Once again we in Scotland have the lowest life expectancy in Western Europe. This is how you can improve it | Devi Sridhar
EWithin a few years, headlines will appear about how Scots have the lowest life expectancy in Western Europe. This was the case in 2005, 2010, and most recent earlier this month, when Paul Johnston, head of Public Health Scotland, highlighted that life expectancy stagnated between 2014 and 2016 and has fallen in recent years. It is currently expected that men and women in Scotland will die just over two years earlier than those in England.
What exactly is happening in Scotland to explain this pattern, and are we (I say βweβ as I have lived in the country for about a decade) really that different from other parts of Britain and Europe? The first issue to highlight is that life expectancy varies depending on where you live. In Glasgow, life expectancy varies enormously between the richer and poorer parts of the city. If you lived in Pollokshields West in 2021, life expectancy was 83 years, while in Greater Govan it was 65.4 years β a difference of 18 years. Averages hide a deeper story linked to deprivation and inequality in Scotland. Where and how you live plays a crucial role in how long you live.
Another problem is that life expectancy has fallen in almost all countries (including Britain in general) due to the Covid-19 pandemic: of 204 countries and territories analyzed in a study new Lancet studysaw an 84% decline in life expectancy in 2020 and 2021. In 2021, Covid was the second leading cause of death worldwide and reduced global life expectancy by 1.6 years. The study’s lead author, Austin Schumacher, said: βFor adults around the world, the Covid-19 pandemic has had a deeper impact than any event in half a century, including conflict and natural disasters.β
The pandemic also put extra pressure on the NHS, and Scotland’s higher mortality is partly linked to difficulties in accessing healthcare. But focusing only on acute care β which is provided in hospitals when someone is sick β would be a mistake. It is the last line of defense in saving someone. I use the football analogy with students: focusing on hospitals is like expecting the goalkeeper to save the team.
What is the rest of the team made up of? Secondary prevention β identifying early indications of possible diseases and intervening earlier, for example high blood pressure, pre-diabetes and cancer screening β is the equivalent of defense. Further down the field, the rest of the life expectancy team should focus on primary prevention or underlying population risk factors. In short, what causes these diseases?
The causes are well known in Scotland: high alcohol consumption (particularly binge drinking), unhealthy diet (leading to large numbers of overweight or obese people), sedentary behavior (not helped by the weather and the closure of public gyms and leisure centres). centres) and the number of smokers (which are slightly higher in Scotland than in England). Scotland also has the worst drug death rate in Europe, with 248 deaths per million people aged 15 to 64, compared to 88 across Britain, although this figure has fallen in recent years. Deaths are related to deprivation. Julie Ramsayfrom the National Records of Scotland, said: βThose living in the most deprived areas of Scotland are almost 16 times more likely to die from drug abuse compared to people living in the least deprived areas.β
The causes of premature death have been recognized by the Scottish government for years. Investing more in secondary prevention and screening is a step forward, but difficult within a limited healthcare budget and with a focus on saving lives in hospitals (acute care) versus identifying earlier disease characteristics. Outside the healthcare system, the Scottish Government has made relative progress in reducing smoking, implementing alcohol regulations such as minimum pricing, and tackling the drugs crisis. Changing diet and activity patterns has proven more challenging: the number of people in Scotland (and England) who are overweight or obese remains stubbornly high and is involved in almost a quarter of deaths.
The elephant in the room for each of these issues is hardship, with an estimate 21% of the Scottish population living in relative poverty after housing costs. The Scottish Government has attempted to address this with a range of policy measures, including the Scottish Child Payment Scheme launched in 2021: a weekly payment of Β£26.70 for each child under 16 to those receiving income-related benefits. The child poverty rate in Scotland remains high at 24%but is still lower than that of Wales (28%) and England (31%).
Looking ahead, the cost of living crisis, a new Covid disease adding to existing causes of death, and very high rates of obesity and overweight people mean that increasing healthy life expectancy is an ongoing challenge. Recent analysis suggests that austerity policies at the UK level have had a negative impact for more than a decade. In short, spend less social security and public services by the UK government has reduced the amount of funding allocated to Scotland to keep pace with health concerns. Scotland was already lagging behind in life expectancy, and without further investment this simply will not change.