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'Significant’ health outcome gap persists in Scotland, latest data show

Some inequalities have narrowed over the long-term, but overall picture is of little or no change

Caroline White

Wednesday, 12 December 2018

Despite some notable improvements, “significant” gaps in health outcomes between the most and least deprived areas remain in Scotland, reveal the latest data in the annual report* on long-term health inequalities monitoring in the country.

A Ministerial Task Force on Health Inequalities was set up in 2007 to identify and prioritise practical actions to reduce the most significant and widening health inequalities in Scotland.

A technical advisory group, set up in 2008, recommended a range of indicators on health inequalities to be monitored over time, and most recently met in July 2015 to review the list of indicators and methods.

This latest report presents data on premature deaths under the age of 75, mental wellbeing, birthweight, self-assessed health, limiting long-term conditions and a range of indicators for illness and death relating to alcohol, cancer, and coronary heart disease.

It shows that with the exception of the healthy birthweight indicator, significant health inequalities persist for each indicator covered in the report, although some gaps have narrowed.

For several indicators, absolute inequalities- the gap between the most and least deprived areas- have narrowed over the longer-term: the premature mortality gap has fallen by 17 per cent from its peak in 2002, and is currently lower than at the start of the time series in 1997.

The coronary heart disease gap has more than halved since its widest point in 1998, while the gap for hospital admissions associated with excess alcohol has fallen by 43 per cent since the start of the time series in 1996.

Other indicators also show progress: the low birthweight gap has reduced by 25 per cent since its peak in 2004, with most of this reduction occurring in 2008, and fluctuating since then.

The divide in cancer deaths has fallen by 22 per cent since its widest point in 1998, while the gap for alcohol-related deaths is currently 30 per cent lower than at its peak in 2002.

But after a period of narrowing, this gap has been increasing since 2013, and is currently 10 per cent higher than at the start of the time series in 1997.

The limiting long-term conditions gap has fallen by 26 per cent since its peak in 2014-15 but is currently slightly higher than at the start of the time series in 2008-9.

For the other indicators in the report, there has either been little change, or the long-term trends in the absolute gap are less clear. These include mental wellbeing; admissions for heart attack; cancer incidence; all-cause mortality (15-44 years); healthy birthweight; self-assessed health.

The relative index of inequality (RII) indicates the extent to which health outcomes are worse in the most deprived areas compared to the average throughout Scotland. It is possible for absolute inequalities to improve, but relative inequalities to worsen.

There are three illness indicators for which the RII can reasonably be compared with one another: alcohol-related hospital admissions; heart attack hospital admissions; and cancer incidence.

Among these, relative inequalities in alcohol-related hospital admissions have remained the highest over the longer-term. Relative inequalities in heart attack admissions have fallen over the past year but remain higher than at the start of the time series, while cancer incidence inequalities have remained relatively stable.

Among the three comparable mortality indicators (coronary heart disease, alcohol-related, and cancer deaths), relative inequalities in coronary heart disease deaths have increased over the long-term.

The relative inequalities in alcohol-related deaths have shown more year to year fluctuation over the same period, but ultimately the RII has increased by 10 per cent since the start of the time series in 1997.

The RII for cancer mortality has increased slightly over the longer-term. But inequalities in alcohol-related deaths and coronary heart disease deaths have widened.

Of the other indicators in the report, the two indicators relating to premature mortality (under 75 and among those aged 15-44) have both shown increases in RII over time.

*Long-term Monitoring of Health Inequalities. A report prepared by the Scottish Government, December 2018.

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