Scotland's life expectancy figures reveal the greatest failure of devolution – John McLaren
At the dawn of devolution in 1999, one of the key shortcomings in Scottish society was its shockingly poor life expectancy compared to other countries. Yet, there was room for hope as the powers given over to the new Scottish Parliament were extensive, including autonomy over health matters. Unfortunately, as the latest life expectancy figures have illustrated, the outcome has been bitterly disappointing.
There are two issues that need to be analysed in relation to this. The first is the levelling off of life expectancy since around 2013 that has been seen in many countries. The second is how Scotland’s relative position has remained unchanged in comparison to other parts of the UK and in international terms.
On the first issue, Scotland is by no means alone in seeing an end to growing life expectancy. The UK as a whole has experienced something similar, as have countries like France and Germany and the situation is notably worse in the USA. So there is a general malaise at work, which some commentators put down to rising ‘deaths of despair’ – suicide and poisoning by alcohol and drugs – which are in turn associated with slowing economies and cutbacks on benefits and public services since the 2009 financial meltdown.
While this first issue should concern us, it is the second issue where the Scottish Government, across a series of parliaments, is more culpable. In 1999, Scotland had the lowest life expectancy of any region in the UK. The latest figures show the same to be true now and the the gap has not closed.
In terms of Scotland’s experience over the Covid period, things don’t look any better. Office for National Statistics data for ‘healthy life expectancy’ (HLE) across the UK shows Scotland to have the biggest national fall in this measure, post versus pre-Covid, as well as an above UK average decline in ‘disability-free life expectancy’ (DFLE). By contrast, both Wales and Northern Ireland saw HLE rise in the same period and a fall in DFLE that was below the UK average.
In international terms, Organisation for Economic Co-operation and Development data showed that, compared to 38 other countries, Scotland had the lowest life expectancy across its member states in 2019 (ie, pre-Covid, where data should still be fairly reliable), barring only six Eastern European countries, and Colombia, Mexico, Turkey and the USA.
What’s more, Scotland’s fellow laggers have done much better in terms of catching up the longer-lived nations since 1999. While the average Scottish life expectancy rose by less than four years over these two decades, most Eastern European countries saw gains of over five years and Estonia of over eight years. Outside of the newly democratic Eastern Europe, past strugglers like Denmark, Ireland, Korea and Portugal also saw rises of between five and eight years. Scotland, as a lagging nation, should have caught up, like these other examples, as there exists more scope to improve by copying good practice elsewhere.
Only the USA went backwards compared to Scotland, a pretty damning fact, given that country’s record in terms of drug and gun deaths, along with its bare-bones social welfare system. To avoid deaths of despair requires communal support at all stages of life, which the USA is particularly poor at providing. Scotland’s problem would appear to be different, but it has also proved difficult to tackle.
What has gone wrong policy-wise since devolution? The smoking ban was positive, but has also been undertaken in most other countries. The alcohol minimum price has had an impact, but not enough. Otherwise, there has been a lack of rigour and focus; for example, both preventative and mental health measures remain firmly in the shadow of the NHS as a funding priority.
So what needs to be done to help turn this around? The Glasgow Centre for Population Health has analysed potential causes of this slowdown in life expectancy and outlined a litany of recommendations to improve matters, based around sweeping changes to the UK’s economic order and widespread spending increases by governments, all un-costed. While it is difficult to gauge the net impact of such radical changes, they remain, for now, unrealistic and ignore the underlying decline in productivity and economic growth from whence stems the lower revenues to pay for public services.
Coming at the problem from a more pragmatic angle, and focussing on non-economic issues, then clearly the NHS, and its funding, has a big role to play but it goes far beyond that. Amongst other initiatives there is a need for: much more emphasis on, and funding support for, preventative and mental health measures and staffing; greater legislation impacting on sales of alcohol, tobacco, sweet and salt-laden foods, processed foods etc; support for good practice in key institutions, like schools and hospitals; the expansion rather than contraction, as is currently happening, of sports and leisure facilities; easier access to cheap, high-quality fruit and vegetables.
Others will have equally valid suggestions. None of this works if it’s done on the cheap and results will take time to filter through, but they are at least plausible goals to set. While some may view such changes as unwarranted government interference in people’s lives, instead they might validly be characterised as government intervening where the market is failing and commercial pressures are such that bad, or ill-informed, consumer decisions are being taken.
All of this is important in terms of citizens’ health and in living a long and full life, but it is also important for the economy. Going into an era of an ageing population, early deaths and shorter ‘healthy’ life expectancies are a further weight dragging down economic and productivity growth. There is also a corporate, as well as a government, role that needs to be leveraged in. It is a tangled web indeed but continued lagging life expectancy is the biggest failing of devolution and needs to be recognised as such.
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