What is the Scottish approach to poor health?

Life Expectancy

Equally Well is the Scottish Government’s report into Health Inequalities. There are a wide range of health inequalities.

In Scotland in 2006, healthy life expectancy at birth was 67.9 years for men and 69 years for women. In the most deprived 15% of areas in Scotland in 2005-06, healthy life expectancy at birth was considerably lower at 57.3 years for men and 59 years for women.

The five authorities with the highest premature death rates are Glasgow City, West Dunbartonshire, Inverclyde, Dundee and North Lanarkshire. These are all authorities with serious problems of social deprivation.

“Scotland” is not the sick man of Europe. If we were to take these authorities out of the equation, Scotland would be one of the healthiest countries in the world!

Early years

The rate of pregnancy among 13- to 15-year-old girls in the most deprived fifth of areas is twice as high as the average, and four times as high as in the least deprived fifth.

Equally Well notes that a higher proportion of babies born to mothers living in the most deprived fifth of the population have a low birth weight than those born to mothers living in the most affluent areas (9% compared to 5% in 2004-05).

Almost four-fifths of 5 year olds in the most deprived areas have some decayed teeth compared to two-fifths of those in the least deprived areas.

Mental Health

In Scotland in 2006, people who had a low household income, or reported finding it difficult to manage on their household income, had poorer mental wellbeing than those with a high household income or who reported finding it easy to manage on their income.

Those living in the most deprived 10% of areas of Scotland have a suicide risk double that of the Scottish average.

Know the Score with Cocaine In Scotland in 2006, more than two thirds of the total alcohol-related deaths were in the most deprived two fifths of areas.

49% of men in the most deprived areas smoke regularly compared to 26% of men in the least deprived areas. The divide is similar for women: 43% smoke in the most deprived areas, compared to 24% in the least deprived.

Drug-related deaths have increased by 95 per cent since 1997 in Greater Glasgow and Clyde NHS Trust.

In 2006, 43% of the total number of methadone users in Scotland were in Greater Glasgow.

It is estimated that in Glasgow more than 6,000 children are living with a parent with a substance abuse problem.

Scotland’s alcohol problem

Scottish Government Ministerial Taskforce on Health Inequalities

The Scottish Government has set up a Ministerial Taskforce on Health Inequalities. Dr Barry Burns, Scotland’s Chief Medical Officer, has played a leading role in its approach. There is now a much bigger focus on early intervention in children’s lives. This is why the Scottish Government, has attempted, among other things, to introduce free school meals for all in P1-P3.

Dr Burns has investigated why poorer people, particularly in the west of Scotland and particularly since the 1950s, suffer from worse health than richer people. His conclusions are that difficult social circumstances, especially in the early years of life, have a dramatic effect on the body’s host defences. A child who is brought up in a chaotic environment, for example, having parents with drink or drugs issues, instability of care, neglect and/or poor housing will be brought up in an aggressive environment.

It’s not all to do with lifestyle

Poor lifestyle choices do make a difference to health and life expectancy.

But, the middle classes smoke and drink too!

So, lifestyle choices on their own do not explain health inequalities.

A Chaotic childhood is a Killer

This has an immediate effect on the child’s nervous system and, later in life, the body’s capacity to fight illness.

So, the long term answer to health inequalities is to tackle poverty. In the short term it is to intervene early with children who are at risk from chaotic upbringing.

New Political Consensus

All the major political parties now accept that there is a connection between poverty and poor health. This wasn’t always the case. All agree that getting people back to work and tackling poverty is required to reduce health inequalities. The Conservatives are still more likely to emphasise individual responsibility.

Ban on smoking in public spaces

“ All those who smoke play Russian roulette with their lives but the odds are heavily stacked against those in lower income groups as they are much more likely to smoke”.

John Toy, Cancer Research UK The smoking ban has been in existence since 2006 and it has been a great success. There has been a 14% drop in heart attacks since over 40,000 Scots quit smoking since the ban. Further legislation is expected to restrict the display of tobacco products in shops and supermarkets.

Tackle the “bevvy culture”

Proposals going through the Scottish Parliament propose “minimum pricing”. Off licences and supermarkets could be barred from offering promotions such as buy one, get one free bargains. Cheap deals on alcohol could end because the Scottish Government believes they contribute to violence and ill health.

Blitz on under-age drinking

Prescriptions Fees phased out by 2011

“Abolishing prescription charges will help tackle inequalities. As more of us live with long-term chronic conditions, increasingly it is the case that prescription charges are a tax on ill-health.”

Nicola Sturgeon Health Secretary

In April 2008, the charge for a single prescription was reduced from £6.85 to £5.00. For the next two years, that will be reduced by a further £1 a year until 2011, when prescription charges will be abolished altogether. Coincidentally, in time for the Scottish Parliament elections!