Health inequalities are increasing - but why?

A lot can change in ten years. In 2013, the concern was that health inequalities remained high in Scotland despite improvements in the overall health of the population and decreasing mortality rates.

Scottish Government figures show that:

“[B]etween 2002 and 2013 there was a general downward trend [in mortality rates]. Most notably, the absolute gap between the most and least deprived areas reduced every year between 2007 and 2013” (Scottish Government, 2023).

Since then, health inequalities in Scotland have increased according to most indicators. Not only that, but mortality rates are beginning to increase again:

“Life expectancy in Scotland increased from the 1980s to the late 2000s, but over the last decade most areas saw a slow down or a stall in life expectancy growth. And now, many areas have decreasing life expectancy.”

As shown in the tables below, this trend predates Covid-19, Brexit and the current cost-of-living crisis. In 2013, the slight narrowing of the gap in mortality rates between the least and most deprived communities in Scotland began to reverse and the gap has increased almost year-on-year since then. The spike in mortality rates since 2019 is largely due to Covid, and this was most pronounced in disadvantaged communities.

Why are health inequalities increasing?

2010 saw the election of the UK government which, since then, has initiated a series of austerity policies, such as cuts to social security payments and the reduction in spending on public services.

Over the same period, CHEX has developed briefings, consultation responses and other materials setting out the causes of health inequalities, including poverty, housing, education and a range of other factors and the need for policies to reduce them.  We have argued for greater redistribution of wealth and increased support for community-led health approaches.

Many communities have been feeling the adverse effects of these ‘cuts’. As Professor Chik Collins, Director of Glasgow Centre for Population Health, explained in his keynote presentation to the 2023 CHEX conference, austerity is more of a factor behind worsening mortality and morbidity rates than Covid-19 and the current cost-of-living crisis.

Political decisions, then, ultimately make the difference between whether health inequalities grow or decrease, and whether people get ill and die younger. Austerity policies have been driven by the UK government, so much of the blame for growing health inequalities in Scotland can rightly be laid at their door. However, the Scottish Government could have made more use of increased devolved powers, including control over rates and bands of income tax and ability to raise social security benefits, in order to alleviate some of the impact of austerity.

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