Unhealthy Glaswegians: No city for old men WANDER out into the streets of Glasgow after a whisky-soaked summer evening and it is possible to mistake the place for an unexplored corner of New York. The grand converted warehouses of Wilson Street might be SoHo; the reddish sandstone buildings of the West End were built while brownstone was cheap and fashionable on Manhattan. One difference is the deficit of financiers and surplus of people traipsing around with cello cases, off to play in one of many state-funded concerts. Another is that Glasgow, for all its charms, is sick - and not metaphorically. Glaswegians die younger than other Britons and nobody knows why. Even in wealthy neighbourhoods mortality rates are 15% higher than in similar districts of other big cities. In rougher parts the difference is starker. A study by the Glasgow Centre for Population Health found that between 2003 and 2007 there were 4,500 more deaths in the city than might have been expected given the age and poverty of the population. Glaswegians between 15 and 44 are especially likely to die before Liverpudlians and Mancunians of the same age group (see chart). People have a tendency to blame Glasgow's peculiar outcomes on whatever they worry about most in Britain today. At last count there were 17 competing explanations for the phenomenon, ranging from the unquantifiable (culture) to the simplistic (not enough vitamin D), via DNA, inequality and history. For this reason, the "Glasgow effect" is also resistant to the remedies peddled by politicians. What needs explaining is the following: in modern times, up until 1950 Glasgow did not stand out as particularly sickly. But between 1950 and 1980 a gap opened up between it and other big cities in Britain. The difference was mainly explained by a greater number of deaths from cancer and heart disease. Then, starting in about 1980, the gap widened again, though this time the symptoms were different. Glasgow still had too many cancers and heart attacks; but the marked difference from other cities came in deaths from suicide, violence, drug abuse, alcohol and traffic accidents. At first this seemed to be explained by poverty: poorer people are less healthy and Glasgow has lots of them. But about ten years ago studies began to show that the city was still dying younger than it should have done. Adjusting for age, poverty and gender, Glasgow has more than twice as many deaths from drink and drugs as Liverpool and Manchester. One theory is that the city is captured by its history, locked into multi-generational patterns of bad behaviour that get passed from parent to child. On this analysis, Glasgow is still feeling the after-effects of a particularly sudden industrial revolution in the 19th century, when rapid urbanisation cramped workers into unsanitary housing. There was often nowhere at home to sit down, so men did so in the pub and have been drinking hard ever since. Victorian Glasgow was certainly grim in parts: life expectancy at birth in 1840 - shortly before the picture above was taken - was just 27, a full 20 years lower than in Aberdeen. But nothing much follows from this in terms of public policy other than resignation, and besides, other places have overcome grim histories to prosper. An alternative spin on the history-as-destiny thesis is that Glasgow is suffering from the effects of deindustrialisation, which often include a decline in health as well as employment. The yards on the river Clyde were once to shipbuilding what Silicon Valley is to tech. When that industry vanished it destroyed the clusters that had grown up around it, from firms making propellers to potteries making the china for first-class passengers" breakfast. To test this theory, the Glasgow Centre for Population Health examined 20 regions in Europe that went through rapid deindustrialisation. Glasgow came out sicker, even when its residents were richer and better educated than their continental peers. An increase in the number of deaths from what looks like despair - drugs, drink, suicide - since 1980 suggests that something else is at work. One theory is that Glaswegians are just gloomier than other Brits and put a lower price on the future. This manifests itself in, among other things, an excessive love of deep-fried Mars bars and other health-sapping delicacies. The numbers, however, suggest that poor Mancunians and Liverpudlians eat just as few green vegetables as poor Glaswegians (Glasgow also smokes and binge-drinks less than the other two cities). And the data on self-reported happiness are inconclusive. "When you ask people in a room to write down how happy they are on a scale between one and ten," says Phil Hanlon of Glasgow University, "they tend to write something between six-and-a-half and eight," so the differences between Glasgow and other cities are not that big. Even if subsequent research provides evidence that Glaswegians are more prone to despair, it will not explain why. Levelling down The devolved Scottish government, or at least its agency charged with improving public health, has its own ideas. It has absorbed the arguments put forward in "The Spirit Level" by Richard Wilkinson and Kate Pickett, who maintain that in very unequal societies everyone's health suffers, but especially that of those at the bottom. Greater income inequality in Britain followed Margaret Thatcher's election in 1979 and Glasgow, like many industrial cities, was on the losing end. The admixture of thwarted Scottish nationalism bred a layer of grievance not felt in English cities, one argument goes. There may be something to this, but it does not explain why Glasgow fares worse than the rest of Scotland. Of the mainstream theories, that leaves awful housing and family breakdown, both of which might lead to stratospheric stress levels. The city is indeed cursed with terrible council estates and has many single-parent families. But so do other British cities, and so far there has been no comparative work measuring cortisol, the stress-hormone that some reckon could be the biological link through which an unpleasant environment results in an early death. The "Glasgow effect" may well be a problem without a solution. It is as if a malign vapour rises from the Clyde at night and settles in the lungs of sleeping Glaswegians. Improvements are likely to emerge from the cumulative effect of many small changes, rather than from a single big thing. Just do not expect anyone to be able to explain it when it happens.