The Glasgow Effect: Political or Personal?

The Glasgow effect is an expression commonly used in the media following a report in 2010 which compared mortality rates and socio-economic disadvantage between Glasgow and the post-industrial cities of Manchester and Liverpool (Walsh et al, 2010). With Glasgow experiencing a premature mortality rate (less than 65 years old) 14% greater than that of both cities (Schofield et al., 2021). In 2010-2012, 54% of excess deaths were due to alcoholism, 74% due to suicide and 250% for drug abuse (Schofield et al., 2016). While this is often portrayed as an arbitrary phenomenon, many scholars have alluded to a ‘political effect’ as a result of poor living conditions and free market driven political policy (Schofield et al., 2021). This essay will closely examine the influence of the implementation of neoliberalism under Margaret Thatcher and the Conservative-Liberal Democrat coalition government of 2010-2015 on health outcomes, as well as trends overseas under neoliberal governance, as well as social democracies with more interventionist and generous policies. Finally looking into the influence of housing policies with regards to overcrowding and socio-spatial division to address the reasons as to why Glasgow experiences high levels of health inequality.

Between 1979 and 1990 leader of the Conservative government Margaret Thatcher set about reversing the previous egalitarian driven policies of the ‘post-war rebuild’ through application of neoliberal policies. With a political attack on the working class through deindustrialisation and cuts to welfare expenditure, adopting a laissez-faire style of governance (Smith et al., 2015). In industrial inner-city areas with a vast working-class demographic, such as Cowlairs, male unemployment rates in 1990 hit 36.1%; contrasted with the middle-class suburban areas, such as Bearsden, with unemployment rates of 3.5% (Lever, 1991). On top of this, Thatcher targeted trade unions and workers’ rights with the 1984 trade union act, as well as a £1.5B cut between 1979-1982 to state expenditure on social security, leaving workers with minimal unemployment support, in addition to the reduced resistance power surrounding deindustrialisation. This coincided with an alarming rise in mortality inequality between social classes (Scott-Samuel, 2014), with suicides, violence, crime, and drug and alcohol abuse increasing across Glasgow (Shaw et al., 2002). Relative inequalities in Scotland (particularly in Glasgow) increased to such an extent that by 2001, Scotland had the highest health inequalities in Central and Western Europe (Mackenbach, 2008). Thus, it is clear that the neoliberal, market-centric policies of the Thatcher government heavily exacerbated health inequalities in post-industrial Glasgow. Furthermore, 20 years on to the Conservative-Liberal Democratic coalition government of 2010-2015 the trend continued, with male mortality in Glasgow initially declining at a rate of 9.8% in 2010, this then plateaued to 1.3% by 2015 (Walsh et al., 2020). With all-cause mortality in Glasgow between 2014-2018 was 12% higher for all-cause mortality compared with Manchester and Liverpool, and 17% higher for premature deaths. This has been ascribed to the £48B in social security cuts, adopting a regressive Thatcherite philosophy affecting the socioeconomic disadvantaged, coupled with Scotland’s limited capabilities to mitigate or soften the effects due to devolved powers (Walsh et al., 2020). Again, demonstrating the structural force on mortality rates in Glasgow exclusive to those low on the socioeconomic hierarchy.

The association between neoliberal politics and health inequalities can be seem overseas with disparities in mortality rates between low- and high-income groups in New Zealand under Roger Douglas’ neoliberal reforms between 1984 and 1988. With mortality rates falling by 6% for men and 11% for women in low-income groups, and 34% and 45% for high income groups, during the same period relative and absolute inequalities exacerbated (Blakely et al., 2008). As well as other Western States like the United States who under Ronald Reagan experienced a plateau in average health across the populations (McCartney et al., 2012), in addition to a rapid rise in health inequalities between income and ethnic groups (Krieger et al., 2008). The reverse of this trend was seen under communist regimes whereby post-war Russia and the constitute USSR states’ life expectancy improved to such an extent that it was that of Western and Central Europe by 1980 as a result of egalitarianism and universalism in public policy (Collins et al., 2015). However, this plummeted by 8 years following the restoration of capitalism which brought about mass deprivation and its by-products of crime, violence and alcohol abuse. While some welfare provision, through social programmes and more generous benefits, has helped to recover the demise in health equality, mortality rates and life expectancy remain far worst off in Eastern Europe (Struckler et al., 2008). Thus, as many scholars have proposed, population health improves in line with welfare systems predicated on universalism and egalitarian policies (Lundberg et al., 2008), contrary to the inequality in health under neoliberalism in Glasgow.

