Background Research has shown that Glasgow has an almost identical deprivation profile to Liverpool and Manchester. However, premature mortality is 30% higher, with mortality at all ages almost 15% higher. Many hypotheses have been proposed to explain this phenomenon: for many, however, no data have been available by which their plausibility could be properly assessed.
Methods A representative population survey of Glasgow, Liverpool and Manchester was undertaken. Data for various hypotheses were collected from 3,600 respondents (1,200 in each city): a 55% response rate was achieved. The hypotheses included: lower ‘sense of coherence’ (SoC) in Glasgow; lower social capital; the effects of historical government policy; different individual ‘values’ (e.g. psychological outlook (optimism, aspirations)), hedonism; lower social mobility. Wherever possible, previously validated questions and scales were used (e.g. Antonovski’s SoC Scale, Schwartz’s Human Values Scale, Life Orientation Test). Multivariate linear and logistic regression analyses were employed to assess whether any differences existed between the cities for these topics (after adjustment for age, gender, ethnicity, social class, area deprivation, education etc).
Results Aspects of social capital (trust & reciprocity, social participation) were significantly lower in Glasgow. For example: respondents in Liverpool and Manchester were more than twice as likely to have volunteered in the previous year compared to those in Glasgow (fully adjusted ORs Liverpool 2.6 [2.0, 3.4], p<0.0001; Manchester 2.5 [1.9, 3.3], p<0.0001); Liverpool and Manchester respondents were significantly more likely to report that ‘most people in their neighbourhood could be trusted’ (odds ratios: Liverpool 1.71 [1.4, 2.09], p<0.0001; Manchester 1.45 [1.18, 1.78], p<0.0001). However, SoC was shown to be significantly higher in Glasgow: Liverpool and Manchester respondents were associated, respectively, with fully adjusted mean SoC scores of -4.99 (-5.95, -4.03), p<0.0001 and -8.10 (-9.06, -7.14), p<0.0001 compared to those in Glasgow. The Glasgow sample was not associated with more negative individual values (e.g. lower optimism, hedonism), nor by motivations for social mobility. No clear ‘city’ differences emerged from the political effects questions.
Conclusion These new data suggest that some of the hypotheses proposed to explain higher mortality in Glasgow are plausible (social capital), and others less plausible (e.g. lower ‘sense of coherence’, different ‘values’). Others (e.g. political effects) remain less clear and require different methodological approaches. These analyses add focus to future research needs to help better understand reasons for excess levels of poor health seen in Glasgow compared to these two very similar post-industrial cities.
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