Life expectancy, the number of years that a
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A discussion of the factors that contribute to lower life expectancy in
the west of Scotland as compared to other parts of the U.K
Life expectancy, the number of years that a person can expect to live on average, is a single measure of population health which is used to monitor public health, health inequalities, and the outcome of health service interventions and to allocate resources.
Life expectancy in Scotland
The relationship between health and wealth is complex. One as yet unexplained paradox in Scotland is that, even when matched with their English counterparts of comparable socio-economic status, Scots are relatively less healthy over a range of indicators from age standardised mortality to specific disease outcomes (Figure 1).
Figure 1: Directly standardised mortality rates per 1,000 populations, 1990/92, by country and deprivation quintile.
These findings suggest that there are factors at work, other than simply wealth, which are making Scots unhealthier than people in other parts of the UK (Scottish executives 2007).
West of Scotland: A Description
West of Scotland is one of the eight electoral regions of the Scottish Parliament which were created in 1999. In terms of local government areas the region covers:
West Dunbartonshire
East Renfrewshire
Inverclyde
Most of Renfrewshire (otherwise within the Glasgow region)
Most of East Dunbartonshire (otherwise within the Central Scotland region)
Part of Argyll and Bute (otherwise within the Highlands and Islands region)
Part of North Ayrshire (otherwise within the South of Scotland region)
Within Scotland, life expectancy is lowest for people living in the west of Scotland. According to the Scottish household survey, healthy life expectancy at birth is 63.3years and 60.3years in females and males, respectively of greater Glasgow for example. These figures are the lowest in the UK (Scottish Public Health Observatory 2007).
Life in the West of Scotland
While parts of west Scotland have prospered with greater employment and better paid middle-class jobs, in other parts ‘worklessness’ and low income are commonplace. The issue for west Scotland is that greater reductions in disease have been achieved elsewhere and so west Scotland’s health has become worse relatively in comparison to other UK cities. Estimates of life expectancy suggest that people living in west Scotland not only live shorter lives, but succumb to disease and illness earlier in life. An explanation to this is that the health of an individual is largely determined by the circumstances in which he or she lives. Poor health is associated with poverty, poor housing, low educational status, unemployment and a variety of other life circumstances (Tackling Health Inequalities 2007). Health inequalities within Scotland and between the west of Scotland and the rest of the UK appear to be widening. In the 10 years to 2001, average male life expectancy in Scotland increased by 3% but the rate of increase was more rapid in the most affluent parts of the country, with the least affluent west areas falling behind (Whyte and Walsh 2004). The recent decline in death rates from common conditions such as cardiovascular disease has also been more rapid among the more affluent (Krawczyk 2004). Thus, despite the overall improvements, the west of Scotland still lags behind.
Economic factors
A number of trends related to the economy are also notable in West Scotland. There are now more women than men in employment in Glasgow and part-time work has grown to represent more than a quarter of all jobs. The service sector has grown to become the most important sector of the heart of West Scotland’s economy, while manufacturing employment has shrunk (Scottish Public Health Observatory 2007).
Social factors
It is common knowledge that those who smoke, become obese through eating a poor diet or through lack of exercise, and those who drink alcohol in excessive quantities or abuse drugs have poor health. Smoking levels in west Scotland have remained higher than those observed in other parts of the UK. Hanlon and his colleagues (2001) have shown that, by 1991, deprivation appears to explain only 40% of the excess deaths in Scotland (2001). Gillis and his colleagues (1988) have found that, at comparable daily smoking rates and levels of affluence, men in the West of Scotland are more likely to die from lung cancer than other populations in the UK or the US (Gillis 1988) (Figure 2).
Figure 2: Comparison of lung cancer mortality in Renfrew and Paisley with three major cohorts in US and UK.
The increasing impact of alcohol is undeniable: There are estimated to be more than 13,500 ‘problem alcohol users’ resident within Glasgow City, and since the beginning of the 1990s, there has been a striking increase in numbers of alcohol related deaths and hospitalisations especially in west Scotland. Simple projections of alcohol related deaths based on recent trends suggest that the number of alcohol related deaths in Greater Glasgow could double in the next twenty years (Figure 3) (Scottish executives 2007).
