Glasgow, Scotland’s largest city is a health promotion and social care professional’s nightmare. In spite of hundreds of millions of pounds spent on programmes and a plethora of initiatives targeted at poor health and lifestyle, the city stubbornly remains at the bottom of the table when it comes to bad health, atrocious diet, dreadful levels of violent crime not to speak of appalling instances of domestic violence and prevalence levels for drugs and alcohol which are shocking and world-beating.

At the same time it has become almost a cliché to speak of Glasgow as a veritable schizophrenic city. The city has reinvented itself as a cultural centre teaming with good shops, nightlife and restaurants; a buzzing and vibrant place. Yet it contains large areas of multi-deprivation, high concentrations of unemployment and destitution with life expectancy for adult males in some parts amongst the lowest in Europe.

This apparent paradox and the persistence of chronically bad health and lifestyle indicators, in spite of resources expended, has led some to speak of an inherent Glasgow ‘dynamic’; a blend of cultural, socio-economic, political and psychological factors which predispose Glaswegians to poor health and wellbeing. This dynamic, it is claimed obviously affects the poor and deprived most, but it also has a corrosive impact across the board and impacts on the population of the city at large in terms of confidence and positive outlooks on life.

Carol Craig’s book, The Tears that made the Clyde attempts to synthesise the evidence for this thesis. Glasgow has dreadful levels of poverty, deprivation and inequality, but they are no worse or better than other cities in the UK, yet in terms of health, crime and addictions amongst others, Glasgow appears to score persistently worse. In other words the source of Glasgow’s continuing problems, according to Craig, cannot exclusively be attributed to external economic factors, important though these are.

Instead, rejecting a reductionist approach, she develops a picture of a historical set of multi-dynamic factors and influences that have crucially shaped the city’s cultural horizon. These factors encompass alcohol, work, education, class, relationships amongst others. Combined they have produced a very materialist culture, premised on traditional hierarchical relationships at work, a macho mindset where men effectively turn their backs on family life, a strong tendency to addiction and a very negative, insensitive cynical outlook on life, all of which interact with each other and provide the framework within which ill-health and inequality can have consequences far deeper than elsewhere: the so-called ‘Glasgow factor’.

To combat the Glasgow factor will require more than just material resources. Carol Craig contends that the negative and damaging culture prevalent in the city has to be replaced  with a more positive outlook which would also incorporate ‘transcendental’ and ‘spiritual’ values.

How valid is this thesis? Glasgow’s experience has been that of very rapid industrialisation accompanied by all the problems associated with unplanned urbanism: high population density, crime, infant mortality, massive inequality and squalor. Equally, the city has de-industrialised rapidly and Glasgow is now heavily dependent on (vulnerable) public sector, finance and service jobs. Both have produced huge levels of dislocation and blight.

In other words Glasgow has gone through massive processes of change and transformation to a far greater extent than most other post-industrial cities. Its traditional heavy industrial base has been effectively wiped out, leaving a legacy of chronic long-term inter and intra-generational unemployment. It has had to re-house vast numbers of people and demolish most if it’s unfit housing stock in a short period of time; a task which would have challenged any authority. The response to chronic overcrowding and terrible housing conditions was the creation of huge housing schemes and a frenzy of multi-storey tower-block construction. These have produced their own problems, not least in creating pockets of concentrated multi-deprivation. Yet, we should not succumb to the temptations of the historian’s fallacy of viewing the past exclusively from the perspective of the present. In their time housing schemes and tower-blocks (“villages in the sky”) were viewed as an optimum and humane solution to rat-infested, grossly overcrowded, soot begrimed tenements, which met with universal approval.

Beginning in the early 1980s new globalised heroin markets and sources of supply began to infiltrate inner-city areas and housing schemes reeling from economic recession and youth unemployment and found fertile ground to spread rapidly. In addition, the erosion of the traditional family unit along with urban relocation and displacement allied to the proliferation of fast food outlets, the extensive use of alcohol as a sedative and most people getting little or no exercise in a damp, cold climate has led to the perpetuation of a tradition of ill-health.

But, critically, none of this gives credence to the notion of a special “Glasgow factor” because all of these factors are replicated in virtually every city that has gone through the trauma of post-industrial transformation. There are pockets of inner city London as well as entire districts of Liverpool, Newcastle and Belfast that can rival anything Glasgow can offer in the way of concentrated deprivation. This is definitely not to downplay or be complacent of the city’s manifold problems but to assert that Glasgow’s problems may be huge, but they are differences of degree, not of kind.

Yes, Glasgow has a cynical, negative side to it, exemplified by its sardonic humour, but this is no different in essence from typical working-class humour elsewhere, and the city’s humour, blunt though it may be, is often its saving grace.

Carol Craig’s book is well-written and accessible and mercifully avoids jargon. It is an excellent compendium of most aspects of Glasgow’s politics, culture and history. But in trying to avoid reductionism it tends to fall into the opposite trap of trying to cover and do too much, with sometimes meagre evidence. There is also some confusion with the central thesis. Material deprivation alone, it is asserted, cannot explain the extent of Glasgow’s problems because they are no worse than elsewhere, and yet one of those factors, inequality, is meant to be a prime causal factor for those same problems?

Surprisingly, one important area that is paid scant attention to, despite providing a continuous backdrop in the narrative, is the religious divide in Glasgow and its profound effects on employment, politics, education and not least culture and which still exerts an admittedly fading residual influence today. Glasgow was never Belfast, but at times, particularly in the 1920s and 1930s, it became alarmingly close to it. This is a serious omission for any work that seeks to address the major factors that have affected Glasgow’s history, culture and dynamic.

The effects of unplanned rapid de-industrialisation on cities like Glasgow have wreaked havoc. The major response to this has been short-term health related and social care programmes and initiatives. These mainly focus exclusively on individuals and lifestyles while simultaneously attempting to achieve grand aims such as eliminating homelessness or reducing health inequalities with little resources (trying to achieve macro solutions with micro means) and result in having either no or only marginal effects. In a sense then decision-makers and policy makers in health and social care services, which have mushroomed in the past decades and who have committed themselves to this managerialist framework, can only experience a sense of frustration that so much has been expended for so little return. Inadvertently, The Tears that made the Clyde echoes that frustration by seeking to attribute deep causes to what are, yes complex but actually quite transparent historical, regional, national and international forces which have produced Glasgow’s current situation.

 One other deficit that can occur when working in social care and associated fields and is reflected in the book, is that the world can come to be seen solely through the prism of people experiencing problems and issues, in this case around deprivation. It ignores the fact that most Glaswegians enjoy standards of living, health and wellbeing and opportunities unprecedented in human history and which would have been unthinkable to their predecessors only a couple of generations ago. Yes, Glasgow has tremendous problems, which will require concerted effort and real resources to tackle, but it’s not the full story.

Most people in Glasgow lead a reasonable life, certainly compared to previous generations and people in other parts of the world. They and their families, experience ups and downs, but make every effort and mostly succeed in achieving a decent life for themselves and their children. In that they are no different from people in any other city in the world and, by and large, are not concerned with, nor are they in any need of an infusion of transcendental or spiritual values. What that sizable minority of Glaswegians who do not have a decent life need is to partake of the same opportunities and chances the rest do, and that again is no different from anywhere else.

Tears did make a contribution to making the Clyde, but so did laughter and no small amount of pride.