The mystery of why Scotland’s health is worse than England’s

Last week saw the publication of the latest Scottish Health Survey. There is plenty of interest – scroll down to figure 2, showing how cigarette smoking is correlated to deprivation, with about 12% of the least deprived fifth of men smoking compared with more than 40% of the most deprived fifth. But what it doesn’t do is compare Scotland’s health to that of other parts of the UK.

I wrote about the four UK nations’ performance on healthcare in 2005 for HSJ, based on a thorough piece of research by Prof Sheila Leatherman and Kim Sutherland. This found that, per person, Scotland was spending more on healthcare than the other three nations and had more NHS staff, but that Scots died earlier than their counterparts, with a two year, nine month gap between Scotsmen and Englishmen (see end of the archive article), and a much higher rate of heart attacks.

Red pointers represent male life expectancy of less than 75; pink from 75 up to 77; yellow from 77 up to 79; green from 79 up to 81; and blue 81 and over.

The health gap is still there. Office of National Statistics data from October 2010 on council areas, mapped on this site (with a subset above) showed a 13.3 year difference in male longevity between Glasgow and Kensington & Chelsea, with eight out of the 10 worst council areas in Scotland. In August, the ONS added that Scotsmen’s healthy life expectancy (in other words, years lived while in good general health) declined 1.4 years from 61.2 to 59.8 between 2005-7 and 2008-10, while Englishmen’s healthy lifespan rose 2.8 years from 61.6 years to 64.4 years over the same period. (Wales followed England in the right direction, while Northern Ireland followed Scotland the other way.)

Although Scottish diets may well be part of the problem, the reason people tend to mention first – the deep-fried Mars bar –  is more of a symbolic novelty item than a major cause of ill-health, according to a recent BBC investigation. It also points out several places where you can buy one – reporter Steven Brocklehurst’s expenses claim must have been interesting (and possibly a bit sticky).

At a more significant level, while Scotland will soon vote on independence, it has run its NHS independently since 1999. It has rejected and reversed some English policies, with this trend accelerating since the SNP took over at Holyrood. Changes include central capital funding for hospitals rather than PFI (including for the new children’s hospital in Edinburgh, although some trusts in England are considering alternatives to PFI as well), the phasing out of prescription charges for everyone (completed last year) and free personal and nursing care for the over-65s.

The SNP has also made a general rejection of England’s use of market techniques in healthcare: last year, then health secretary Nicola Sturgeon told David Torrance that the changes in the Health and Social Care Act “will end the NHS in England as we know it”. Under new health minister Alex Neil, Holyrood will introduce integration between health and social care (although other parts of the UK are moving in the same direction), and introduce a minimum unit pricing for alcohol. The country has also done better on some aspects of healthcare IT, having successfully introduced a near-universal emergency care summary record several years ago.

On that basis, as well as continuing higher spending, Scotland should have better health than England. But government policies are just one factor in a nation’s health, and anyway take years to produce results, particularly in the ultimate measure of longevity. The Economist recently compared the health of Glasgow with that of Manchester and Liverpool, which have similar post-industrial problems. Even after adjustments for age, poverty and gender, the Scottish city still has twice as many deaths from drink and drugs as its two counterparts in north-west England. Having noted that Glasgow did not have a health gap with these cities until after 1950, and having considered explanations including unhealthy behaviour handed down within families and poor housing, it decided that none explain the differences: “It is as if a malign vapour rises from the Clyde at night and settles in the lungs of sleeping Glaswegians,” it concluded.

Regardless of the overall question of Scottish independence, Scotland’s (particularly Glasgow’s) distinctive health problems seem best tackled by a government in Scotland. (The same may well be true of councils taking responsibility for public health in England from next year – Greater Manchester was already considering its own minimum alcohol price last year.) Furthermore, England, Wales and Northern Ireland benefit from having a neighbour willing to take bold steps, letting the rest of the UK decide whether or not to follow in Scots’ footsteps.

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