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Scotland's People Annual Report: Results from 2014 Scottish Household Survey

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9 Health

9.1 Introduction and Context

Improving health is one of the Scottish Government's five strategic objectives:[55] Help people to sustain and improve their health, especially in disadvantaged communities, ensuring better, local and faster access to health care.

This is supported by the national outcome 'We live longer, healthier lives'. A series of national indicators and targets assess progress towards achieving these outcomes and strategic objectives. A number of these indicators are directly related to health and related risk factors. For example, the 'Reduce the percentage of adults who smoke' target was set in relation to smoking. The Scottish Household Survey (SHS) is used to monitor progress towards this target.

Although other sources of data on health in Scotland exist, such as the Scottish Health Survey (SHeS)[56], the long time-series and relatively large sample sizes available from the SHS mean that it is currently better placed than other surveys to monitor progress towards the smoking reduction target. The SHS also provides data on self-assessed health, which is used to produce estimates of healthy life expectancy as reported in the national purpose target 'To match average European population growth over the period from 2007 to 2017, supported by increased healthy life expectancy'. This chapter also includes results showing the prevalence of long-term conditions.

The section on adult smoking shows trends in cigarette smoking prevalence between 1999 and 2014 and includes patterns by age, sex and deprivation. General health measures are summarised, including analysis of the influence of factors such as housing tenure, household income and area deprivation.

Main Findings

Twenty per cent of adults were current cigarette smokers in 2014, a reduction from 23 per cent of adults in each of the three previous years and from 31 per cent in 1999.

One in three (34 per cent) adults in the 20 per cent most deprived areas in Scotland smoke cigarettes, significantly higher than 9 per cent of those in the 20 per cent least deprived areas.

More men than women smoke cigarettes (22 per cent and 19 per cent, respectively), with the gender gap widest (nine percentage points) between the ages of 25 and 34 years.

Four in ten (39 per cent) households in Scotland contain at least one person with a long-term condition.

Social rented households (58 per cent) are more likely to contain someone with a long-term condition compared to owner occupier households (35 per cent) or private rented households (22 per cent).

Three quarters of adults (74 per cent) reported being in 'good' or 'very good' general health, compared to 7 per cent in 'bad' or 'very bad' health.

People living in the 20 per cent most deprived of areas in Scotland are more likely to report their health is 'bad' or 'very bad' compared to those living elsewhere in Scotland (11 per cent compared to 5 per cent).

9.2 Smoking

In 2013, the Scottish Government's 5 year tobacco control Strategy, 'Creating a Tobacco-Free Generation'[57], set a target to reduce smoking prevalence in Scotland to 5 per cent or lower by 2034. It also set out milestones at five year intervals for smoking prevalence in Scotland and by area deprivation quintile. The strategy describes a range of measures to support young people to choose not to smoke, to protect people from second hand smoke and continue to support those who do smoke to quit. The actions taken by the Scottish Government to tackle the harm caused by tobacco include legislation to prohibit smoking in public places, which came into effect in March 2006, raising the age of sale for tobacco from 16 to 18 in 2007, implementation of a tobacco retail register in 2011, a ban on self-service sales from vending machines in 2013, and the introduction of a tobacco display ban in shops from 2013.

The Scottish Household Survey is currently the preferred source for statistics on smoking prevalence among adults in Scotland and asks whether the random adult smokes cigarettes. The Integrated Household Survey (IHS) provides a set of estimates of smoking prevalence in Scotland, Wales, England and Northern Ireland on a fully comparable basis[58].

The Scottish Health Survey, Health Survey for England, Health Survey for Northern Ireland, and the Welsh Health Survey also provide useful estimates of smoking prevalence in each UK country. Smoking prevalence statistics taken from these various sources are partially comparable.

Figure 9.1: Whether respondent smokes cigarettes by year

1999-2014, Adults (minimum base: 9,800)

Figure 9.1: Whether respondent smokes cigarettes by year

The proportion of adults who smoke cigarettes declined from 31 per cent in 1999 to 20 per cent in 2014. The decline between 2013 and 2014, from 23 per cent to 20 per cent, is the sharpest year-on-year reduction over the full time series. This follows a period between 2011 and 2013 when smoking rates were relatively stable at 23 per cent.

More men than women smoke cigarettes (22 per cent and 19 per cent respectively), with the gender gap widest (nine percentage points) for the age group 25 to 34 years. Smoking prevalence drops markedly in the older age groups. Among adults aged 60 to 74 years old, 17 per cent currently smoke, reducing to 8 per cent among those aged 75 and over (Figure 9.2).

Figure 9.3 shows how cigarette smoking rates vary by economic status. Almost half of adults who are permanently sick or disabled (48 per cent) or unemployed and seeking work (46 per cent) are current smokers.

