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Enhancing Scotland’s Life Expectancy: Strategies for Improvement

Every few years, reports surface regarding the comparatively lower life expectancy of Scots within western Europe. This issue was underscored recently by Paul Johnston, the head of Public Health Scotland, who drew attention to the stagnation of life expectancy between 2014 and 2016, followed by a subsequent decline. Presently, individuals in Scotland are projected to have a life span just over two years shorter than their counterparts in England.

The question arises: What factors contribute to this trend in Scotland, and how distinct is the nation, where I have resided for about a decade, from other regions of the UK and Europe? One crucial point to note is the variation in life expectancy based on geographical location. Disparities are stark in Glasgow, particularly evident between the affluent and deprived areas of the city. In 2021, life expectancy in Pollokshields West stood at 83 years, whereas in Greater Govan, it was 65.4 years—a significant gap of 18 years. These averages mask a more profound narrative intertwined with poverty and inequality within Scotland. The geographical and social circumstances significantly influence one’s longevity.

Furthermore, the decline in life expectancy has been a global phenomenon, exacerbated by the Covid-19 pandemic. A study analyzing 204 countries and territories revealed that 84% experienced a reduction in life expectancy in 2020 and 2021. Covid-19 emerged as the second leading cause of death worldwide in 2021, contributing to a 1.6-year decrease in global life expectancy. The principal investigator of the study, Austin Schumacher, emphasized the unparalleled impact of the pandemic on adults globally, surpassing the repercussions of conflicts and natural disasters witnessed in the past half-century.

The pandemic strained healthcare systems, with higher mortality rates partly attributed to challenges in accessing medical services. However, focusing solely on acute care, provided in hospitals during illness, would be shortsighted. It is akin to relying solely on the goalkeeper to secure victory in a football match.

In this analogy, secondary prevention—identifying early signs of potential illnesses and intervening proactively—acts as the defense line. Moving forward, primary prevention addresses the underlying population risk factors contributing to disease development. Scotland grapples with well-documented issues such as excessive alcohol consumption, an unhealthy diet leading to a high prevalence of obesity, sedentary lifestyles exacerbated by inclement weather and closures of public fitness facilities, and higher smoking rates compared to England. Scotland also faces the highest drug-related death rate in Europe, underscoring the impact of deprivation on mortality. A report from the National Records of Scotland highlighted that individuals residing in the most deprived areas are nearly 16 times more likely to succumb to drug misuse than those in the least deprived regions.

The Scottish government has long acknowledged these mortality factors and has made strides in enhancing secondary prevention and screening efforts. However, resource constraints within the healthcare system pose challenges, particularly in balancing acute care with early disease detection. Beyond healthcare interventions, progress has been made in reducing smoking rates, implementing alcohol regulations, and addressing the drug crisis. Yet, altering dietary habits and promoting physical activity remains a persistent challenge, given the high prevalence of obesity in Scotland and England.

Deprivation emerges as a central issue underlying these health challenges, with a significant proportion of the population living in relative poverty post-housing expenses. The Scottish government has implemented various policies to tackle poverty, including the Scottish child payment program launched in 2021, providing a weekly stipend to families with children under 16 receiving income-related benefits. While Scotland’s child poverty rate has decreased, it remains lower than that of Wales and England.

Looking ahead, the compounding factors of the cost of living crisis, the enduring impact of Covid-19, and the prevalence of obesity pose obstacles to increasing healthy life expectancy. Research indicates that austerity measures at the UK level have adversely affected public health outcomes over the past decade. Reduced funding allocations from the UK government have impeded Scotland’s ability to address its health challenges adequately. Without substantial investments, the trajectory of life expectancy in Scotland is unlikely to improve significantly.

  • Prof Devi Sridhar, Chair of Global Public Health at the University of Edinburgh