Long-term monitoring of health inequalities in Scotland by area deprivation

About this release

Responsibility for long-term monitoring of health inequalities in Scotland by area deprivation reporting has moved from the Scottish Government to Public Health Scotland. The last Scottish Government report was published in 2023 and included data to 2021.

Public Health Scotland is developing a new reporting framework and Scottish Public Health Observatory (ScotPHO) dashboard to replace the previous reporting arrangements. This interim report uses existing ScotPHO indicators to provide an updated overview of how health outcomes vary according to the level of deprivation in the areas people live. It includes the latest available data, including recent National Records of Scotland life and healthy life expectancy estimates.

Users are invited to share feedback on the report's content and structure via email to phs.scotpho@phs.scot.

Main points

Health inequalities in Scotland by area deprivation remain substantial and persistent, demonstrating that decades of policy efforts have not matched the magnitude of the challenge. Recent trends are mixed: while some indicators show recent narrowing of inequalities, others show no sustained change or continued widening. These findings reinforce the need for sustained and strengthened action to reduce poverty, improve the living and working conditions that shape health, and address the barriers that prevent people from realising their right to health.

Scale of inequalities

Large differences in both life expectancy and healthy life expectancy persist between the most and least deprived areas.

• Life expectancy differs by 8.7 years for females and 11.1 years for males between the 20% most and least deprived areas (2022–2024).
• Healthy life expectancy differs by 23.4 years for females and 20.8 years for males between the 20% most and least deprived areas (2022–2024).
• Deaths among those aged under 75 years are more than three times higher in the 20% most deprived areas compared to the 20% least deprived (2021–2023).

The gap in healthy life expectancy is substantially larger than that in life expectancy, highlighting particularly pronounced inequalities in years lived in good health.

Recent trends in inequality measures

Recent progress in reducing inequalities is mixed.

Some indicators show narrowing inequalities, including life expectancy, deaths among those aged 15-44 years, adult mental wellbeing, and alcohol- and drug-related hospital admissions.

However, inequalities in healthy life expectancy for females, deaths aged under 75 years, and early deaths from coronary heart disease and cancer have widened in recent years.

Several indicators show no sustained recent change, including healthy life expectancy for males, cancer registrations, alcohol-specific deaths, adult self-reported general health, and adult self-reported limiting long-term illness.

Interpretation

Although some indicators show recent narrowing, substantial inequalities remain across all indicators. In several key indicators, particularly healthy life expectancy for females and premature mortality, inequalities have widened over the past decade.

The COVID-19 pandemic affected mortality patterns, diagnoses, service delivery, service use, and data collection across multiple indicators. Recent trend changes should therefore be interpreted with that in mind.

Wider context

Health inequalities are strongly influenced by social and economic conditions. High levels of poverty and income inequality persist in Scotland, affecting people's ability to afford food, heating, and good-quality housing, and increasing exposure to chronic stress and long-term poor mental and physical health.

Published research has attributed the stalling of decades-long improvements in life expectancy in the early 2010s to UK wide austerity policies, which involved cuts to social security, local government funding, and other public spending, with the most deprived areas experiencing the most severe impacts.

The recent COVID-19 pandemic and cost-of-living crisis have exacerbated these challenges.

Preventative healthcare uptake such as immunisation and screening remains lower in more deprived areas.

These wider factors help explain the patterns observed in this report.

Background

Health inequalities are the systematic, avoidable and unfair differences in health outcomes that can be observed between populations, between social groups within the same population or as a gradient across a population ranked by social position. They are driven by the unequal distribution of income, wealth and power, which shapes the social determinants of health such as education, employment, housing and community environments.

Area deprivation is measured by the Scottish Index of Multiple Deprivation (SIMD) which ranks Scotland's data zones, small geographical areas designed to have relatively similar population sizes and characteristics, from most to least deprived based on seven domains: income, employment, education, health, housing, crime, and access to services.

Further information

The next release of this publication will be in 2027.