In terms of post-war housing in Glasgow the Scottish Office set about tackling health and housing issues via the Clyde Valley Regional Plan which set out to build four peripheral housing estates (East Kilbride, Cumbernauld, Houston and Bishopton). However, only one (East Kilbride) was pursued due to scepticism from the newly elected Conservative government (Walsh et al., 2016). This reluctance of the government to include Glasgow in the modernisation plans in central Scotland to attract investment meant that peripheral housing was that of poor quality, high-rise flats with little amenities and often overcrowded – with around 1.27 persons per room in 1951, compared with 0.82 in Liverpool and 0.74 in Manchester (Taulbut et al., 2016). Little was done to mitigate or resist this, with overcrowding amongst the most deprived communities standing at 60% in 1971 – over double that of Manchester and Liverpool who tackled the issue via council housing to deal with overspill. It could be said that this exacerbated the effects of Thatcherism in these communities, making them more vulnerable to the ‘neoliberal shock’ (Walsh et al., 2016) – thus contributing to health outcome disparities between Glasgow and post-industrial Manchester and Liverpool. Furthermore, with the decline in council housing across the UK from 31.7% in 1978 to 14.4% in 2001 and the implementation of Thatchers’ social mobility driven homeownership ‘right to buy’ scheme meant that housing stock remaining was of subpar quality and in areas of high deprivation (Bolger, 2010). Many with heating and insulation issues – which acts as a cause of winter excess mortalities (Aylin et al., 2001), as well as dampness which links with respiratory issues (Zock et al., 2002). With Scotland’s homeownership levels below that of the UK average at 66% and socially rented housing above average at 24%, suggesting higher levels of deprivation (Morago, 2016). As illustrated by Martin et al (2004) whereby 54% of social housing contains a non-working adult; compared with only 5% of those who own their homes. With socio-spatial division and housing deprivation acting as a determinant of poor health and health inequality between the social classes (Marsh et al., 1999), it could be argued that Thatcher’s housing policy adversely impacted Glasgow’s health inequalities.

This disparity between the UK average level and Glasgow’s level of socially rented tenancies has been shown to prove detrimental in terms of health outcomes. Lawder et al (2014) found that communities with a large socially rented sector (above 25%) were prone to have poorer self-rated health, in comparison to areas of homeownership predominance, as a result of issues like area stigmatisation and low self-esteem due to the ubiquity of deprivation. As well as being 2 to 3 times more likely to be admitted to hospital for accidents in the community, as a result of the communities being of higher risk primarily due to crime and violence (Leather et al., 2004). Worst of all, residents in areas of high socially rented properties were 4 times more likely to be admitted to hospital as a result of alcoholism (Lawder et al., 2014). Thus, the ‘ghettoization’ of social housing following the increase in ownership of council housing under Thatcherism has exacerbated both physical and mental health inequalities between those pulled up and left behind under such neoliberal housing agendas within Glasgow.

In conclusion, the Glasgow effect is not so much an arbitrary geographical anomaly as it is a product of market-driven neoliberal policy – affecting the socioeconomically disadvantaged demographic. Thus, it must be addressed via structural change. As seen under deindustrialisation in working class districts of the city in comparison to middle class suburbs whereby a disparity in unemployment rates coincided with a rise in excess mortality rates in these districts. As well as the socio-spatial division created under Thatcher’s right to buy scheme, which has helped to drive these mortalities. This trend continued under the coalition government in line with austerity cuts and can also been seen under neoliberal systems globally. In contrast with social democratic states whereby egalitarian and universal welfare policy produce falling excess mortality rates and increasing life expectancy across the population.

References

Aylin, P., Morris, S., Wakefield, J., Grossinho, A., Jarup, L. and Ellio􏰀, P. (2001), ‘Temperature, Housing, Deprivation and their Relationship to Excess Winter Mortality in Great Britain, 1986–1996’, International Journal of Epidemiology 30: 1100–108.

Blakely, T., Tobias, M., and Atkinson, J. (2008) Inequalities in mortality during and after restructuring of the New Zealand economy: Repeated cohort studies. British Medical Journal, 336(7640): 371–375.

