers and their families to move to new towns. In the end, the council did a combination of both: New Towns like East Kilbride and Cumbernauld are now among the most populous towns in Scotland; many of those who stayed in Glasgow were relocated to large housing estates such as Drumchapel, Easterhouse and Castlemilk.
This rapid change in the city’s makeup was soon recognised as disastrous. Relocating workers and their families to new towns was described in mid-1960s parliamentary discussions as “skimming the cream”. In an internal review in 1971, the Scottish Office noted that the manner of population reduction was “destined within a decade or so to produce a seriously unbalanced population with a very high proportion [in central Glasgow] of the old, the very poor and the almost unemployable…”
Although the government was soon aware of the consequences, these were not necessarily intentional, says Walsh. “You have to understand what sort of shape Glasgow was in, in terms of the really lousy living conditions, the levels of overcrowded housing and all the rest of it,” he says. “They thought the best approach was to just start afresh.”
Anna left the tenements for a high-rise in Glasgow’s Sighthill estate, where she has lived on and off since the mid-60s. She was a teenager when she moved with her mother and sister to a brand-new fourth-floor flat, picked from a bowler hat. It had two bedrooms, a bathroom, a kitchen and a glass partition in the hallway. “It was like Buckingham Palace,” remembers Anna. She is now 71, dressed in jeans and a denim shirt, with a blonde bob and a raspy cough that doubles as a laugh.
You’re more likely to have violence, you’re more likely to have conflict; even sexual abuse is much higher in households where there are drinkers
Sighthill’s 10 20-storey tower blocks were meant to herald the future. Set in parkland, with a view over the city, they would house more than 7,000 people drawn from the tenements and the slums.
Until then, the family had lived in a tenement building in nearby Roystonhill. “I slept with my mammy and my sister in a recess,” she says. The toilet was shared.
But when the tenements went, something else went, too. “There were communities which had a social fabric, if you like, which were then broken up by these processes,” says Walsh.
Anna recalls the change. “When we were in the tenements, you’d shout up to the window: ‘Mammy, I want a piece of jam!’ Before you knew it there was a dozen of them being thrown out of the window.” In the tower block, she did not let her own children play unsupervised. Neighbours only spoke if they took the same lift. Her daughter was threatened with a bread knife.
By the 2000s, the tower blocks were infamous for deprivation, violence and drugs. Many residents had moved out, including Anna and her family. Empty flats were used to rehouse asylum seekers. Fractures within the community were worsening. Glasgow Housing Association eventually decided to condemn the buildings, and the towers were demolished over eight years; the last one came down in 2016.
But the roots of Glasgow’s excess mortality stretch back further – to the Industrial Revolution, argues Carol Craig, who has written two books on the subject. In Glasgow, then called the Second City of the Empire, factories and the docks needed workers. Overcrowding coupled with a culture of drinking produced an explosive situation.
Faced with the prospect of returning to a cramped tenement, many men preferred to visit the pub; there were few other public meeting places. “You’re more likely to have violence, you’re more likely to have conflict; even sexual abuse is much higher in households where there are drinkers,” Craig says.
Being exposed in childhood to stressful events like domestic violence, parental abandonment, abuse, or drug and alcohol addictions is thought to be linked to poor mental and physical wellbeing in later life. The higher a person’s number of adverse childhood experiences (ACEs), the more likely they are to suffer from mental illness or addiction. In turn they are more likely to expose their children to similar types of experiences, she says: “ACEs tend to cascade through the generations.”