Scotland's Population Health Framework: Equality Impact Assessment

Key Findings

The development of the Framework has been informed by evidence, provided through our evidence narrative discussing the current state of the health of our population and through vital insights provided by our stakeholders and partners throughout the extensive engagement process in 2024.

To support this, an initial scoping of the key health inequalities facing each demographic group has been carried out.

Age

Age plays a significant role in shaping health and social outcomes in Scotland. In 2024, data from Growing Up in Scotland revealed that mothers in the most deprived areas were nearly twice as likely to report poor health during pregnancy compared to those in the least deprived areas.^[2] Children born in these areas also faced increased risks of low birth weight and were more likely to have required care in neonatal units. Obesity remains a concern across all age groups, with 17% of children at risk of obesity and 30% considered overweight or obese — a pattern that has stayed consistent since 1998.^[3]

Environmental factors compound these issues. Children in deprived areas are nearly five times more likely to be exposed to alcohol outlets within a 500-metre radius of their home.^[4] Poverty affects all age groups, with 24% of children, 20% of working-age adults, and 15% of pensioners living in relative poverty after housing costs between 2021 and 2024.^[5]

Mental health issues also vary across age groups. In 2023, 10% of adults reported feeling lonely most or all of the time, a rate that peaked among 16–24-year-olds and those in the most deprived areas.^[6] Younger adults also showed the poorest mental wellbeing scores. Food insecurity was highest in younger adults, with 20% of those aged 16–44 worrying about running out of food, compared to just 5% of older adults. Similarly, older households experienced the highest rates of fuel poverty in 2023, with 37% affected.^[7]

Older adults were more likely to consume alcohol at hazardous or harmful levels, particularly men aged 65–74. Drug use and vaping, however, were more common among younger adults. E-cigarette use was highest among those aged 16–24 and lowest in the 75+ age group. While 57% of 16–24-year-olds were within a healthy weight range, the adult average was only 33%.^[8] Self-reported health status declined with age, with 85% of young adults rating their health as very good or good, compared to only 55% of those over 75. Chronic conditions such as cardiovascular disease and COPD were markedly more prevalent in older age groups.

Scotland’s unpaid carers reflect a wide age distribution. In 2023–24, 58% of carers were working-age adults, 26% were aged 65+, and 16% were under 18. Young carers were more likely to live in deprived areas and reported high levels of stress and inadequate support from schools or colleges. Suicide rates were highest among those aged 25–64, highlighting a critical public health concern among mid-life adults.^[9]

Sex

Sex-based disparities are evident across Scotland’s health and social data. Women make up 51.4% of the population, and 43% report living with a long-term condition or disability that limits daily activities. Although women tend to live longer than men, they also spend more years in poor health. In 2021–2022, anxiety symptoms were most common among young women aged 16–24, affecting 33% of this group, compared to 13% of young men.

The labour market reflects persistent sex based inequalities. Women are significantly more likely than men to work part-time — 39.1% compared to 13.2%. ^[10]A growing area of concern is the economic impact of menopause, with around 60,000 UK women out of work due to symptoms, contributing to an estimated £1.5 billion loss to the economy each year.^[11]

Health behaviours also vary by sex. Men are more likely than women to drink at hazardous levels, use drugs, and smoke. In 2023, 28% of men drank at harmful levels compared to 14% of women. Similarly, 18% of men reported drug use, while only 11% of women did.^[12] Men are more physically active on average, with 68% meeting national guidelines compared to 59% of women. Among children, physical activity among girls tends to decline sharply during adolescence.^[13]

Women are disproportionately impacted by caring responsibilities. In 2023–24, 73% of all carers were female, and 80% of working-age carers were women. ^[14]Women are also more likely to be victims of domestic abuse, with 83% of incidents involving a female victim and male perpetrator.^[15] Additionally, suicide remains significantly more common among men, who are 3.2 times more likely than women to die by suicide. ^[16]

Gender Reassignment

Transgender and non-binary individuals in Scotland face substantial health and social inequalities. Discrimination and negative experiences with healthcare providers are prevalent. Over half of non-binary people reported that their GP did not understand their needs, and 40% of trans people described negative or harmful encounters in medical settings, including being ignored or subjected to inappropriate questions. ^[17]These barriers often lead to avoidance of essential healthcare.

Economic insecurity is also common. More than half of trans people said they had to choose between transition-related expenses and basic needs like food and heating. Mental health concerns are acute in this population: 66% of trans youth reported suicidal thoughts — nearly double the rate of their cisgender peers.^[18]

Sexual Orientation

LGBT+ individuals in Scotland are at greater risk of poverty and poor mental health. From 2020 to 2023, 25% of non-heterosexual adults lived in poverty, compared to 19% of heterosexual adults.^[19] Loneliness and mental health issues are more prevalent, with half of LGBT youth in 2023 reporting suicidal ideation and 43% saying they had self-harmed.^[20] These disparities underscore the need for inclusive mental health and social services that reflect the unique experiences of LGBT+ communities.

Race

Racial inequalities persist across many areas of Scottish society. Minority ethnic people are more likely to live in poverty and in deprived neighbourhoods. Black and minority ethnic people are 60% more likely to live in the most deprived parts of Scotland than their white counterparts.^[21] Between 2018 and 2023, children in minority ethnic families were almost twice as likely to experience poverty compared to the national average. ^[22]Despite often achieving higher levels of educational attainment, minority ethnic adults face discrimination in employment, receive lower pay, and are more likely to work irregular hours or be underemployed.^[23]

Mental health outcomes for minority ethnic groups are under-researched, but available data suggests that some groups are at increased risk of poor mental health and have less access to culturally appropriate support services.^[24]

Religion or Belief

Religious affiliation correlates with varying levels of poverty in Scotland. Between 2018 and 2023, Muslims experienced the highest poverty rate after housing costs, at 61%, compared to 16% among members of the Church of Scotland and 18% of those with no religion.^[25] Discrimination and harassment based on religion were also reported, particularly among individuals identifying with minority religions.^[26] These experiences can affect health, employment opportunities, and access to services.

Marriage and Civil Partnership

Marital status impacts household income and poverty risk. Between 2020 and 2023, single adults and those who were divorced or separated had significantly higher poverty rates — 30% and 28%, respectively — compared to 15% of married individuals. ^[27]Cohabiting and widowed adults also experienced higher levels of economic insecurity. These differences highlight the protective economic effects of marriage and the vulnerabilities faced by single-person households.

Disability

Disabled people in Scotland face widespread barriers in housing, safety, health, and employment. Despite significant need, only 1% of homes are fully wheelchair accessible, and tens of thousands of people are waiting for vital home adaptations.^[28] Disabled individuals are also more likely to experience crime and feel unsafe in their neighbourhoods. Children with disabilities often have fewer friendships and more behavioural challenges than their peers.^[29]

Disabled people are less likely to meet physical activity guidelines and report poorer mental wellbeing. In 2021, adults with long-term conditions had significantly lower wellbeing scores and were more likely to experience anxiety and depression. They also face higher levels of poverty, food insecurity, and unemployment. Children and adults with learning disabilities suffer from poorer health outcomes and shorter life expectancy, with a higher proportion of their deaths considered avoidable.

Pregnancy and Maternity

Pregnancy can intensify financial hardship and is linked to worsening health outcomes for mothers in deprived areas.^[30] For some households, the arrival of a baby pushes them into poverty.^[31] Domestic abuse is another serious issue, with one in three pregnant women reporting some form of abuse, and pregnancy often cited as a trigger or worsening factor in abusive relationships. These intersecting challenges contribute to significant health inequalities during a critical period in family life.^[32]