Long-term Monitoring of Health Inequalities March 2023 report

Annual update of the long-term monitoring of health inequalities headline indicators.

Impact of the COVID-19 pandemic

The COVID-19 pandemic is likely to have had an impact on the recent data for most indicators included in this report. Where there has been analysis undertaken to assess the impact of the pandemic that is relevant to a specific indicator the details have been included in the corresponding chapter.

Analysis of A&E attendances by Public Health Scotland found that the number of attendances decreased to 41% of normal pre-COVID-19 levels in the week ending 29 March 2020 before increasing to around 85% of normal levels throughout August and September 2020[1]. From mid-September 2020 until the start of February 2021, A&E attendance decreased to 63% of normal pre-COVID-19 levels before increasing to 101% of normal pre-COVID-19 levels in the week ending 20 June 2021 and a similar peak was seen in late August 2021[1]. A&E attendance rates were then relatively stable between mid-October and mid-December before dropping in late December[1].

A&E attendance figures provide an indication of the wider impact COVID-19 has had across the NHS. Changes in the use of healthcare services during the pandemic could be due to a number of factors, including a real change in the need for these services, reduced availability of services or a reduced demand for services, for example due to a reluctance to burden the NHS or anxiety about risk of infection.


The report uses a combination of measures of health inequalities to give a fuller understanding of the different aspects of inequalities. These are:

  • Scale: How big is the problem? This measure describes the underlying scale of the problem, puts it into context and presents past trends at Scotland level.
  • Relative Index of Inequality (RII): How steep is the inequalities gradient? This describes the gradient of health observed across the deprivation scale, relative to the mean health of the whole population. Unless explicitly explained, the RII indicates the extent to which health outcomes are better in the least deprived areas, or worse in the most deprived areas, compared to the mean.
  • Absolute range: How big is the gap? This measure describes the absolute difference between the extremes of deprivation.

Following recommendations from the expert group, an area-based index derived from the income and employment domains of the Scottish Index of Multiple Deprivation (SIMD) is used to define deprivation. This reflects the absence of individual-level data on socio-economic circumstance.

The index is referred to as the Income and Employment Index (IEI).

These indicators and measures were recommended for long-term monitoring of deprivation-related health inequalities at Scotland level. Monitoring health inequalities due to other factors, such as age, gender and ethnicity, and indicators at a local level, may require different indicators and measures. Further information on the methods is provided in Annex 1.


Email: morag.shepherd@gov.scot

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