Figure 9.2: Percentage of respondents who smoke cigarettes by age and gender

2014 data, Adults (minimum base: 340)

Figure 9.2: Percentage of respondents who smoke cigarettes by age and gender

Figure 9.3: Percentage of respondents who smoke cigarettes by economic status

2014 data, Adults (minimum base: 330)

Figure 9.3: Percentage of respondents who smoke cigarettes by economic status

Figure 9.4 illustrates the strong association between smoking prevalence and area deprivation[59]. Adults in the 15 per cent most deprived areas of Scotland are considerably more likely than those in the rest of Scotland to be current cigarette smokers (34 per cent and 18 per cent, respectively).

There is a trend of generally decreasing cigarette smoking prevalence with decreasing area deprivation. Although the pattern is broadly similar to that in previous years, prevalence has reduced in all deprivation quintiles in the last year, most notably from 39 per cent to 34 per cent in the 20 per cent most deprived areas.

Figure 9.4: Percentage of respondents who smoke by Scottish Index of Multiple Deprivation

2013-2014, Adults (minimum base: 1,450)

Figure 9.4: Percentage of respondents who smoke by Scottish Index of Multiple Deprivation

Figure 9.5 illustrates that the mean number of cigarettes smoked per day by current smokers has gradually declined from 16.0 per day in 1999 to 13.4 per day in 2014.

Figure 9.5: Average number of cigarettes smoked per day by year

1999-2014, Current smokers (minimum base: 2,090)

Figure 9.5: Average number of cigarettes smoked per day by year

Smoking causes and exacerbates a number of chronic respiratory diseases and cardio-vascular disease, and can worsen the health of people with long-term conditions such as asthma. Figure 9.6 compares the self-assessed health of non-smokers and smokers. Smokers are less likely than non-smokers to describe their health as 'good' or 'very good' (64 per cent and 77 per cent respectively) while 12 per cent of smokers say their health is 'bad' or 'very bad' compared with only 5 per cent of non-smokers.

Figure 9.6: Self-assessed general health by smoking status

2014 data, Adults (minimum base: 2,150)

Figure 9.6: Self-assessed general health by smoking status

9.3 Long-term Conditions

The SHS asks participants whether anyone in their household, including children, "has a physical or mental health condition or illness lasting or expected to last 12 months or more." The question is a subjective measure of the existence of long-term conditions and is not subject to further verification. This wording does not capture all forms of disability covered by the legal definition within the Disability Discrimination Act 2005. This represents a change to the survey question, effective from 2014 onwards, so like-for-like comparisons with figures for earlier years are not possible.

Figure 9.7 shows that four in ten households in Scotland (39 per cent) contain at least one person with a long-term condition. This covers all members of the household, including children. Households comprised of older people are more likely to contain someone with a long-term condition (59 per cent of 'single pensioner' households and 57 per cent of 'older smaller'[60] households) compared to other types of households.

Figure 9.7: Households where someone has a long-term condition by household type

2014 data, Households (minimum base: 550)

Figure 9.7: Households where someone has a long-term condition by household type

Figure 9.8 shows that approximately half of households with an income of between £6,000 and £20,000 per year include someone with a long-term condition. The proportion of households containing someone with a long-term condition then declines with increasing net income, with one in five (21 per cent) households with a net annual income of over £40,000 including someone with a long-term condition.

These findings are partly explained by the associations between age and household income. For example, eight in ten (79 per cent) single pensioner households have a net household income of between £6,001 and £20,000.

Figure 9.8: Households where someone has a long-term condition by net annual household income*

2014 data, Households (minimum base: 310)

Figure 9.8: Households where someone has a long-term condition by net annual household income

* Household income in the SHS is that of the highest income householder and their partner only. Includes all adults for whom household income is known or has been imputed. Excludes refusals/don't know responses.

Six in ten (58 per cent) social rented households contain someone with a long-term condition. This is significantly higher than the proportion of owner-occupier (35 per cent) and private rented (22 per cent) households which do so, despite a greater proportion of owner occupied households being either single pensioner or older smaller households (37 per cent of owner occupied households compared to 30 per cent of social rented households are single pensioner or older smaller households; Figure 9.9).

Figure 9.9: Households where someone in the household has a long-term condition by tenure of household

2014 data, Households (minimum base: 170)

Figure 9.9: Households where someone in the household has a long-term condition by tenure of household

9.4 Self-Assessed Health

Self-assessed health is an important measure of the overall health of people in Scotland. Poor self-reported health is a good predictor of mortality and is strongly correlated with area deprivation. Self-reported health data from the Scottish Household Survey is used in calculations of healthy life expectancy, which is reported as part of the Scottish Government's Population purpose target[61].

