Health inequalities: Scottish comparisons and trends

The Scottish Government’s Long-Term Monitoring of Health Inequalities report presents trends in socioeconomic inequalities for a number of different health outcomes (the latest data are for 2021, published in the 2023 report. A report in 2024 is not planned). These include healthy life expectancy, mental wellbeing, all-cause premature mortality and cause-specific mortality and hospitalisation. Two examples are included here. 

Chart 1 shows a relative measure of inequality. Inequalities can be expressed in both absolute terms (e.g. the size of the difference in mortality rates between groups) and relative terms (e.g. how many times higher the mortality rate in one group is compared to another). Relative Index of Inequality (RII)) - shown in Chart 1 – represents the gradient of mortality across the whole deprivation spectrum (from the most through to the least deprived areas in Scotland, using the Scottish Index of Multiple Deprivation (SIMD)) relative to the mean level of mortality of the whole Scottish population.  

Using this measure we can see relative inequalities in premature mortality in Scotland have widened considerably over the past 25 years. This is because the mortality rates of those living in the least deprived areas fell much more than those living in the most deprived areas (seen in Chart 2). 

Chart 2 below show the premature mortality for those living in the least and most deprived areas of the country. It shows a steady decline for both groups until 2015. At this time the mortality rate for the most deprived stopped falling and for some years started to increase. By 2020, the downward trend for the least deprived was also disrupted.

Chart 3 below shows both the relative (RII) and absolute (SII) measures of inequality. Around 2013 the absolute gap in mortality (SII) between those living in the most and least deprived areas started to increase also.

Both the recent increases in mortality rates and the widening inequality have been shown to be linked to UK Government 'austerity' measures (see the GCPH report “Resetting the course for population health").

Additional increases in mortality rates in 2020 are related to the COVID-19 pandemic.

Chart 4 demonstrates the scale of inequalities in premature mortality in Scotland: in 2021 mortality rates of those living in the 10% most disadvantaged neighbourhoods in Scotland were four times greater than those living in the 10% least disadvantaged neighbourhoods (defined by domains of the SIMD). Other data presented in the Scottish Government’s Long-Term Monitoring of Health Inequalities report show that, for example, rates of mortality for causes such as alcohol related conditions and coronary heart disease are more than five times higher among the most disadvantaged groups compared to the least disadvantaged.