Health Inequalities Scotland 1: Lower Life Expectancy

Scotland’s Population Has Lower Life Expectancy Than The Rest of the UK

A gap in health equality exists between Scotland with the rest of the UK.  Females in Scotland have a life expectancy of 81.1 years compared to a UK average of 82.9.  Males in Scotland have a life expectancy of 77.1 years compared to a UK average of 79.6.  On average,  we Scots experience increased episodes of life threatening disease with poor outcomes, increased chronic disease and reduced life expectancy.  Some 5000 people die each year as a result of the excess mortality associated with this health gap.  The root cause of this health deprivation has been subject to many academic studies but as yet all have failed to unequivocally identify the causal factors unique to Scotland.  Successive governments, the Scottish Parliament (ScotGov) and before that the UK Government have all tried but failed to close this gap with a range of health and social policies and initiatives.  While the health of Scotland’s population has increased over the past 50 years the gap between Scotland and the rest of the UK has not closed.

This is the first in a series of posts aimed at gleaning useful information and insight from published health data.  Data that in its raw published format is frequently complex and not readily interpreted, and which requires further manipulation to process it into an useful format.  It is often hidden away deep in the complex layers (or do I mean lairs) of the  ScotGov websites.

In its latest online mission statement Public Health Scotland states “The biggest public health challenge facing Scotland is the stall in life expectancy.  Life expectancy has stalled across all socio-economic groups and in our poorest areas it has actually decreased.”  see Public Health Scotland.

The conclusions of many studies show that:

  • All age groups are affected but especially the case in working age population.
  • All socio-economic groups are affected but with greatest impact in deprived groups.
  • Increased deaths arise from causes such as cancer, heart disease and strokes and, in the younger population groups, there are the impact of increased suicide rates and deaths caused by the abuse of alcohol and drugs.
  • Comparator cities (Liverpool and Manchester) with historically similar socio-economic deprivation have improved their health profiles over the past 40 years leaving Glasgow is lagging behind.
  • The death rates even when corrected for socio-economic factors such as smoking, poor diet and exercise level still demonstrate unexplained excess deaths which correspond to 5000 excess deaths per year.
  • As yet no study has been able to provide a satisfactory explanation with the result that the health gap with the rest of the UK continues.

For a detailed and comprehensive review of the causal relationships between health and socio-economic data and the poor health profile to see “History, politics and vulnerability: explaining excess mortality” published by The Glasgow Centre for Population Health:

Comparison Between Scotland and the Rest of the UK
UK-wide Life Expectancy data has been published for periods from  2002 to 2017.  Based on the most recent data, residents in England have the highest life expectancy across the UK followed by Northern Ireland, Wales and Scotland – which lags somewhat behind the other nations.

Females: All nations show increased life expectancy from 2002 to 2012 after which the values plateau for all four nations.

Males: Like females, all nations show increases in life expectancy from 2002 to 2012 but unlike females for England and Northern Ireland a slower increase persists whereas for Scotland and Wales the values reach a plateau at 2012.

Fig1a & 1b, Life Expectancy For Females and Males in United Kingdom
Life Expectancy* data for the four UK Nations.  Data is published in year bands e.g. 2001 to 2003. For the purpose of charting the mid point of the range is used to form the X axis or Period.  Thus 2001 to 2003 becomes 2002; 2002 to 2004 becomes 2003 etc.  Note that the y-axis origins are set above zero to highlight the differences and are different for females and males.

* life expectancy at birth assuming it does not alter during lifetime.

Variation Within Scotland’s Local Authority Areas
The latest data published by the Scottish Government relates to the period 2017 – 2019.  The overall life expectancies for Scotland’s females and males are 81.1 and 77.2 respectively.  For individual Council Areas the Life Expectancy values for females range from 84.0 years  (East Renfrewshire ) to 78.5 years (Glasgow City).  For males the Life Expectancy values range from 80.5 years (East Dunbartonshire) to 73.6 (Glasgow City).  The difference in years between the best and worst Councils is 5.1 and 6.9 years for females and males respectively.

Fig2 below (Life Expectancy for Females and Males in Scotland) which compares the Life Expectancy for all Scotland’s Council Areas for females Fig2a and includes the overall Scotland value for comparison and Fig2b for males. It is notable that areas with lower life expectancy than the overall Scotland value tend to be those areas where post industrial deprivation is high – encompassing Glasgow City and the surrounding industrial towns in Central and Western Scotland.

Life Expectancy or the average age of death  is of course only one measure of the impact of the health deprivation in Scotland.  Millions of Scots live with disability and or the daily impact of poor health for many years of their lives.  This aspect will be explored in a future post.

Fig2a & 2b, Life Expectancy For Females and Males in Scotland

Life Expectancy for all Scotland’s Council Areas plus the overall Scotland value females Fig2a  and Fig2b for males.  The red vertical line marks the overall value for Scotland.  Note that the x-axis origins are set above zero to highlight the differences and that the order of local authorities is different in both parts because of differences between females and males in each local authority.

Historical Life Expectancy Growth

Life expectancy in the UK did not alter much from medieval times until the 19th century was around 30 to 40 years depending on factors like pandemics and famine caused by poor harvests.  It was driven by high rates of childhood mortality (possible up to 50% of children dying before their 15th birthday) and infections in adults.

In the past 170 years life expectancy in the UK has increased dramatically due to improvements in living conditions and healthcare.  During the Victorian era improvements in housing, sanitation and the availability of clean water were big drivers.  In the first half of the 20th century improvements in healthcare, primarily the ability to reduce mortality caused by infections saw further increases and in the latter half modern medical advances resulted in improved health outcomes.

Figure 3 shows the dramatic improvement in life expectancy since 1850.  Note the dip caused by the Spanish Flu outbreak of 1918.

Fig 3 Increased Life expectancy in UK

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