The health enigma: part 1 by Kenneth Roy
There is something about Scotland that I don’t understand. Just the one thing?, I hear you say. But this particular something is different. I suspect that, once you are aware of it, you won’t understand it either. No one does.
Here it is in the form of a question. Why do the Scots die younger than most other people in Europe? There are a few plausible theories out there, but, as I intend to show, none of them really adds up to a satisfactory answer. We have an unsolved mystery about our own low life expectancy.
Scotland’s wretched health is widely known and analysed, although the full horror of our situation may not be fully appreciated even now. Partly this is because we tend not to express it or think about it in terms of comparison with other countries: ie countries outside the UK.
First, then, a few examples of the national malaise:
- Scotland’s health is improving more slowly than any other country in Western Europe.
- Our record of deaths in infancy and childhood, old age too, is unremarkable. But among adults of working age, the Scottish mortality rate is exceptionally bad compared with our European neighbours.
- For cardiovascular diseases and lung cancer, Scotland has the worst death rate in all of Europe. The death rate from lung cancer among Scottish women is the worst in the world.
- There is a general trend across the world of increasing cancer survival rates. In Europe, they are particularly good if you live in Finland, France, the Netherlands and Switzerland, particularly bad if you live in Scotland and Poland.
- Across all age groups, Scottish men and women have either the worst or second worst one-to-five-year cancer survival rate in Europe.
The overall Scottish improvement in the last decade also obscures a more damaging set of comparisons – international ones – of which we hear rather less.
Had enough? Let’s look now at general life expectancy. At first glance, this presents a more encouraging picture. A decade ago, the average Scottish man died at 72.7 years; now he lives to 75.4. For the average Scottish woman, the outlook is even better: there has been an improvement in female life expectancy from 78.2 to 80.1 over the same 10-year period.
These figures do, however, obscure some well-publicised inequalities. How long you live in Scotland depends on where you live. Up here, life itself is a post-code lottery. If you are a man living in Glasgow, for example, the statistical likelihood is that you will die one month after your 71st birthday. A few miles away, in leafy Milngavie, you are likely to survive seven years longer. The Glasgow woman dies at 77; her Milngavie counterpart goes on until she is 83. These gaps between rich and poor, advantaged and disadvantaged, are rated ‘substantial’ by health experts.
The overall Scottish improvement in the last decade also obscures a more damaging set of comparisons – international ones – of which we hear rather less.
- In Western Europe, only Portugal has a lower life expectancy for men.
- Women in Scotland lead shorter lives than women in any other Western European country.
- Across both sexes, we have the lowest life expectancy in Western Europe.
- Scotland’s nearest neighbours in the league of life expectancy are Costa Rica and Cuba. Both are poorer countries, yet Cuban life expectancy is now better than Scottish.
Why is this? There is no obvious explanation. Do the Scots smoke more, eat more red meat and less fresh fruit, drink more, consume more junk food than the Cubans? Do the Cubans have a different approach to their health? I don’t know. Does anyone? But since Cubans are now living slightly longer than the Scots, it could be worth finding out. Let’s go to Havana and learn from the Cubans. It isn’t a frivolous suggestion.
It seems that the rot set in, from Scotland’s point of view, between the early 1950s and the 1970s and our comparative position has gone on declining ever since.
But here’s the really interesting bit: the source of the mystery. It was not always like this.
For much of the 20th century, men in Scotland lived as long as other men in Western Europe. In the first half of that century, for both men and women life expectancy in Scotland was actually higher than it was in France, Italy or Spain. Across the continent, we were average.
The comparison between Scotland and Finland, officially the best-educated country in Europe, is particularly striking. In 1910, life expectancy for men in Scotland was 50.1, while for men in Finland it was only 45.4. By 1930, the gap had narrowed: Scots men lived to 56, Finnish men to 52.9. By 1970, the gap between the two countries had almost closed: the average life expectancy for Scots men was 67.3, for Finns, 66.2. And then, at the turn of the century, our Scandinavian neighbours finally overtook us. Finnish men now live seven months longer, Finnish women two years three months longer.
It seems that the rot set in, from Scotland’s point of view, between the early 1950s and the 1970s and our comparative position has gone on declining ever since. Yet Finland has its own health problems: the Finns are noted for their excessive drinking and depression; Finland’s suicide rate is among the highest in the world. Why, then, have the Scots fallen behind a country over which we enjoyed so pronounced an advantage in life expectancy for so long? What are the Finns doing right – or the Scots doing wrong?
If we can’t go to Havana, let’s go to Helsinki instead.
Courtesy of Kenneth Roy – read Kenneth Roy in the Scottish Review