BLIGHTED by industrial decline, poverty and ill-health, they are the regions across Europe which share the unenviable reputation of being the grimmest parts of their respective countries.

The west of Scotland is often considered to be at the bottom of this heap, with poor health and life expectancy earning Glasgow in particular the "sick man of Europe" tag.

The 12 regions have now been used as testing grounds to unravel the mystery behind the notorious "Glasgow effect" – the unexplained factor which means those living in the west of Scotland are more likely to fall victim to three major killer diseases – cancer, stroke and heart attack.

There have been some interesting discoveries in the comparative study. Glasgow turned out to have the advantage over its fellow deprived regions in a number of key areas, including lower unemployment, better education and higher levels of life satisfaction.

However, Glaswegians were found to have less "social protection" than other regions, with higher levels of income inequality and more "vulnerable" households, such as those headed by a lone parent.

The west coast of Scotland clearly continues to suffer worse health than other areas in the UK, such as Merseyside, which has a similar social, cultural and political history, as well as the loss of heavy industry as a key employer.

Study co-author David Walsh, public health programme manager at the Glasgow Centre for Population Health, said that like Glasgow the other post-industrial regions examined in the research were poorer economically and had worse health than the rest of their "parent" countries.

The regions studied in the report included the Ruhr area in Germany, Nord-Pas-de-Calais in France, Silesia in Poland, Northern Moravia in the Czech Republic, Saxony in Germany, Wallonia in Belgium and Limburg in the Netherlands. In the UK, Swansea, Merseyside and all of Northern Ireland also came under the microscope.

Walsh said: "The west coast of Scotland is often stigmatised as being a deprived region with poor health and poor health behaviours. All these things you see for the west coast of Scotland, you [also] see in the majority of other post-industrial regions. So we are not alone in that regard."

The regions in the comparative study were selected as they have all suffered from post-industrial decline, often cited as being one of the main causes of poor health for a society as a consequence of loss of employment and resulting poverty.

However, Walsh said there were certain characteristics which stood out in the west of Scotland compared to the other European regions.

"These are in terms of income and health being more unequal, and having higher numbers of what you could describe as potentially vulnerable households – such as people living alone, lone parents, young mothers, these kind of groups," he said.

The high number of vulnerable people does not, however, provide the key to the riddle of the Glasgow effect. As Walsh says: "Many of these characteristics are shared with other UK regions and are subject to the same economic policies.

"What sets west-central Scotland aside from those particular (UK) areas is the health profile and this is something we are looking into. Premature deaths in Glasgow are about 30% higher than in Liverpool and Manchester.

"There is something – we don't know what – when compared to Liverpool and Manchester which means health is so much poorer."

Further research is now under way to try to pinpoint the roots of the Glasgow effect through an in-depth comparison of the west of Scotland with its fellow deprived UK and European cities, Walsh added.

Among the regions used as a comparison in the report is Northern Moravia in the Czech Republic. It was formerly the focus of the country's heavy industry, but the end of communism brought a significant reduction in coal mining and the loss of around one-fifth of the workforce – 80,000 jobs – from the mid-1990s to the mid-2000s.

Yet the region has had improvements in health, unlike Glasgow. Female life expectancy has overtaken that of west-central Scotland and male life expectancy is expected to do the same in the near future.

David Donnison, emeritus professor in the department of urban studies at Glasgow University, pointed out that Czech society appeared to be more equal than Scotland when it came to distribution of wealth and income.

"It seems possible that this may explain why the Czechs, despite experiencing greater poverty and hardship than the Scots, are in many ways healthier and getting healthier faster," he said.

However, he also noted that trends in the Czech Republic were now changing, with growing levels of affluence, falling wages and rising unemployment.

STUDY co-author Phil Hanlon, professor of public health at Glasgow University, explained that Scotland has not always had a poor record on health, with life expectancy on a par with other Western European countries during the 1950s.

He said: "There is nothing intrinsically unhealthy about the Scots. This is a phenomenon that has developed. I think the feeling that [poor health] is inevitable – that there nothing very much we can do about it – is very prevalent. But almost everywhere else has done something better about it."

The west-central Scotland region used for the research – which encompasses Glasgow, Ayrshire, Inverclyde, Lanarkshire, Renfrewshire and Dunbartonshire – accounts for around 40-50% of the population of the country.

So it could almost be described as the Scotland effect rather than the Glasgow effect.

Hanlon said the poor health of this area impacted on Scotland as a whole, making it "less successful, less resilient and more expensive to run".

He argued it was also necessary to address the issue of how to reverse this at a time when the debate over whether or not Scotland should become independent was under way.

"Scotland is in this crucial phase of our political and social history and there is so little debate about all of this," he said.

"I think it is pretty much clear that we are going to have some kind of increased control of our own future.

"Control in itself is not worthwhile unless it is for a purpose and one of the primary purposes is that we should address the legacy of poor health that has built up over these last few decades."

Hanlon said the priority for politicians should be correcting the "vulnerability" of households and the "stark inequalities" which have built up over the past three decades.

"Unless we do so, we can't even begin to hope to reverse some of these adverse health trends," he added. "We treat these health trends as if they are individual responsibilities, or as if they are simply the inevitable consequence of de-industrialisation and poverty, and neither is true."


