Scotland's poorest areas suffer a devastating health divide Health inequalities in Scotland: An independent review

The review consolidates research undertaken for the independent charity the Health Foundation by the MRC/CSO Social and Public Health Sciences Unit at University of Glasgow, the Fraser of Allander Institute at University of Strathclyde, Nesta in Scotland, and the Diffley Partnership. The findings bring together evidence of trends in health inequalities and wider determinants of health over the past two decades since devolution and outline the consequences of worsening health in the most deprived areas.

Overall, stalled improvements in health mean that, since 2013, expectations of how long people are expected to live have reduced by 4.4 years, from 90.4 to 86 years.

The findings show that across a range of measures, there is a wide gap between the health of people living in the most and least deprived areas with people living in the most deprived areas increasingly left behind the rest:

• Infant mortality is rising for the most deprived fifth but is static or falling among the rest of society. In the last decade, inequalities have also widened for infant immunisation uptake, low birth weight and childhood obesity.  
• Avoidable mortality rates among females living in the most deprived fifth of areas have increased by 8% since 2010 despite reducing for the rest. Rates are now around 50 per cent higher in the most deprived fifth than in the second most deprived fifth.

The report raises a number of areas of concern which need immediate action, in particular, improving the health of children in their early years and the health of young to middle aged men.

Young to middle aged men are the most likely to suffer from deaths related to drugs* (see chart below), alcohol or suicide, with the exponential rise in drug deaths concentrated among men in their mid-30s to early-60s. Drug related death rates are 18 times higher in the most deprived areas compared to the least deprived fifth. This group engages less with health services and is the most likely not to attend hospital appointments.  Being younger, single, white and male is most strongly associated with experiencing severe multiple disadvantages, which are linked to greater risk of poor health.

The review highlights that an unprecedented decade of stagnation in pay and living standards is acting as a brake on health improvement. In 2019/20 a typical household income in Scotland was £70 per week lower than if pre-2010 trends had continued. A lack of progress to close educational attainment gaps, reduce income inequalities and the fragility of public services following a decade of austerity risk the gap between the most disadvantaged and the rest continuing to grow.

Commenting on the findings, David Finch, Assistant Director of the Health Foundation, said:

'Life expectancy varies greatly across Scotland. In the most deprived areas, men are dying over 13 years earlier than their peers in the least deprived areas– and women almost a decade earlier.

'A healthy community derives from a range of factors: stable jobs, good pay, quality housing and education. Poor health is almost inevitable when some or all of these factors are absent. Scotland's wide and sustained health inequalities are being driven by the accumulation of severe multiple disadvantages, a lack of improvement in living standards and public service fragility due to the ongoing impact of austerity.

'Understanding the causes is not enough; a radical shift in approach is needed. The Scottish government, local authorities, businesses and the third sector must come together and collaborate closely with communities. Without action, Scotland’s most deprived communities are likely to continue suffering from poor quality of life and die younger.'

Chair of the Health Foundation’s Expert Advisory Group Chris Creegan added:

'This review is the most comprehensive study of health inequalities in Scotland since devolution, and while the findings are complex, what they clearly illustrate is that inequality in health is stubbornly high in Scotland.

'The public is receptive to longer term preventative interventions aimed at tackling the fundamental causes of health inequalities, rather than short term measures. They will support a bold, collective response.

'We need actors across economic, financial, social and health systems in Scotland to take note of these findings and use them to build on the strong policy intent we already have to reverse these trends and improve health outcomes for the future. But there is no need for a new strategy; over the last decade, several policy plans and strategies have focused on tackling health inequalities, most recently, 2018’s Public Health Priorities for Scotland. We have the policies, we now need action.'

Notes to editors

* 'Extreme poverty’ is defined as households whose income (after housing costs) is below 50% of the median, rather than below 60% of the median.

** The overall rate of drug deaths increased from 6.2 per 100,000 in 2001 to 25.1 per 100,000 in 2020. This has been driven by the increase in deaths in the most deprived areas to 68.2 deaths per 100,000 people in 2020 –18 times as high as in the least deprived areas.

Health Inequalities in Scotland: an independent review, can be read in full here and a short summary document can be read here. It was a collaborative research project undertaken by independent charity the Health Foundation, working with four Scottish research partners and advised by an expert advisory group. The research partners are the University of Glasgow, the Fraser of Allander Institute, Nesta in Scotland, and the Diffley Partnership. The Health Foundation’s final report, together with the work of the partners, will provide a robust evidence base and set a direction for future policy development and delivery to improve people’s long-term health and close the health gap between the richest and poorest. Scotland has the power and the ability to act, and we hope that this review will help Scotland’s policymakers make meaningful progress on improving health outcomes.

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