The first in a series of guest posts from Sam
What are the big issues for Scotland, independent or not?
"Of all the challenges facing Scotland, the gaping health inequalities and high mortality rates are clearly our biggest." That quote comes from Gerry McCartney's academic paper published in 2012, "What would be sufficient to reduce health inequalities in Scotland?"
So, what are the effects on Scottish society that health inequalities cause and what are the reasons for those inequalities? Most people in Scotland know that there are areas in Scotland, particularly in West Central Scotland, where life expectancy is much lower compared with areas nearby. A map of the Glasgow underground, for instance, can reveal how much life expectancy differs in short hops across Glasgow.
For too many years Scotland has been known as the "sick man of Europe". For example, mortality in the 15-44 age group among women in 2009 was 46% higher in Scotland than in England and Wales, while for men in that group it was 54% higher. In this age grouping, mortality reduced from the mid 1950s to the mid 1980s, the decline stalled from 1982 for men and from 1987 for women. Scotland's relative ranking for this group is now the highest among the 16 Western European countries studied. What happened in the 1980s to stall mortality reductions in Scotland?
Mortality for women in Scotland from lung cancer has either been the highest or second in Western Europe for 50 years.
Bear in mind that 50 years ago life expectancy in Portugal was 10 years less than that in Scotland. Now, Portugal has overtaken Scotland. Why? What began to happen 50 years ago that started this change in comparative rates of life expectancy? In Scottish society at this time life expectancy between the richest and poorest in Scotland began to diverge. If the poorest men in Scotland had seen their life expectancy keep the same gap to that of the wealthiest as it was 50 years ago, Scottish life expectancy would be three years higher than it is today. It is likely to be the health of the poor that makes the difference.
Mortality rates for Scottish men of working age (15-74 years) have been falling at a similar pace to other Western European countries but have remained consistently higher than the West European average. For women, reductions of the mortality rate in Scotland have not fallen at the same pace as in Western European countries. The mortality rate of Scottish women of working age (15-74) has remained 30% higher than the mean in Western Europe. Scotland has had the highest mortality in Western Europe among working age men and women since the late 1970s.
The causes of changes in Scottish life expectancy starting after 1950 are not clear and further research is needed.The most likely explanation is that Scotland suffered a combination of more precarious employment, overcrowding, poverty and ill-conceived reconstruction than other countries during this period.
The changes to life expectancy in the 1980s - the halting of the declines in mortality rates - are to do with the "neoliberal" economic policies of the 1980s. Thatcherism.
This is a human tragedy, but it also causes a reduction in economic output and social problems. Of all the challenges facing Scotland, the gaping health inequalities and high mortality rates are clearly our biggest." (McCartney, 2012 "What would be sufficient to reduce health inequalities in Scotland?)
It is a tragedy that mostly affects the poor. The fundamental drivers of health inequalities are the inequalities in Scotland of wealth, power and income. That needs to change.
McCartney again: "It is only a reduction in the current inequalities in income, wealth and power, which are contributed to by policies across the UK, Scottish and local government, that would be sufficient to generate a reduction in health inequalities."
"If health inequalities in Scotland are to be reduced, this will require leadership at all levels to reduce the stark inequalities in the socio-economic circumstances prevalent today."