MRC/CSO Social and Public Health Sciences Unit

By Gillian Bell, Engagement & Communications Manager, MRC/CSO Social and Public Health Sciences Unit.

In 2022, the Health Foundation commissioned an independent review of health inequalities in Scotland.

To inform this review, we were asked to produce a report describing trends in inequalities in the timing and causes of deaths, health and wellbeing, health-related behaviours, and health and social care services in Scotland over the last two decades.

We have now created a website – healthinequalitiesscot.gla.ac.uk - which presents the key messages from this report.

What did we find?

The first thing to say is that health inequalities in Scotland are not inevitable. While those of us working to improve population health and reduce inequalities feel frustrated at the lack of progress, there was actually a period of health improvement between 2000 and 2013. Life expectancy was increasing, and deaths caused by cancer, cardiovascular disease and alcohol were all falling. These improvements have now slowed, with signs of increase especially in the most deprived areas.

It is unjust and unacceptable that today, a child born in the most deprived tenth of areas in Scotland can expect to live almost 25 years less in good health than those born into the most affluent areas. People living in the most deprived fifth of areas are at least twice as likely to die for each of the outcomes considered in the report compared to those in the least deprived fifth of areas.

Which groups are faring particularly badly?

Health gets worse as disadvantage increases. We call this a social gradient in health. Unfortunately, people living in the very most deprived areas in Scotland and experiencing the highest levels of disadvantage are far more likely to have poor health, to die young, and to face very high barriers to health services.

Our report also highlighted particular concerns around young and middle-aged men. They are more likely to experience deaths of despair (suicide, drugs and alcohol) and more likely to be affected by multiple overlapping social disadvantages such as homelessness, justice involvement, opioid dependence and psychosis. We also know that men are most likely to miss GP and outpatient appointments.

In the early years, we found a mixed picture. For some aspects of child health, inequalities have been improving including smoking in pregnancy, breastfeeding at 6-8 weeks, and development in toddlerhood. But inequalities in childhood immunisations and risk of obesity have widened. It’s interesting to note that health inequalities don’t always match patterns in health behaviours. For example, risk of childhood obesity increases with deprivation but we don’t see inequalities in children’s daily physical activity levels. Children from less advantaged backgrounds are just as active as their more advantaged peers.

Why have things got worse?

It wasn’t an aim of our report to consider this, but we know from the accompanying Fraser of Allander Institute report that over the same period, some negative changes in important influences on people’s health also occurred. Austerity measures led to increased poverty, housing and other costs have risen, and low-paid jobs have become more common. In many cases inequalities widened during and after the COVID-19 pandemic so the findings in our report may not always fully reflect the size of the current problem in Scotland.

Let us know what you think

We hope that the website will increase engagement with the report findings by making them more accessible to advocacy organisations, policymakers, students and other groups. The website also includes a repository of downloadable graphs so you can use them in your own presentations and reports.

We would love to hear from you if you have comments on the website and report, or if you have any questions about the data. 

---

First published: 25 March 2024