Scotland’s health – latest report projects burden of disease, but the future is not fixed

In November 2025, NHS Scotland began using two regional planning areas: Scotland West and Scotland East, alongside local NHS board planning. These are the current planning arrangements and do not assume the outcome of wider consultations on future structures. In this blog, Dr Fatim Lakha, Consultant in Public Health Medicine, and Dr Grant Wyper, Principal Epidemiologist at Public Health Scotland, discuss what the latest Scottish Burden of Disease report tells us about future health needs. 

What will Scotland’s health look like in 2040? No estimate can give us a perfect answer, but our latest Scottish Burden of Disease study report offers a clear warning and an opportunity to act. It explores what could happen to the burden of disease if historic patterns of health loss remain unchanged while Scotland’s population changes. The measure used is disability-adjusted life years, or DALYs, which bring together years lost through premature death and years lost to illness or disability. Put simply, DALYs describe the healthy time taken away by disease and injury.  

Between 2025 and 2040, Scotland’s annual disease burden is estimated to rise by 16% because of changes to our population alone. The increase is estimated at 14% in Scotland West and 18% in Scotland East, with changes in the size and age of the population in every territorial NHS board resulting in increased estimated burden everywhere. That includes seven boards where the overall population is projected to fall. A smaller population, in other words, does not necessarily mean less healthcare need. As the population ages, the balance of need changes – and health loss rises particularly sharply at older ages. Across every area, cancers, cardiovascular diseases and neurological disorders remain the three leading broad causes of burden in 2040. Mental health and musculoskeletal disorders also remain prominent, while substance use disorders are among the leading causes in parts of Scotland West.  

Why equity must shape our response 

One finding needs particular care. Some of the largest percentage increases are estimated in NHS boards with relatively less deprived populations, but this should not be read as meaning that more deprived communities have less healthcare need. The pattern reflects a deeper inequality. People in more deprived areas are more likely to become ill at younger ages and to die earlier. As a result, fewer people survive into the oldest age groups, where the projected increase in disease burden is steepest. So, a lower projected percentage increase can still sit alongside a much heavier burden today, earlier onset of illness and shorter lives – a pattern also reflected in estimates of inequalities in healthy life expectancy. 

That is why equity cannot be an afterthought. Decisions should consider the existing level of health loss, the age at which it occurs, the absolute number of healthy years lost and the projected direction of travel. Resources based only on population growth or percentage change could unintentionally widen inequalities. Equitable planning means proportionate action: universal services, but with greater scale and intensity where disadvantage and current need are greatest. It also means protecting access for deprived, rural, and island communities when services are redesigned or delivered across larger geographical areas.  

What this means for planning 

As Scotland considers how health and care should be planned across larger geographical areas as part of wider public sector reform, these findings underline an important principle: strategic scale needs to be matched by strong local intelligence. Scotland East and Scotland West each contain communities with very different demographic trajectories, disease profiles, deprivation patterns and practical barriers to care. Planning across larger populations can support shared capacity and greater consistency, but it must retain strong local intelligence to understand where need is greatest and how it is changing. Planning also needs to consider the implications of changing population need across health, social care and wider community support.  

For local and regional planning, the report provides a baseline against which strategies can be stress-tested. Plans should ask:  

• Are prevention and early intervention protected when immediate treatment pressures grow?  

• Can services respond differently to different patterns of population need across growing urban areas, ageing rural populations and island communities, while considering the potential impact of service changes on health inequalities?  

• Are workforce and service plans taking account of population ageing and the projected increases in disease burden, particularly from the largest and fastest-growing disease groups, while also addressing conditions associated with the greatest health inequalities, and the implications of frailty and multimorbidity?  

• Are primary care, community services, social care, third-sector, rehabilitation, and carer support developing together?   

Changing the trajectory is possible 

The encouraging message is that these estimates are not fixed. They assume that age and sex-specific rates of disease burden remain unchanged, so they do not capture future improvements or deterioration in health within those population groups. Sustained action on the building blocks of health can make a real difference: improving income, housing, education, work and local environments; reducing exposure to tobacco, alcohol, unhealthy food and other health-harming risks; preventing disease earlier; diagnosing it sooner; and helping people already living with conditions to avoid complications and maintain independence. The greatest gains will come when we work across the whole system to improve the wider building blocks of health.  

The challenge is not to plan for a 16% increase in disease burden as though it were inevitable. It is to understand where future need is likely to grow, how much of that burden we can prevent or delay, and how fairly we respond.  

Read our report here.