Bolger, J. (2010). Social Policy for Social Work, Social Care and the Caring Professions: Scottish Perspectives (S. Hothersall, Ed.) (1st ed.). Routledge. https://doi-org.ezproxy.lib.gla.ac.uk/10.4324/9781315609584

Collins, C., McCartney, G. and Garnham, L. (2015). Neoliberalism and health inequalities. Health Inequalities, pp.124–137.

D. Walsh, N. Bendel, R. Jones, P. Hanlon. It's not ‘just deprivation’: why do equally deprived UK cities experience different health outcomes?

Krieger, N., Rehkopf, D. H., Chen, J. T., Waterman, P. D., Marcelli, E., and Kennedy, M. (2008) The fall and rise of US inequities in premature mortality: 1960–2002. PLoS Medicine/Public Library of Science, 5(2): e46.

Lawder R, Walsh D, Kearns A, Livingston M. Healthy Mixing? Investigating the Associations between Neighbourhood Housing Tenure Mix and Health Outcomes for Urban Residents. Urban Studies. 2014;51(2):264-283. doi:10.1177/0042098013489740

Leather, P., Mackintosh, S., Rolfe, S. (2004) Papering over the cracks: housing conditions and the nation’s health. Joseph Rowntree Foundation, York.

Lever, W.F. (1991). Deindustrialisation and the Reality of the Post-industrial City. Urban Studies, 28(6), pp.983–999.

Lundberg, O., M. Yngwe, M. Stjarne, J. Elstad, T. Ferrarmi, O. Kangas, T. Norström, J. Palme, and J. Fritzell. 2008. "The Role of Welfare State Principles and Generosity in Social Policy Programmes for Public Health: An International Comparative Study." Report prepared for the NEWS Nor- dic Expert Group. Lancet 372 (9650): 1

‌

Mackenbach, J. P., et al. Socioeconomic inequalities in health in 22 European countries. N. Engl. J. Med. 358:2468–2481, 2008.

Marsh, A., Gordon, D., Pantazis, C. and Heslop, P. (1999), Home Sweet Home? The Impact of Poor Housing on Health (London: Policy Press).

Martin, C., Dudleston, A., Harkins, J., Hope, S., Li􏰀lewood, M., Murray, L. and Ormston, R. (2004), Scotland’s People: Results from the 2003 Scottish Household Survey. Annual Report (Edinburgh: Scottish Executive National Statistics, TNS Social Research and Mori Scotland). Public Health, 124 (9) (2010), pp. 487-495

McCartney, G., Walsh, D., Whyte, B., and Collins, C. (2012) Has Scotland always been the ‘sick man’ of Europe? An observational study from 1855 to 2006. European Journal of Public Health, 22(6): 756–760.

Schofield L, Walsh D, Munoz-Arroyo R, McCartney G, Buchanan D, Lawder R, Armstrong M, Dundas R, Leyland AH. Dying younger in Scotland: trends in mortality and deprivation relative to England and Wales, 1981-2011. Health & Place 2016; 40:106-115.

Schofield, L. et al. (2021) ‘Excess mortality in Glasgow: further evidence of “political effects” on population health’, Public Health, 201, pp. 61–68. doi: 10.1016/j.puhe.2021.10.004.

Scott-Samuel, A., Bambra, C., Collins, C., Hunter, D. J., McCartney, G., and Smith, K. (2014) The impact of Thatcherism on health and well-being in Britain. International Journal of Health Services, 44(1): 53–71.

Shaw, M., Dorling, D., and Davey Smith, G. Mortality and political climate: How suicide rates have risen during periods of Conservative government, 1901–2000. J. Epidemiology. Community Health 56:722–727, 2002.

Smith, K.E., Bambra, C. and Hill, S.E. eds., (2015). Health Inequalities. Oxford University Press.

Stuckler, D., King, L., and McKee, M. (2008) Mass privatisation and the post-communist mortality crisis: A cross-national analysis. The Lancet, 372: 1–9.

Taulbut M, Walsh D, McCartney G, Collins C. Excess mortality and urban change: Investigating similarities and differences in the extent of urban change in Glasgow, Liverpool and Manchester and their surrounding regions from 1945, and the extent to which this might be part of the excess mortality explanation. Edinburgh: NHS Health Scotland; 2016

Zock, J.P., Jarvis, D., Luczynska, C., Sunyer, J., Burney, P. and European Community Respiratory Health Survey (2002), ‘Housing Characteristics Reported Mould Exposure, and Asthma in the European Community’, The Journal of Allergy and Clinical Immunology 110: 285–92.