History, politics and vulnerability: explaining excess mortality in Scotland and Glasgow

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 level of mortality is particularly pronounced in and around the country’s largest city, Glasgow: although poor health in Glasgow is principally explained by its high levels of poverty and deprivation, mortality in the city is much higher than would be expected for such levels of deprivation, and much higher than in other UK comparable cities such as Liverpool and Manchester. Undertaken with colleagues in NHS Health Scotland, the University of the West of Scotland and University College London, this report summarises all the research that has been undertaken into this phenomenon, and from a detailed examination of all the available evidence, identifies the most likely underlying causes and, therefore, the most appropriate policy 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