Associate feature: Poverty’s high price on health

Since 1950, mortality rates in Scotland have steadily declined. This was because the risk of dying at every age declined, including in infants, children and young people, adults and in retirement. Inequalities in health also decreased in the decades up to the 1970s. However, from the 1980s onwards, income inequalities began to rise and so too did health inequalities. Since 2012, improvements in life expectancy have stalled and made this inequality worse. For those living in Scotland’s poorest areas, mortality is going up for all age groups and for almost all causes of death.

The burden of poverty is costly both in terms of money and health. We know the most likely causes of the stalled life expectancy trends in Scotland and across the UK and USA, are economic. Research has provided good evidence that countries that have cut public services and social security benefits following the economic downturn have had the worst trends. In Scotland, this has meant that thousands of people, especially our poorest households, have had no income at all for periods of time, putting them under severe stress and hardship.

The financial pressures on the population have come at the same time as strained budgets for many public services that people rely upon at times of need, including those provided by local government. This has created something of a ‘double whammy’ for our communities and their health. This simply isn’t right, but ensuring that we think about health and health inequalities in developing economic policy can improve the situation.

Many things can be done to reverse these trends, by a range of institutions and levels of government, to ensure everyone is as healthy as they can be. Policies that protect and maximise income can create a fairer society and improve health. For example, through the Fairer Scotland action plan there has been progress to support low income households through investments in housing, childcare, employment support and social security. These are particularly important for lifting children and families out of poverty.

Ensuring that poverty is reduced and the incomes of the poorest groups stabilised, precarious work is reduced, and good quality public housing and public services are adequately funded are all going to be important for people to live longer, healthier lives. In taking these actions, we can reduce health inequalities and improve Scotland’s life expectancy again in the same way that many other countries have continued to improve theirs. As we move into Public Health Scotland next year, the new organisation will take a leading role in the research to better understand the causes of these trends, and in ensuring that the public and policymakers understand what is needed in the coming year.

Dr Gerry McCartney is Head of The Scottish Public Health Observatory at NHS Health Scotland.

NHS Health Scotland is a national health board working to reduce health inequalities and improve health and is part of NHS Scotland. For more information visit our website at www.healthscotland.scot

This piece was sponsored by NHS Health Scotland