Five years ago we published a major report with NHS Health Scotland (now Public Health Scotland (PHS)), the University of the West of Scotland and University College London into the causes of the much publicised ‘excess’ levels of mortality that we see in Glasgow: that is, higher mortality compared to other, similar, post-industrial cities such as Liverpool, Manchester and Belfast (and after taking into account any differences in socioeconomic deprivation). The excess is what the media often refers to as a ‘Glasgow effect’.

The report, officially endorsed by leading figures in public health and other disciplines across the UK, demonstrated that Glasgow’s poorer health was largely explained by a toxic combination of historical adverse living conditions and poor political decision-making at different levels of government and at key points in time. In other words, and as we said at the time, what we see in the city is not a ‘Glasgow effect’, but a political effect.

This is really important for anyone who seeks to understand – and more importantly, do something about – health inequalities in society. The political causes of poor health and inequalities are well understood. What’s happened in Glasgow is one particular ‘case study’ of a much wider phenomenon. Indeed, in the last decade we have witnessed political effects on health across all parts of the UK: increasing death rates among the more deprived populations of England, Scotland, Northern Ireland and Wales. These have been attributed in large part to UK Government ‘austerity’ cuts that have had a calamitous impact on the poorest and most vulnerable people in our society. In a country as wealthy as the UK, this is nothing short of a scandal.

However, these changes to mortality rates in different parts of the UK have not led to media headlines about an ‘England effect’ or a ‘Wales effect’. Nor have we seen similar headlines about Leeds, Birmingham, Manchester or Liverpool ‘effects’ – all cities with communities where life expectancy has decreased in the last decade. Yet the ‘Glasgow effect’ headline persists.

Evidence of both excess mortality in Glasgow, and of these widening changes in mortality across all parts of the UK, come together in newly published research. The original analyses comparing mortality and deprivation in Glasgow, Liverpool and Manchester (quoted alongside other research in the 2016 report) are now well out of date. With colleagues in PHS, Manchester City Council and the University of Liverpool, we therefore updated the analyses up to 2018 – providing a picture of pre-pandemic mortality levels in all three cities.

The results showed that the overall excess has not changed much: for all ages, mortality levels in Glasgow are still about 12% higher than in Liverpool and Manchester, after adjusting for levels of deprivation (in the original analyses for 2003-07 the figure was 14%). And among men, the excess for premature mortality (deaths under 65 years of age) is still extremely high: 25% higher in Glasgow. For females, however, the excess for these younger deaths has decreased markedly: from 24% to just 5% higher.

However, this is not because things have suddenly improved in Glasgow: premature mortality rates have actually become worse in recent years, especially – and really worryingly – among the city’s more deprived communities. It is because rates in Liverpool have increased to an even greater degree, thereby narrowing the gap between the cities. It goes without saying that in an extremely wealthy society such as the UK, mortality rates should not be increasing anywhere. They should be going down, as they were prior to the introduction of austerity policies.

Political problems require political solutions. Action at UK Government level to reverse the cuts to social security that have been so disastrous for society is urgently required. Alongside this, the Scottish and other devolved governments must do everything in their powers to protect the income, and therefore the health, of the poorest. But we also need people to care, and to be vocal, about what’s been happening.

Although the pandemic laid bare many of the pre-existing societal inequalities, it also seems to have distracted people from the effects of austerity – the very policies which exacerbated inequalities to such a huge degree. This is vitally important context for post-pandemic recovery policy and future population health. It is more important than ever that we understand this, and that there is a concerted and urgent call across society for the necessary solutions to be implemented.