History, politics and vulnerability: explaining excess mortality in Scotland and Glasgow

Preface: Scotland experiences high levels of ‘excess’ mortality: that is, higher mortality over and above that explained by the country’s socioeconomic profile. Compared with England & Wales, and adjusting for differences in poverty and deprivation (the main causes of poor health in any society), 5,000 more people die every year in Scotland than should be the case.

This excess plays a major role in explaining why Scotland has both the lowest life expectancy, and the widest mortality inequalities, in Western Europe. Although usually expressed in statistical terms (such as standardised rates or ratios or expected years of life), behind such summary epidemiological expressions lie genuine human tragedies: individual stories of shortened, wasted lives, pain, sickness, early death and grief, affecting individual men, women and children, their families, friends and communities.

This report seeks to summarise all the research that has been undertaken into this phenomenon, with the aim of achieving a greater understanding of its most likely underlying causes and, therefore, the most appropriate responses. As the report makes clear, however, such responses need to be entwined with ever more urgent actions to address the key drivers of overall poor health in the country – poverty and deprivation – and to seek to narrow the widening gaps in income, power, wealth and, therefore, health in Scottish society.

The conclusions of the report, including a list of policy recommendations, have been endorsed by a wide range of experts in public health and other disciplines, who are listed below. Together with these signatories, we implore action on the part of both national and local government to address the many issues highlighted in this research.