Figure 3: Alcohol related mortality in West Scotland: Greater Glasgow
The impact of the use of illicit drugs also serves to further decrease life expectancy in west Scotland in comparison with other parts of the UK. Between 1996 and 2004, drug related deaths in Greater Glasgow for example, rose by a third. There are estimated to be around 25,000 problem drug users in the West of Scotland, of whom more than 11,000 live in Glasgow (Scottish executives 2007). Life expectancy for drug addicts is expectedly very low and these figures will impact negatively on the overall life expectancy for the region.
In Glasgow and other parts of west Scotland, it is predicted that single adults will account for 49% of all households in the next ten years, while lone parent households may rise to make up almost one in two of households with children (Scottish Public Health Observatory 2007).
Obesity levels have risen exceedingly in west Scotland to the extent that in Greater Glasgow, for example, a fifth of males and almost a quarter of females are now estimated to be obese, with well over half classified as overweight. Trends in hospitalisation for diabetes, much of which is associated with obesity, have also risen dramatically in recent years (Scottish executives 2007).
A cultural issue
The ethnic minority population of west Scotland has risen in recent years and looks set to increase further, particularly taking into account the recent rise in the asylum seeker and refugee population. The influence of this trend on life expectancy within the region remains to be determined (Scottish Public Health Observatory 2007).
Provision of services
Despite improvements in overall house conditions and dramatic decreases in levels of overcrowding, housing-related problems persist for considerable numbers of residents of Greater Glasgow and the West of Scotland (Scottish Public Health Observatory 2007).
Recent research suggests other important ways in which the environment and life circumstances can affect biological processes which in turn can make individuals more susceptible to ill health. By following the progress of male civil servants over a 10 year period, Marmot and his colleagues found that mortality was approximately three times greater among the lowest grades than the highest (Marmot et al 1978). When deaths from heart disease were considered, the recognised risk factors of smoking, high blood pressure and elevated cholesterol levels could account for part of the differences between the groups. Other studies have confirmed that higher levels of risk of death in a working population are explained by health-related behaviours (Marmot 2000). There is mounting evidence that at least part of the unexplained increase in risk across the social classes is related to how the body responds to social stress. Available data shows that people are perhaps exposed to a high level of stress factors in west Scotland (Scottish Public Health Observatory 2007). Whether these stress types and levels are more or comparable to what is obtainable in other parts of the UK remains an unanswered question.
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References
Gillis CR, Hole DJ, Hawthorne VM, 1988.Cigarette smoking and male lung cancer in an area of very high incidence-II Report of a general population cohort study in the West of Scotland. J Epidemiology and Community Health 42: 44-48.
Hanlon P, Walsh D, Buchanan D, Redpath A (2001). Chasing the Scottish Effect. Public Health Institute of Scotland (now NHS Health Scotland) Glasgow 2001.
Marmot MG, Rose G, Shipley M, Hamilton PJ. (1978) Employment grade and Coronary Heart Disease in British civil servants. J Epidemiol Community Health. 1978 Dec; 32(4): 244-9.
Marmot MG (2000) Multi-level approaches to understanding social determinants in Berkman and Kawachi (eds) Social Epidemiology New York. Oxford University Press pp 349-367.
Scottish executives (2007) [Internet] Available at http://www.scotland.gov.uk/Topics/Statistics/Browse/Health/TrendLifeExpectancy
Scottish Public Health Observatory (2007): Healthy life expectancy in Scotland (Internet) (Accessed 15/04/07) http://www.scotpho.org.uk/web/site/home/Populationdynamics/Healthylifeexpectancy/hle_intro.asp
Tackling Health Inequalities – An NHS Response (2007) [Internet] (Accessed 15/04/07) www.sehd.scot.nhs.uk/nationalframework/Documents/TACKLING%20HEALTHINEQUALITIES240505
Whyte B and Walsh D. (2004) Scottish Constituency Profiles 2004.www.phis.org.uk/info/sub.asp?p=bbb
Krawczyk A. (2004) Monitoring Health Inequalities. Scottish Executive Health Department Analytical Services Division 2004.
