Abstract
To date, multiple hypotheses have been proposed for the Scottish effect and, more specifically, Glasgow's high mortality rate and the associated Glasgow effect. Previous authors have highlighted the improbability of a single factor as responsible for this effect with seventeen possible hypotheses presented. These have ranged from socio-economic factors, lifestyle and cultural factors such as sectarianism, and political and economic factors. Although these may all be contributory factors to this paradox, the underpinning reasons for the observed effect remain relatively unexplained. In this paper, we suggest that the compounding effect of a unique blend of accumulating life stressors may predispose Scots, and particularly socially-disadvantaged Glaswegians, to a wide-range of health disorders. In short, a confluence of social, environmental, attitudinal and cultural stressors perhaps combine to negatively influence biological health. Future directions should consider the stress remediating role of physical activity, and the problems presented by barriers to participation in physical activity and exercise during key transitional stages of life.
Highlights
Unravelling the Glasgow effect: The relationship between accumulative biopsychosocial stress, stress reactivity and Scotland's health problems
We suggest that the compounding effect of a unique blend of accumulating life stressors may predispose Scots, and socially-disadvantaged Glaswegians, to a wide-range of health disorders
Within this article we explore the potential drivers of the Scottish effect through the lens of an updated 21st century understanding of the impact, on multiple dimensions of health, of excessively accumulating life stress
Summary
The electronic databases: Medline, Embase, Cochrane reviews, Omnifile, ABI inform and Google scholar, were searched for UK and worldwide academic literature published between 1985 and 2016, using the key search terms: Scotland effect; Glasgow effect; stress; health inequalities; Scottish and Glasgow health. On analyzing data from the recent Scottish health survey, a Scottish Government report suggested living in Glasgow was independently associated with poorer health outcomes and increased all-cause mortality (Landy et al, 2010) This phenomenon, a further health disparity nested within the Scottish effect, has been termed ‘The Glasgow Effect’ (Gray, 2008; Walsh et al, 2010). In the late 1980's a UK-wide report highlighted that premature mortality in Scotland was more severe than in England or Wales (Carstairs and Morris, 1989; Walsh et al, 2010; Whynes, 2009a; Whynes, 2009b) These higher mortality rates were initially attributed to higher levels of deprivation, more recent investigations suggested that these health inequalities were not fully explained by deprivation levels alone. As illustrated by recent Medical Research Council findings, Glasgow's health profile
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