Previous studies have suggested dissatisfaction with life can be linked with higher death rates among men – and could therefore influence the "Glasgow effect". But when asked to rate their life satisfaction, Greater Glasgow and Clyde residents scored an average of 7.3 on a scale of zero (complete dissatisfaction) to 10 (complete satisfaction). The figure is higher than in many regions such as Northern Moravia in the Czech Republic and Saxony in Germany, which both had a rating of 6.2. The highest was in Limburg in the Netherlands at 7.69, followed by Northern Ireland at 7.47. Over two-thirds of adults in Greater Glasgow and Clyde said their health was good or very good, significantly higher than in the German and East European regions, but researchers note this may be influenced by different ideas of what good health is.


Some theories suggest that societies which are more unequal tend can suffer trends such as worse health, higher levels of crime and increased mental illness.

The researchers found that income inequality in the west coast of Scotland is high in European terms.

This could help explain the "Glasgow effect" – but not fully, as other areas in the UK which enjoy better health, such as Northern Ireland and Wales, have comparable levels of income inequality. The study also found fewer adults in west-central Scotland reported finding it difficult to manage on their household income in 2007.

Income inequality was measured by the Gini coefficient, with zero indicating complete equality of income distribution and one complete inequality.


Fewer marriages and more singles could be contributing to west-central Scotland's poor health. Studies indicate that tying the knot can help protect against premature death, particularly for men.

The report found 63% of adults aged 25 to 64 were married in west-central Scotland, which is lower than nine other regions, including Silesia, Northern Moravia, Limburg and Northern Ireland. Only in Merseyside was the rate lower at around 58%. Research has also show higher levels of people living alone are associated with higher rates of suicide and poor mental health. Just over one-third of households in west-central Scotland contained a single adult, higher than in six other regions. In Silesia and Nord-Pas-de-Calais the figure is nearer one in four.


The researchers used data for the whole of Scotland to compare the average trust levels to the other post-industrial regions. This factor was measured as some experts have argued that higher trust levels are associated with people reporting better health. The system used a score of zero for people who believe "you can't be too careful" when it comes to trusting others, up to 10 for those who think that most people can be trusted. At odds with its poor health record, Glasgow and Greater Clyde recorded the second-highest average trust level of 11 European regions, with a score of 5.4, the same as Wales. The region which recorded the lowest levels of trust was North Moravia in Poland, which had an average of 3.7.


The picture of how people's educational status may contribute to the "Glasgow effect" is a mixed one.

Scotland compares well to other regions in some areas of education, with one-third of adults educated to college or university level – higher than in any of the other regions in the study, with the exception of Saxony.

But when it comes to having no qualifications or only poor ones, Scotland does not fare so well. Just over one-quarter of Scots adults were in this category, worse than six other regions and high compared to regions such as Silesia, where the equivalent figure is 8.7%.


Just under a third of men (29.9%) in west-central Scotland said they smoked daily, according to the study, a higher rate than Northern Ireland, South-east Wales and Saxony, but similar to five of the other comparable European regions.

The smoking rate for women in west-central Scotland was 28.4%, the highest of all the European regions. The lowest was in Saxony at 13.2%. The report also shows west-central Scotland fares badly in terms of deaths due to liver cirrhosis, with the rate for both men and women worse than in nine of the other regions included in the study.


A HIGHER proportion of "vulnerable" households is one factor which may contribute to the Glasgow effect. Around one-third of households with children in west-central Scotland were headed by a lone parent. The researchers say this is high compared to most of the other post-industrial regions, with an equivalent figure of around one in seven in Limburg and one in six in Silesia. The statistics also show that around 8.5% of births in west-central Scotland were to mothers under the age of 20, higher than everywhere else apart from Swansea and the same as the figure in Merseyside. Teenage mothers are known to be at greater risk of giving birth prematurely and to low-weight babies.


The loss of jobs as a result of the decline of heavy industry could be seen as one factor in the "Glasgow effect", but the research seems to suggest this is not the case.

The employment rate for men in the west-central area of Scotland was 74%, higher than in six of the European regions examined, and only worse than one. For women the rate was 62%, which was better than in five other regions, but worse than three.

The study also notes that employment rates for men in west-central Scotland have been similar to the average for the other Western European regions since the late 1980s.

Prior to that, Scotland lagged behind areas in Eastern Europe – obviously due to the communist policy of full employment – but the collapse of the USSR brought marked improvements in its relative position in the early to mid-1990s.

Employment rates for women in west-central Scotland have been consistently higher than the average in other similar European regions for the past three decades.

The research found the unemployment rate in Scotland was low at 5.8% – better than in eight of the European regions and worse than two.

However, these statistics were taken from 2008, before the full impact of the current economic crisis, to allow researchers to make comparisons with the data which is available from other countries.

The study also notes that from 2005 to 2008 the position of Silesia and Northern Moravia improved, with big falls in unemployment.

West-central Scotland is ahead of regions such as Nord-Pas-de-Calais in France, which has an unemployment rate of 12.9%, and the Ruhr in Germany at 10.9%.

This suggests that unemployment is less likely to be an explanation for west-central Scotland's markedly poorer health.


Male life expectancy in west-central Scotland was worse or similar to nine regions at 72.8 years old, while female life expectancy – at 78.3 years old – was worse than in nine other countries and similar to two. However, the researchers note that improvements in the European regions which currently have the lowest life expectancy for men – Silesia and Northern Moravia – means that they are likely to overtake west-central Scotland in around a decade's time. For both sexes, life expectancy in the "worst" areas of west central Scotland is already similar to that in the most deprived districts of Silesia and Northern Moravia.