Scotland has ‘substantial and persistent’ health inequalities, report warns

Health inequalities in Scotland are “substantial and persistent”, a report has warned, saying efforts to tackle the gap in health between rich and poor have “not matched the magnitude of the challenge”.

Public Health Scotland said in some areas there has been a “recent narrowing of inequalities”, but others “show no sustained change or continued widening”.

As a result, it said there now must be “sustained and strengthened action to reduce poverty” as well as efforts to “improve the living and working conditions that shape health”.

Overall, it warned: “Health inequalities in Scotland by area deprivation remain substantial and persistent, demonstrating that decades of policy efforts have not matched the magnitude of the challenge.”

The report noted life expectancy for men and women is higher in the most affluent areas than it is in the poorest communities – with females in the poorest parts of Scotland expected to live to 76.2 years, compared to 84.9 for women in the least deprived areas.

Men in the most deprived areas have a life expectancy of 71.1 years, while those in the least deprived communities are expected to live over a decade longer to 82.2.

Women in the poorest parts of Scotland can expect to spend 46.2 years in good health, while those in the least deprived areas have a healthy life expectancy 23.4 years longer at 69.6 years.

This difference in healthy life expectancy is also seen for men, with those in the most deprived expected to live 47.8 years in good health, compared to 68.6 years for their peers in the least deprived communities.

The report notes: “The gap in healthy life expectancy is substantially larger than the gap in life expectancy, highlighting particularly stark inequalities in the number of years people can expect to live in good health.”

Public Health Scotland also highlights how deaths in those aged under 75 are more than three times higher in the 20% most deprived areas compared to the 20% least deprived.

While inequalities are “narrowing” in some areas, including life expectancy for both men and women, the report said the gap between rich and poor is widening in female healthy life expectancy and in deaths aged under 75, as well as in “early deaths” under the age of 75 from cancer and coronary heart disease.

The report describes health inequalities as the “systematic, avoidable and unfair differences in health outcomes” between social groups, with NHS Health Scotland having made clear previously these are “not the result of individual choices, but are driven by the unequal distribution of income, wealth, and power”.

It said: “Although some indicators show recent narrowing, substantial inequalities remain across all indicators.

“In several key indicators, particularly healthy life expectancy and premature mortality, inequalities have widened over the past decade.”

The findings of the report “reinforce the need for sustained and strengthened action to reduce poverty, improve the living and working conditions that shape health”, it added.

Public health minister Jenni Minto said: “Reducing health inequalities and supporting people to live longer, healthy and fulfilling lives remains a clear ambition for this Government.

“The evidence is clear that our health is closely linked to the circumstances and environments in which we are born, grow up, live, work and age; known as the wider determinants or ‘building blocks’ of health.”

She added that together with local government body Cosla, ministers have published a population health framework which she said “aims to improve health and life expectancy, while reducing the life expectancy gap”.

Ms Minto said this work “is supported by holistic actions that will be taken forward across the key drivers of population health which promote health and wellbeing, reduce health harming behaviours and enable equitable access to healthcare”.