Death rate improvements stall, report finds

Data published by Scotland’s most senior doctor underscores deprivation’s effect on Scots’ health

Thursday 25th April 2019

In a situation ‘almost unprecedented since the Second World War’, mortality in Scotland has ‘hardly improved’ in the last five years, statistics published today show.

Dr Catherine Calderwood – Scotland’s Chief Medical Officer (CMO) – has published a summary of the health of the nation as part of her latest annual report.

A summary of the health of the nation looks at mortality trends in Scotland and at patterns of health in six public health priority areas identified in the Scottish Government’s public health reform programme in 2018.

Within the public health priority areas, the report makes clear the myriad ways living in a more deprived community can affect an individual’s health are becoming increasingly clear, with issues like maternal obesity and drug related deaths continuing to affect poorer communities more than their more affluent counterparts.

Although Scotland’s mortality trend compares favourably to countries including the USA, England and Wales over the same period, many other countries have experienced continued improvements.

Male life expectancy improvements slowed to an average increase of 4.5 weeks per year between 2012 and 2016 – a ‘substantially lower’ rate than before 2012 where life expectancy in Scotland for men was increasing by over 17 weeks per year.

For Scotland’s women, life expectancy increased by an average of 2.4 weeks per year between 2012 and 2016, while Wales and England experienced smaller increases over the same period. However, ‘other countries had much more stable and larger increases’, including Denmark and Spain.

The reasons behind the slowdown in mortality improvements ‘are not clear’, the report states. Neither are the causes of increasing mortality inequalities in Scotland since 2011.

The CMO advises there is some evidence to suggest austerity measures, influenza and pressures on health and social care services ‘may be contributing’, before adding: ‘Further work is being undertaken urgently to improve our understanding’.

Homelessness

The first of the patterns of health examined in the CMO’s report, homelessness is described as a revealing illustration of the huge impact social circumstances can have on health.

For the first time at a national level in Scotland, a health and homelessness study was undertaken, linking datasets to explore the relationship between homelessness and health, and ultimately evidencing the importance of considering both aspects together.

Early years

Among the many contributors to children’s health, Dr Calderwood focuses on the proportion of babies born premature or preterm ‘because being born too early influences many aspects of children’s subsequent health and development’.

The rate of premature births has been increasing over time in Scotland.

Of the 22 countries that data is available for, Scotland had the third highest prematurity rate among singleton babies. Scotland also had the second highest prematurity rate among babies from multiple pregnancies (twins or more).

‘Scotland’s high, and increasing, prematurity rate is a cause for concern’, the report states. It is suggested that greater efforts to tackle the risk factors linked to preterm births – such as maternal smoking and obesity – could help Scotland to reduce the number of babies born preterm or prematurely and ‘ensure that children have the best chance to flourish in their early years’.

Mental health

‘Mental health problems represent a very substantial proportion of the overall burden of disease in Scotland’, according to the summary.

Mental health problems among Scots are now very common and have worsened; the report notes the increased prevalence of anxiety and depression in more deprived areas of Scotland, before stating:

A public mental health approach [to mental health] requires us to look at the factors that are changing the experiences of mental health across the whole population, focusing on the prevalence of cases rather than the causes of cases or the provision of services.’

Reducing the harm from alcohol, tobacco and drugs

The CMO’s report advocates reducing the harm caused by smoking, drinking and drug use.

Despite positive trends in smoking cessation, the habit remains a leading cause of preventable disease and premature death.

Meanwhile, the fall in the alcohol consumption death rate achieved between 2001 and 2013 has not been maintained and ‘the decline in inequalities in alcohol-specific deaths rates has now plateaued’.

In 2017, Scotland experienced its highest number of drug-related deaths since recording began, and a threefold increase on the number of deaths that occurred in 2000. The ‘marked deprivation effect’ is highlighted – as half of those who died from drug use lived in the 20% most deprived neighbourhoods in Scotland.

Child poverty

Although many measures of poverty have improved in Scotland over the last 20 years, income inequality has remained fairly static and at an historically high level’, according to the summary.

Child poverty is predicted to increase markedly into the future’, with much of that increase attributed to changes in the social security system ‘that will erode the value of benefits’ in the coming years.

The report highlights modelling carried out by the ScotPHO Triple I project that suggests income-based policies that redistribute wealth to the poorest in society are likely to effective in improving health and reducing health inequalities – reported on by healthandcare.scot yesterday.

An active nation

Focusing on maternal obesity, the summary emphasises the strong correlations between a mother’s weight and the weight of her children. Over half of women giving birth in Scotland in 2015 were overweight or obese.

Although common across Scotland, being maternally overweight or obese is more common among women living in more deprived areas.

However, Scotland bucks the trend among Western European countries in terms of physical activity. While the number of people achieving the recommended 150 minutes of weekly activity is decreasing elsewhere, since 2012 there has been an increase in the number of adults reaching the target in Scotland.