Scotland’s public health challenges

Scotland faces a number of significant public health challenges.

COVID-19

The public health challenge facing Scotland as a result of the global COVID-19 epidemic is unprecedented.

The pandemic is impacting on health both directly and indirectly. Scotland’s routemap sets out the four ways in which COVID is harming health:

1. The virus causes direct and tragic harm to people's health
2. The virus has a wider impact on our health and social care services in Scotland
3. The restrictions which have been put in place affect our broader way of living and society
4. The impact on our economy, with a damaging effect on poverty and inequality.

We are working closely with national and local government, NHS Boards and other partners to minimise the impact of COVID on population health. This includes sharing data and intelligence, producing guidance and advising local and national partners on effective measures.

The pandemic is impacting differentially on communities across Scotland, including less advantaged areas and Black and Minority Ethnic communities. Health inequalities are likely to widen without action to support those most vulnerable to the direct and indirect impacts of the pandemic. We are working with partners to build the evidence base and advice on effective action.

Enduring health inequalities

Scotland has the worst health inequalities in western and central Europe:

• The gap in life expectancy between the most and least deprived areas in Scotland is roughly 13 years for males and 10 years for females
• The gap in healthy life expectancy (the number of years lived in good health) is even greater - roughly 23 years for males and 24 years for females.

The fundamental causes of health inequalities are an unequal distribution of income, power and wealth. Inequalities in income, wealth and power can lead to poverty and marginalisation and also influence the distribution of wider environmental influences on health, such as the availability of work, education, and good quality housing.

These ‘social determinants of health’ shape individual experiences across the population and lead to inequalities in health outcomes.

Health inequalities are not inevitable. They are caused by the way society is structured and organised and can be reduced by taking action to make Scotland a fairer place to live.

You can read about what PHS is doing to help create a Scotland where we have a sustainable, inclusive economy with equality of outcomes for all.

Stall in life expectancy

Life expectancy is an important measure of population health and a good marker of overall societal progress. Life expectancy in Scotland had been increasing since the 1950s but this increase has now stopped. There has been almost no change in life expectancy in Scotland since 2012.

The stall in life expectancy can be seen across all socio-economic groups and almost all age groups, not just the oldest.

Life expectancy in our poorest areas has actually decreased. This means that health inequalities are worsening and that socioeconomic position is increasingly impacting on how long we live for, and how long we live in good health.

The best evidence currently available suggests that this is due to austerity and that pressure on health and social care services are also contributing. You can find out more about this on the ScotPHO website .

Drug-related deaths

2018 saw the number of drug-related deaths in Scotland reach the highest number recorded for the fifth year in a row. 1,187 people lost their lives to a drug-related death, each of which was preventable. Ministers have declared this to be ‘a public health emergency’ and set up a National Drug Deaths Taskforce.

Deprivation and inequality create difficult conditions in which people live, and problematic drug use is commonly a sign of these complex social circumstances. The number of people living with, or dying from, drug use is 17 times higher in our poorest areas compared to the wealthiest.

The loss of life, particularly amongst those aged 35-55 years, means that drug-related deaths are impacting on overall life expectancy trends for Scotland and are exacerbating health inequalities.

Addressing wider social inequalities, for example in housing and employment, as well as tackling poverty, therefore plays an important role in the prevention of problematic drug use and associated harms.

You can read about what PHS is doing to help create a Scotland where we reduce the use of and harm from alcohol, tobacco and other drugs.

Environmental sustainability and climate change

Environmental sustainability and climate change is another major public health challenge. Human health depends on healthy natural systems and environments. Continued degradation of the environment through, for example, emissions of greenhouse gases and pollution poses a significant threat to population health now and for future generations.

There is international evidence that the impact of climate change on population health is not evenly distributed and will more negatively impact on those with the least resources and power.

The Scottish Government supports the international agreement that urgent action is needed to limit global temperature rises through the reduction in greenhouse gas emissions. It has declared a climate emergency and has proposed a target for net zero greenhouse emissions by 2045.

You can read about what PHS is doing to help create a Scotland where we live in vibrant, healthy and safe places and communities.