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In Scotland we aim to increase life expectancy by 5 years in the next 10 years and decrease health inequalities.
These ambitions are bold. If life expectancy trends continue, Scotland will fall further behind the rest of Western Europe. Although premature mortality continues to fall, the trajectory of our improvement is currently more modest than that being achieved by other countries. And despite all efforts, health inequalities continue to grow. The gap between the rich and the poor is widening, with the richest 20% now living 10 years longer than the poorest 20% in Scotland.
A fresh approach: health creation
Albert Einstein defined insanity as ‘doing the same thing over and over again and expecting a different result.’
The excess mortality in Scotland requires something new to be done. It may partly stem from the social breakdown and loss of jobs when heavy industry (dominated by shipbuilding, coal mining and steel) declined, particularly in West Central Scotland in the latter half of the 20th century. Those affected were given housing and benefit, and remained predominantly in the region. Although the collapse of heavy industry happened in other countries in Europe, for example, Katowice in Poland, alternative suitable work was found and the sense of control, and community that goes with purpose and employment was preserved. The net result is that Scotland's excess mortality when compared with the rest of Europe can be partly attributed to causes such as violence, drug misuse, alcohol excess and suicide. Interestingly, similar patterns of excess mortality have been noticed in other population groups …
Contributors The article was conceived by AM. The main manuscript and metadata were drafted, revised and edited by both HB and AM.
Competing interests: None.
Provenance and peer review Commissioned; internally peer reviewed.