Has Scotland always been the ‘sick man’ of Europe? An observational study from 1855 to 2006

Abstract

Background: Scotland has been dubbed ‘the sick man of Europe’ on account of its higher mortality rates compared with other western European countries. It is not clear the length of time for which Scotland has had higher mortality rates. The root causes of the higher mortality in Scotland remain elusive. Methods: Life expectancy data from the Human Mortality Database were tabulated and graphed for a selection of wealthy, mainly European countries from around 1850 onwards. Results: Scotland had a life expectancy in the mid-range of countries included in the Human Mortality Database from the mid-19th century until around 1950. After 1950, Scottish life expectancy improved at a slower rate than in comparably wealthy nations before further faltering during the last 30 years. Scottish life expectancy now lies between that of western European and eastern European nations. The USA also displays a marked faltering in its life expectancy trend after 1981. There is an inverse association between life expectancy and the Index of Economic Freedom such that greater neoliberalism is associated with a smaller increase, or a decrease, in life expectancy. Conclusion: Life expectancy in Scotland has only been relatively low since around 1950. From 1980, life expectancy in Scotland, the USA and, to a greater extent, the former USSR displays a further relative faltering. It has been suggested that Scotland suffered disproportionately from the adoption of neoliberalism across the nations of the UK, and the evidence here both supports this suggestion and highlights other countries which may have suffered similarly.

How can socioeconomic inequalities in hospital admissions be explained? A cohort study

“…There are also no baseline risk data for physical activity or diet, or for a wider range of risk factors that may be applicable to mental health outcomes. Although the study is internally valid, there may be limited generalisability beyond this time period and the West of Scotland—both because of the higher mortality and wider health inequalities in this population than in most other populations in western Europe during this time period24–26 and because patterns of hospital use will inevitably reflect the particular healthcare system in which they occur.…”

Spatial inequalities in life expectancy within postindustrial regions of Europe: a cross-sectional observational study

“…Scotland's position as the ‘sick man’ of Europe—characterised by a slower rate of improvement in LE compared with other West European nations since the 1950s, and a consequent relative deterioration in its international position—has been discussed elsewhere 27 28. Furthermore, the within-region spatial gap in mortality was greater in Scotland than any other region of Britain 29.…”

Alcohol-related mortality in deprived UK cities: worrying trends in young women challenge recent national downward trends

“…Scotland has the highest working age mortality rate in western Europe;1 improvements in the nation's health faltered in the 1950s2 when overall life expectancy in the country increased more slowly than in other comparable European countries. The excess poor health in Scotland is in part due to greater deprivation in the city, supporting the call to reduce material and social inequalities 3.…”