Scottish ‘excess’ mortality: comparing Glasgow with Liverpool and Manchester

This research programme involves a number of different projects, all aimed at gaining a better understanding of what lies behind the ‘excess’ levels of poor health (i.e. that which does not appear to be explained by socioeconomic deprivation alone) seen in Scotland and, in particular, Glasgow, compared to other parts of the UK.

Excess mortality final

Phase 1 

The first stage explored the relationship between socioeconomic circumstances and mortality in Glasgow and its two most similar and comparable post-industrial UK cities: Liverpool and Manchester. This showed that while the deprivation profiles of the cities were almost identical, mortality in Glasgow was significantly higher (30% higher for premature deaths; 15% higher for deaths at all ages). 

Download the Investigating a Glasgow Effect report. 

Following publication of this report, a separate piece of work in 2011 sought to summarise, and assess, the various explanations for Glasgow’s (and Scotland’s) poor health status. 

Download the Accounting for Scotland's Excess Mortality: Towards a Synthesis report. 

A range of people were invited to comment on this synthesis report. The responses received have been collated into a short commentary report.  The synthesis is currently being updated in the light of the considerable amount of subsequent research that has been undertaken, some of which is summarised below.   

Phase 2 

The second phase of research incorporates a number of different projects relating to the many hypotheses that have been proposed to explain Scotland’s and Glasgow’s high levels of excess mortality. 

Qualitative research

Qualitative research has been undertaken in Glasgow, Liverpool and Manchester to explore potential reasons for the poorer levels of health seen across the whole Glasgow population in comparison to those in the English cities. The most recent research was based on interviews with key informants in nine communities across the three cities. Download the final report, published in May 2015.

Population survey

A population survey was undertaken in Glasgow, Liverpool and Manchester in 2011 in which new data were collected for some of the potential explanations that have been proposed in relation to Glasgow's excess mortality, and which were outlined in the 2011 synthesis report

The survey collected new data on social capital, political engagement & perceptions, ‘sense of coherence’, optimism, different ‘individual values’ and more. Results from the analyses of the survey were published in June 2013 and a briefing paper is also available. 

Spatial patterning of deprivation

The results of GCPH-funded analyses by Glasgow University of the differences in the patterning of deprivation in the three cities, and their potential impact on neighbourhood mortality rates, was published in April 2013. Download the report and related briefing paper

Historical changes in deprivation and city structure

A PhD studentship is being funded by GCPH to explore the extent to which historical changes in deprivation and changes in city structure in Glasgow, Liverpool and Manchester may have impacted on health profiles. The PhD will run until 2015, and is based at the University of Glasgow. Further details are available here

Early years research

Longitudinal cohort survey data (and other data sources) were used to assess the extent to which the early years experiences of residents of Glasgow, Liverpool and Manchester may have differed in recent decades. The results are published in a report, Poverty, parenting and poor health, as well as a related briefing paper. 

Impact of local policy and practice

NHS Health Scotland is funding a PhD studentship at the University of the West of Scotland, examining policy and practice of local government in each of the three cities, and their potential impact on population health. The PhD is running from 2014 to 2017. Further details are available on request. 

Alcohol harm

Detailed analyses of patterns and trends in alcohol consumption and harm in Scotland and England (with an additional focus on Glasgow, Liverpool and Manchester) have been undertaken. A journal article, ‘Alcohol-related mortality in deprived UK cities: worrying trends in young women challenge recent national downward trends’, was published in the Journal of Epidemiology and Community Health and a more detailed briefing paper (including results of additional analyses for other Scottish cities) is available

Vitamin D

A systematic review of the link between Vitamin D deficiency and all-cause mortality was undertaken in 2012. The results were published in July 2013 in BMC Public Health. Download the article.

Latest developments 

In May we launched our new synthesis report, identifying the most likely underlying causes of Scotland’s and Glasgow’s levels of ‘excess’ mortality.

The report, History, politics and vulnerability: explaining excess mortality in Scotland and Glasgow, reaffirms that the principal explanation for poor health in Glasgow and Scotland (as in other societies) relates to the well understood effects of poverty and deprivation (and related factors such as deindustrialisation). And the evidence shows that the additional, excess, levels of mortality observed among the Scottish population are best explained by a greater vulnerability to those factors, caused by a series of historical decisions and processes.

The research findings, alongside a detailed set of resultant policy recommendations aimed at national and local government, have been endorsed by a range of experts in public health and other relevant disciplines.

Download our excess mortality Q&A document (PDF).