We focus on four complex health issues more prevalent in urban areas
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In Glasgow, we explored the importance of better understanding the social issues affecting health, in order to spot trends and tailor support to key groups.
This city profile is part of a series of ten, exploring how cities around the world are addressing health inequalities. Read the full report and sign up to receive more insights from us.
Glasgow is Scotland’s most populous city, although significantly smaller than London in both population size and density. Typical of many post-industrial cities, Glasgow experienced significant growth in the early to mid-twentieth century during its time as a manufacturing and shipping hub, followed by population decline and economic stagnation. This period of managed decline was accompanied by urban renewal programmes, which included the demolition of low-income housing and the relocation of primarily lower-income residents to peripheral tower estates and new towns.
Recent decades have seen some reversal of these trends, with Glasgow increasing in population by 7.8% since 1998. As the population has grown it has also become older, with a 25% increase in the 64 plus age group, and more ethnically diverse, with a 400% increase in residents from non-white ethnic groups.
Glasgow’s particularly poor health outcomes have come to be described as the ‘Glasgow Effect’. Glasgow has the highest mortality rates and the lowest life expectancy of any city in the UK or western Europe, but research has shown Scotland’s overall morbidity and mortality rates to be above what would normally be attributable to deprivation.
Speculation as to the cause of the ‘Glasgow Effect’ includes the legacy of urban renewal projects which concentrated marginalised groups and a culture of limited social mobility and risk-taking behaviours. In the absence of a single explanation, Glasgow has adopted a holistic approach to health and social determinants of health to address the city’s poor health outcomes.
The city of Glasgow is home to local welcoming spaces, enabling people to be together, and allowing trusted relationships to be built. People who run these spaces – including community centres, GP surgeries and youth clubs – can help to identify those in need of support.
Having built a relationship based on trust, staff may spot issues linked to subjects that people may not be comfortable speaking about, but which have tangible impact on health outcomes, such as food poverty, debt, financial difficulty or abuse.
Urban areas are often characterised by longstanding communities living side by side with more transient populations. Existing communities may have different health needs and priorities to newer populations.
As a result, initiatives to improve health need to be tailored and offer access to culturally appropriate services. Additionally, there’s often a tension between the short-term need for health initiatives to track impact for funders and to be reactive to immediate population needs, and the desire for interventions to be a catalyst for longer-term change and health impact.
Deep End group is a network of GP surgeries in Scotland. They cover the 100 most deprived patient populations in the country. GPs share experiences of the challenges they face in supporting people with complex needs. A joined-up, holistic approach to healthcare helps support those with multiple long-term conditions, drug and alcohol problems and social isolation.
Deep End GPs have also pioneered working more closely with non-medical experts, for example community Link Practitioners and financial advisors, recognising the importance of social determinants as both risks and benefits to health.
The Glasgow Centre for Population Health generates insights and evidence and supports new approaches to improve health and tackle inequality. Its programmes work to understand the causes of health inequalities and identify and support the implementation of solutions.
Established in 2004, they’ve since recommended a number of actions to support improvements in health including the need for urban planning to consider health impact, initiatives to improve early life experience with a focus on tackling poverty, and to place tackling poverty and reducing income inequalities at the core of all policies and practices. To address these, they work with a wide range of partners to facilitate and stimulate the exchange of ideas, fresh thinking and debate, and support processes of development and change.
“ The ever-changing nature of cities makes evaluating and measuring the impact of initiatives difficult and undertaking longitudinal studies complex. Evidencing impact on wider health outcomes is especially difficult, as they often vary and are dependent on wider context.
The ever-changing nature of cities makes evaluating and measuring the impact of initiatives difficult and undertaking longitudinal studies complex. Evidencing impact on wider health outcomes is especially difficult, as they often vary and are dependent on wider context.
Our report explores how cities around the world are addressing health inequalities and shares their real-world solutions to pressing urban health issues.
In Paris, we saw how they enabled people across the city to make decisions about how public money is spent to improve urban health.
In Detroit, we learnt about the role philanthropic foundations can play in driving health improvements across the city.
In Shanghai, we saw how the city’s approach to urban health recognises the significance of social and cultural factors on health.
In Mexico City, we saw how bringing together experts from different sectors helped them to tackle urban health challenges.