Three quarters of adults (74 per cent) report being in either 'good' or 'very good' general health, compared to 7 per cent who report 'bad' or 'very bad' health (Table 9.1). The proportion of adults in 'good' or 'very good' health declines with age. Around half (48 per cent) of those aged 75 and older report 'good' or 'very good' health, while 16 per cent report 'bad' or 'very bad' health.

Table 9.1: Self-perception of health by gender and age

Column percentages, 2014 data

Adults Male Female 16 to 24 25 to 34 35 to 44 45 to 59 60 to 74 75 plus All
Very Good/Good 75 74 86 86 82 73 66 48 74
Fair 19 19 12 11 14 20 25 36 19
Bad/Very Bad 6 7 1 3 5 7 9 16 7
Total 100 100 100 100 100 100 100 100 100
Base 4,440 5,350 790 1,350 1,430 2,530 2,380 1,310 9,790

One in eight adults with a net annual household income of £6,001-£15,000 report 'bad' or 'very bad' health, significantly higher than the 1 per cent of those whose income is in excess of £40,000. This association is partly explained by the association between household net income and the age profile of household members (Table 9.2).

Table 9.2: Self-perception of health by net annual household income*

Column percentages, 2014 data

Adults £0 - £6,000 £6,001 - £10,000 £10,001 - £15,000 £15,001 - £20,000 £20,001 - £25,000 £25,001 - £30,000 £30,001 - £40,000 £40,001+ All
Very Good/Good 72 61 59 66 73 80 83 89 75
Fair 21 27 28 24 21 15 14 10 19
Bad/Very Bad 7 12 13 10 6 5 4 1 6
Total 100 100 100 100 100 100 100 100 100
Base 300 1,010 1,780 1,550 1,160 920 1,190 1,610 9,520

Due to missing income information "All" figures may not match between tables

Excludes refusals/don't know responses.

Adults who live in the social rented sector are much more likely to report 'bad' or 'very bad' general health (15 per cent) compared to those in owner occupied households (4 per cent) or the private rented sector (3 per cent; Table 9.3).

Table 9.3: Self-perception of health by tenure of household

Column percentages, 2014 data

Adults Owner occupied Social rented Private rented Other All
Very Good/Good 78 58 84 64 74
Fair 17 27 13 27 19
Bad/Very Bad 4 15 3 9 7
Total 100 100 100 100 100
Base 6,040 2,400 1,180 160 9,790

Adults living in the 20 per cent most deprived of areas in Scotland are more likely to say their health is 'bad' or 'very bad' compared with those living elsewhere in Scotland (11 per cent, compared to 5 per cent).

The proportion of adults reporting 'good' or 'very good' health increases with decreasing area deprivation, from 63 per cent in the 10 per cent most deprived areas to 87 per cent in the least deprived areas. There is a corresponding decrease in the proportion reporting 'bad' or 'very bad' health, from 13 per cent in the most deprived areas to only 2 per cent in the least deprived areas (Table 9.4).

Table 9.4: Self-assessed health by Scottish Index of Multiple Deprivation (SIMD)

Column percentages, 2014 data

Adults ←10% most deprived 10% least deprived→ Scotland
1 2 3 4 5 6 7 8 9 10
Very Good/Good 63 67 64 74 73 77 79 79 82 87 74
Fair 25 23 25 19 20 18 17 17 15 10 19
Bad/Very Bad 13 10 11 7 6 6 4 4 3 2 7
Total 100 100 100 100 100 100 100 100 100 100 100
Base 1,000 920 920 1,080 1,070 1,040 1,090 1,020 880 780 9,790
Adults 20% most deprived Rest of Scotland Scotland
Very Good/Good 65 77 74
Fair 24 18 19
Bad/Very Bad 11 5 7
Total 100 100 100
Base 1,920 7,870 9,790

Smokers are less likely than non-smokers to report good health, with 64 per cent of smokers compared to 77 per cent of non-smokers describing their health as 'good' or 'very good'. This mirrors the results in Figure 9.4 and Table 9.4 which show that respondents who live in more deprived areas are increasingly likely to smoke and are less likely to report good health. Self-reported health also varies significantly by physical activity. Eight in ten (82 per cent) adults who have undertaken some physical activity in the last four weeks were in 'good' or 'very good' health, compared to only 46 per cent of those people who have undertaken no physical activity the past four weeks. One in five (21 per cent) adults who have a long-term condition reported being in 'bad' or 'very bad' health, significantly higher than only 1 per cent of those who have no long-term condition (Figure 9.10).

Figure 9.10: Self-assessed health by smoking status, long-term condition and presence and physical activity in the past four weeks

2014 data, Adults (minimum base: 2,140)

Figure 9.10: Self-assessed health by smoking status, long-term condition and presence and physical activity in the past four weeks