Introduction

It is no hyperbole to describe Glasgow as a Sick City within a Sick Country. Across an almost exhaustive set of mortality and morbidity indicators, Glasgow and Scotland perform badly in relation to otherwise comparable places. This chapter has two substantive aims. First, it draws on an extensive and pioneering body of research led by the Glasgow Centre for Population Health (GCPH) to paint a detailed picture of health across Scotland and Glasgow over time. Second, drawing on Scottish, UK and international literature, it presents a summary of explanations as to why Glasgow finds itself with its current health profile. Our argument is not to say that Glasgow's health profile has a different set of causes from those driving health and inequalities in cities across the world but that, in the context of post-industrial cities at least, these causes have aligned in particularly detrimental ways and have been insufficiently mitigated. The chapter should be read within the context of a wealth of international research that recognises that enduring socio-economic inequalities in health may have proximal causes relating to health-related behaviours, but that these can only be properly understood within a ‘fundamental causes’ framework which sees a range of political processes and their ensuing material and psychosocial realities as the drivers of health inequalities (McCartney et al, 2013).

Scotland, Glasgow and west central Scotland: contemporary health profiles in context

The comparatively poor contemporary health profiles of Scotland and, in particular, Glasgow and its post-industrial conurbation of West Central Scotland (WCS) have become widely known. Moving far beyond, and countering, stereotypical portrayals of poor health as being innate to Scots and Glaswegians, the extensive body of work of the Glasgow Centre for Population Health (GCPH) offers a detailed understanding of the health profiles of these populations as they have been shaped over time. This body of work is comprised mainly of epidemiological research, involving analyses of statistical data available at a population-wide level to map inequalities in health outcomes across and between different population groups over time. These health outcomes are primarily measured by life expectancy – the average number of years someone from a defined population can be expected to live for – and by mortality and morbidity rates; respectively, the frequency of deaths, or of an incidence of a specific disease or medical condition, across a given population over a given period of time (typically per year).