History, Politics and Vulnerability: Explaining Excess Mortality in Scotland and Glasgow
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History, politics and vulnerability: explaining excess mortality in Scotland and Glasgow David Walsh, Gerry McCartney, Chik Collins, Martin Taulbut, G David Batty May 2016 A report by the Glasgow Centre for Population Health, NHS Health Scotland, the University of the West of Scotland and University College London David Walsh is a Public Health Programme Manager at the Glasgow Centre for Population Health; Gerry McCartney is a consultant in Public Health and Head of the Public Health Observatory team at NHS Health Scotland; Martin Taulbut is a Public Health Information Manager at NHS Health Scotland; Chik Collins is Professor of Applied Social Science at the University of the West of Scotland; David Batty is Reader in Epidemiology at University College London. Report published by: Glasgow Centre for Population Health Olympia Building 2-16 Orr Street Bridgeton Cross Glasgow G40 2QH Telephone: 0141 330 2747 Email: [email protected] Web: www.gcph.co.uk 1 Contents Preface ....................................................................................................................................... 3 Signatories ................................................................................................................................. 4 Executive summary ................................................................................................................... 6 Acknowledgements ................................................................................................................. 12 Report overview ...................................................................................................................... 13 1. Introduction ......................................................................................................................... 14 2. Aims and research questions............................................................................................... 20 3. Methods .............................................................................................................................. 21 4. Context: Scottish mortality phenomena and the importance of social, economic and historical influences ................................................................................................................. 24 5. Developing explanatory models for Scotland and Glasgow ................................................ 33 6. Discussion ............................................................................................................................ 66 7. Implications and responses ................................................................................................. 75 8. Conclusions and recommendations for future research. .................................................... 82 Appendices .............................................................................................................................. 85 Appendix A. Assessments of hypotheses. ........................................................................... 86 Appendix B. Assessment of hypotheses – summary table ................................................ 279 Appendix C. Participants at June 2015 ‘workshop’. .......................................................... 304 References ............................................................................................................................. 306 2 Preface Scotland experiences high levels of ‘excess’ mortality: that is, higher mortality over and above that explained by the country’s socioeconomic profile. Compared with England & Wales, and adjusting for differences in poverty and deprivation (the main causes of poor health in any society), 5,000 more people die every year in Scotland than should be the case. This excess plays a major role in explaining why Scotland has both the lowest life expectancy, and the widest mortality inequalities, in Western Europe. Although usually expressed in statistical terms (such as standardised rates or ratios or expected years of life), behind such summary epidemiological expressions lie genuine human tragedies: individual stories of shortened, wasted lives, pain, sickness, early death and grief, affecting individual men, women and children, their families, friends and communities. This report seeks to summarise all the research that has been undertaken into this phenomenon, with the aim of achieving a greater understanding of its most likely underlying causes and, therefore, the most appropriate responses. As the report makes clear, however, such responses need to be entwined with ever more urgent actions to address the key drivers of overall poor health in the country – poverty and deprivation – and to seek to narrow the widening gaps in income, power, wealth and, therefore, health in Scottish society. The conclusions of the report, including a list of policy recommendations, have been endorsed by a wide range of experts in public health and other disciplines, who are listed below. Together with these signatories, we implore action on the part of both national and local government to address the many issues highlighted in this research. 3 Signatories The principal findings of this report, including the set of resulting policy recommendations, have been endorsed by the following individuals: • Professor Nick Bailey, Professor of Urban Studies, University of Glasgow • Professor Clare Bambra, Professor of Public Health Geography, Durham University • Professor Sir Harry Burns, Professor of Global Public Health, University of Strathclyde • Colin Cox, Former Deputy Director of Public Health, Manchester • Dr Peter Craig, Senior Research Fellow, MRC/CSO Social & Public Health Sciences Unit, University of Glasgow • Fiona Crawford, Consultant in Public Health, NHS Greater Glasgow & Clyde/Glasgow Centre for Population Health • Professor Mike Danson, Professor of Enterprise Policy, Heriot-Watt University • Professor Sir Tom Devine, Emeritus Chair of Scottish History and Palaeography, The University of Edinburgh • Professor Danny Dorling, Professor of Geography, University of Oxford • Dr Flora Douglas, Lecturer in Public Health, University of Aberdeen • Ruth Dundas, Senior Investigator Scientist, MRC/CSO Social & Public Health Sciences Unit, University of Glasgow • Jackie Erdman, Head of Inequalities, Corporate Inequalities Team, NHS Greater Glasgow and Clyde • Professor John Frank, Director, Scottish Collaboration for Public Health Research and Policy (SCPHRP), and Chair of Public Health Research and Policy, University of Edinburgh • Dr Andrew Fraser, Director of Public Health Science, NHS Health Scotland • Dr Lisa Garnham, Public Health Research Specialist, Glasgow Centre for Population Health • Professor Phil Hanlon, Honorary Senior Research Fellow (formerly Professor of Public Health), University of Glasgow • Professor Annette Hastings, Professor of Urban Studies, University of Glasgow • Dr S. Vittal Katikireddi, Senior Clinical Research Fellow, MRC/CSO Social & Public Health Sciences Unit, University of Glasgow • Lorna Kelly, Associate Director, Glasgow Centre for Population Health • Professor Alastair H Leyland, Associate Director, MRC/CSO Social & Public Health Sciences Unit, University of Glasgow • Professor Mhairi Mackenzie, Professor of Public Policy, University of Glasgow • Professor Alison McCallum, Director of Public Health and Health Policy, NHS Lothian, and Chair of Scottish Directors of Public Health • Dr Jennifer McLean, Public Health Programme Manager, Glasgow Centre for Population Health • Professor Rich Mitchell, Professor of Health and Environment, University of Glasgow, and Head of Public Health & Co-Director of the Centre for Research on Environment, Society and Health (CRESH) 4 • Professor Laurence Moore, Director, MRC/CSO Social & Public Health Sciences Unit, University of Glasgow • Jill Muirie, Public Health Programme Manager, Glasgow Centre for Population Health • Dr John O’Dowd, Consultant in Public Health Medicine, NHS Greater Glasgow and Clyde • Dr Tony Robertson, Lecturer in Public Health, University of Stirling • Dr Katherine Smith, Reader - Global Public Health Unit, University of Edinburgh • Dr Michael Smith, Associate Medical Director for Mental Health, NHS Greater Glasgow and Clyde • Dr Katherine Trebeck, Senior Researcher , Oxfam GB Global Research Team, and Honorary Professor, University of the West of Scotland • Dr David Taylor-Robinson, Senior Clinical Lecturer in Public Health, University of Liverpool • Professor Jim Tomlinson, Professor of Economic and Social History, University of Glasgow • Bruce Whyte, Public Health Programme Manager, Glasgow Centre for Population Health • Dr Andrea Williamson, GP and Director of Community Based Education (Strategy and Innovation), School of Medicine, University of Glasgow 5 Executive summary The poor health profiles of Scotland, and especially that of its largest city, Glasgow, are well known. Much of this is explained by recent experiences of deindustrialisation, deprivation and poverty: the latter are the root causes of poor health in all societies, not just Scotland. However, in addition, high levels of excess mortality – that is, higher mortality over and above that explained by differences in socioeconomic deprivation – have been observed for Scotland compared with England & Wales, as well as for Glasgow compared with similar post-industrial UK cities such as Liverpool, Manchester and Belfast. The scale of this excess is considerable. It accounts for approximately 5,000 extra, ‘unexplained’, deaths per