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

What is the ‘excess’ mortality seen in Scotland and Glasgow?

Essentially, it’s an additional number of deaths that do not appear to be explained by socioeconomic deprivation alone. For example, when Glasgow is compared with the post-industrial cities of Liverpool and Manchester – cities with similar levels of deprivation – there are an additional number of deaths than cannot be attributed to poverty alone (or at least to how we measure poverty).

In Glasgow’s case, the excess is often unhelpfully described by the media as a ‘Glasgow Effect’. This blog explains the reasons why this expression is unhelpful and outdated.

Why is mortality worse in Scotland and Glasgow than other comparable parts of the UK?

Our 2016 report revealed that the causes are multiple, complex and interwoven, but in large part relate to a greater vulnerability among the Scottish population to the main drivers of poor health in any society – poverty and deprivation – 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, were endorsed by a range of experts in public health and other relevant disciplines.

follow-up report published in 2020 assesses the extent to which these policy recommendations have been implemented.

There is also a PDF version of the infographic available.Excess mortality longform infographic 2016 

Film of a 2017 conference presentation which summarises the research findings can be accessed on our YouTube channel.  

Many different strands of research were involved in reaching this understanding. Principally (but not exclusively) based on comparisons of Glasgow with Liverpool and Manchester (cities with similar socioeconomic characteristics and histories), these are summarised below. 

Previous work

2010: the original analyses of deprivation and mortality in Glasgow compared with Liverpool and Manchester, which showed that while the deprivation profiles of the cities were very similar, mortality in Glasgow was significantly higher (30% higher for premature deaths; 15% higher for deaths at all ages).
Report and related journal article available. 

2011: an initial synthesis of the most likely causes of the excess, now updated by the 2016 report.
Initial synthesis report and related journal article available. 

2013: a population survey of Glasgow, Liverpool and Manchester.
Report and briefing paper available. 

2013: analyses of the spatial patterning of deprivation in the cities.
Report and briefing paper available. 

2013: early years research.
Report and briefing paper available. 

2013: A systematic review of the link between Vitamin D deficiency and all-cause mortality.
Journal article available. 

2014: research into alcohol harm in Glasgow, Liverpool and Manchester.
Briefing paper and related journal article available. 

2015: qualitative research based on interviews with key informants in the three cities.
Report available. 

2016: analyses which quantified the levels of excess mortality in Scotland between 1981 and 2011.
Journal article available. 

2016: analyses of the nature (and scale) of urban change experienced in the post-war decades.
Report available (PDF). 

2016: separate research into housing conditions, employment and diet, as well as a review of explanations for differences in population health between high income countries (this research was commissioned to contribute to the 2016 synthesis report). 

2016: Completion of a PhD studentship examining historical changes in deprivation and city structures. 

2020: analyses of long-term mortality trends in Scotland and 10 other UK cities (including Liverpool, Manchester and Belfast) will be published soon.

New research into understanding differences in the experience of poverty and deprivation in Glasgow compared to elsewhere in the UK is underway. For further details, please contact Katharine Timpson.

Related research

2019: publication of a study which quantified the contribution of differences in ethnic diversity to Glasgow's and Scotland's levels of excess mortality

Note also that a PhD studentship comparing regional and urban policy in Glasgow and Liverpool was successfully completed in July 2018. For further details, please contact Katharine Timpson.

It should also be noted other research included within this website (e.g. comparing health and its determinants in West Central Scotland with other post-industrial regions of Europe) is also highly relevant to this work area of research. 

Further information

Access further information about excess mortality in Scotland and Glasgow on the ScotPHO website. For information or enquiries about this research, please email David Walsh.