Note on language:
The phrases 'most deprived' and 'least deprived' are used frequently in discussing health inequities and life expectancy and are based on TheScottish Index of Multiple Deprivation (SMID) which is the Scottish Government's official tool for identifying areas in Scotland of concentrations of deprivation. Each area is assigned a rank from most to least deprived based on seven measures; income; employment; health; education; housing; geographical access; and crime. Measures of deprivation represent an area, not individuals and will therefore not reflect the situation of everyone in an area.
Health inequalities are "differences in people's health across the population and between specific population groups, that are systematic, avoidable, and unfair."
These avoidable differences in health and outcomes from illness across the population are determined largely by economic circumstances. Health inequalities are the result of structural inequalities, that is, laws, policies and practices that do not ensure equal access to the things that determine how long we live, and how healthy that life is.
These include access to what are termed the wider determinants of health (sometimes called social determinants of health) including affordable adequate housing, sufficient income to meet needs, nutritional food, education and the tools to participate in it, internet access, health and social care services, and safe outdoor spaces. Not having access to these essentials reinforces cycles of poverty and discrimination.
It is incredibly difficult for individuals to break links in this cycle: without safe and affordable housing it is difficult to stay healthy, this creates barriers to achieving a good education which in turn impacts employment opportunities and adequate income. Without access to the real Living Wage, affording nutritional food becomes difficult. Add to this the chronic stress caused by lack of money, which can itself influence poorer health outcomes as well as poor housing and adopting and maintaining habits needed for good health feel out of reach.
The sections below provide recent statistics on health and health inequalities in Scotland, highlighting the need for actions across economic sectors to improve population health and equity.
Life Expectancy at Birth in Scotland
Scotland has the lowest average life expectancy of the four UK nations and growing inequalities.
Life expectancy in Scotland is lower than the average across other Western European nations.
Scotland also has some of the worst health in the UK.
In addition to a low average life expectancy, there is inequality in life expectancy across communities in Scotland and this difference has been increasing in recent years as shown by the Scottish Government figures:
- Women living in the least deprived areas of Scotland have a life expectancy at birth of over a decade (10.5 years) more than women in the most deprived areas. For men, this difference is 13.9 years.
- The gap in life expectancy between those living in the most and least deprived areas increased by 2.4 years for females and 1.6 years for males, between 2013-15 and 2019-21.
- The leading causes of death in Scotland for people of all ages are heart disease, lung cancer, cerebrovascular diseases (e.g. stroke, stenosis), and neurological diseases, predominantly dementia and Alzheimer's disease. For those under 75, the main causes are heart disease, lung cancer, chronic lower respiratory disease (e.g. bronchitis, emphysema), and accidental poisonings including drug misuse.
- These are in line with the worldwide leading causes of death in high income countries. Yet, the incidence of, and mortality rate from, the leading causes of death are again greatest for those living in the most deprived areas.
- Like many countries, Scotland also experienced a fall in life expectancy at birth in recent years, particularly among those living in the most deprived areas.
- This fall has been driven by increased inequality in life expectancy, that is, a fall in life expectancy (See tables 1.1 and 1.2 in the linked report) for those in the most income and access deprived areas of Scotland.
Healthy Life Expectancy and Avoidable Death in Scotland
There are even greater differences in healthy life expectancy (the years people can expect to live in good health) than for life expectancy.
People in Scotland's most deprived areas spend around a third of their life in poor health.
The considerable inequalities in income, education, housing and health in Scotland mean that there are striking differences in health outcomes between people living in the most and least deprived areas (see figures 1, 6, 7 in the linked report) which have worsened in recent years.
Women and men living in the most deprived areas of Scotland spend only 47 and 46 years of their lives in good health, respectively.
Healthy life expectancy has been decreasing since the 2016-2018 period for men and 2017-2019 for women in the most deprived areas of Scotland. This decrease has not been observed in the most affluent regions. Healthy life expectancy for women in Scotland is 26 years more in the least deprived decile compared to the most deprived decile for both men and women in the 2019-2021 period.
Those in Scotland's most deprived areas are more vulnerable to the leading causes of death and have worse outcomes from illness such as COVID-19, cancers, circulatory conditions, cardiovascular disease, and dementia.
The effects of ill health (called the burden of disease) are forecast to increase by in Scotland over the next 20 years. These projected trends could look different depending on political decision-making and population changes. Still, if current trends continue, the forecasted patterns of ageing predict that despite a reduction in the population of around 17%, the burden of disease is likely to increase by around 21%.
Health Inequalities in Glasgow City Region
There are higher levels of illness, premature death, and excess deaths in Glasgow City and some of the surrounding regions than the rest of Scotland. Previously termed 'the Glasgow effect', the Glasgow Centre for Population Health states that a more accurate and helpful description is a 'political effect'.
Political decisions made at different levels of government over many decades, combined with factors such as high historical deprivation, poor quality housing stock, and high levels of deindustrialisation have led to poor health and low life expectancy within Glasgow and the wider city region.
Given the strong association between deprivation and mortality, Glasgow City Region has areas with some of the lowest life expectancy in Scotland and the UK (see figure 5 in the linked report). These include Glasgow City; West Dunbartonshire; Renfrewshire; North Lanarkshire and Inverclyde.
The region also has some of the highest life expectancy in Scotland, East Dunbartonshire and East Renfrewshire. There is therefore deep inequality within the region that requires investment to tackle. Inclusive economic development has the potential to create generational transformation in health, wellbeing and equity.
In Inverclyde and Glasgow City around 45% of the population lives in the most deprived 20% of areas in Scotland. In West Dunbartonshire 40% of the population live in areas of high deprivation. It follows that many local authorities in the Glasgow City Region experience a high burden of disease relative to the average across Scotland. Below, a number of indicators highlight public health challenges for Glasgow City and the Glasgow City Region:
Higher avoidable deaths (2019-2021) compared to the rest of Scotland and the UK
- In NHS Greater Glasgow and Clyde there were 403 avoidable deaths per 100,000 people (in NHS Lanarkshire the figure for the same period was 377 per 100,000 people).
- In Scotland there were 336 avoidable deaths per 100,000 people and 266 per 100,000 in the UK.
Higher levels of early death compared to Scotland
- The rate of early death (under age 75) from cardiovascular disease (CVD) for Glasgow City is 136 per 100,000 compared 123 per 100,000 for Scotland (in 2020).
- The rate of early death in Glasgow is the highest in the UK - the range across all UK local authorities was 37-136 per 100,000.
Higher levels of deaths caused by alcohol compared to Scotland and the UK
- Alcohol-specific deaths were 27 per 100,000 population in NHS Greater Glasgow and Clyde compared to 21 per 100,000 for Scotland. The UK rate was lower still, at 15 per 100,000 (2017-2021).
Inclusive economic development has the potential to create generational transformation in health, wellbeing and equity in the Glasgow City Region.
Building Health Through Capital Investment
Source: The Health Foundation (2024), What Builds Good Health. Accessed from: https://www.health.org.uk/news-and-comment/charts-and-infographics/what-builds-good-health.
Factors such as work, money and resources, education and skills, family, friends and community, housing, our surroundings and the food we eat, make up a healthy society (see figure above). Capital investment programmes and projects directly or indirectly provide many of these building blocks, as well as access to these opportunities and services through infrastructure development.
Tackling the burden of ill health requires action from all sectors from national and local government to the private sector.
Primary prevention of poor health includes actions that improve the conditions in which we work, live, and grow, which is where infrastructure projects have incredible potential to improve long term health and equity.
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