2. General Health, Cardiovascular Conditions, and Caring

Erin Deakin and Jack Terris

2.1     Introduction

Population measures of self-reported health have been found to be good assessments of past and future health, as well as predictors of illness recovery, declining functional ability, mortality, morbidity and/or use of health care. These measures can also reflect subjective lived experiences of diagnosed and undiagnosed physical and mental illnesses[i].

A growing proportion of the population in Scotland are living with at least one chronic health condition that necessitate health and social care provision, can affect their potential to work and which will require increasing management as people age[ii]. This increase reflects improvements related to the management of chronic conditions and an ageing population, meaning people are living for, and requiring care for, longer[iii].    

Cardiovascular disease (CVD) is a general term for conditions that affect the heart and blood vessels. Its main components are ischaemic heart disease (IHD) and stroke, both of which are well-established clinical priorities for the Scottish Government[iv],[v]. CVD often presents alongside other comorbidities including diabetes, visual impairment, chronic obstructive pulmonary disease (COPD) and asthma[vi].

Diabetes, the most prevalent metabolic disorder, is a growing health challenge for Scotland. The majority of those registered as diabetic in Scotland have Type 2 diabetes, which can be influenced by demographic factors such as an ageing population, lifestyle factors such as diet, low levels of physical activity and obesity and comorbidities including high blood pressure[vii],[viii],[ix].

It is estimated that 3 in 5 people are likely to become a carer at some point in their lives[x]. The care provided is crucial to the social care landscape in Scotland, however, unpaid caring can impact on an individual’s physical and mental health, their employment prospects, relationships and ability to take time for themselves[xi],[xii].

2.1.1     Policy background

The Heart Disease Action Plan (2021) sets out the priorities and actions Scottish Government and the National Heart Disease Task Force will take to minimise preventable heart disease and ensure equitable and timely access to diagnosis, treatment, and care for people with suspected heart disease in Scotland[xiii],[xiv]. Likewise, the 2023 Stroke Improvement Plan presents the Scottish Government’s vision for minimising preventable strokes and ensuring timely and equitable access to life-saving treatment[xv].

The Diabetes Improvement Plan[xvi] sets out priorities and commitments from 2021 to 2026 to improve the prevention, treatment and care for everyone in Scotland living with diabetes. This will be accompanied by investment of up to £8.8 million in technologies to support adults and children living with Type 1 diabetes[xvii].

The Carers (Scotland) Act 2016[xviii] took effect in 2018, extending carers’ rights to support[xix]. The Scottish Government’s commitment to unpaid carers in Scotland is reflected in the National Carers Strategy[xx] which sets out a cross-government approach to carers issues, including through social care, social security and supporting carers in employment and education through initiatives such as the Short Breaks Fund and the Carer Positive scheme[xxi].

2.1.2     Reporting on general health, cardiovascular conditions and unpaid caring in the Scottish Health Survey

In this chapter, the following data are presented:

• Self-assessed general health for adults and children
• Prevalence of and impairments due to self-reported long-term conditions for adults
• Self-reported CVD and diabetes prevalence for adults
• Insulin and insulin pump use for diabetes management for adults
• Unpaid caring prevalence and adult mental wellbeing (WEMWBS) scores by hours spent providing unpaid care per week

Figures are reported by age and sex.

For definitions of terminology used in this chapter and for further details on the data collection methods for self-assessed general health, CVD, diabetes, stroke, blood pressure,  long-term conditions and unpaid caring, please refer to the Scottish Health Survey 2024 volume 2 technical report.

Further breakdowns for long-term conditions, self-assessed general health, and caring indicators can be found in the Scottish Surveys Core Questions (SSCQ) - gov.scot (www.gov.scot), which asks harmonised questions across the three major Scottish Government household surveys.

An interactive data dashboard is also available presenting key indicators for Scotland, NHS Boards and local authority areas.

2.1.3     Comparability with other UK statistics

The Health Survey for England [xxii], Health Survey Northern Ireland[xxiii] and the National Survey for Wales[xxiv] provide estimates of adults’ general health, long-term conditions, cardiovascular conditions and unpaid caring prevalence in the other UK countries. The surveys are conducted separately and have different sampling methodologies, so general health, cardiovascular conditions and unpaid caring prevalence estimates across the surveys are only partially comparable.

The 2021 censuses for England, Wales and Northern Ireland respectively[xxv],[xxvi] collected data on self-assessed health and long-term conditions for both adults and children. The censuses were conducted separately and health estimates are only partially comparable with SHeS. The Scottish census was carried out a year after the other countries, in 2022, and this impacts comparability [xxvii].

2.2     Results

Summary points

In 2024:

• Seven in ten adults reported their general health to be 'very good/good' (70%), a proportion at the lowest end of range 70%-77% recorded since 2008.
• The prevalence of self-reported very good/good general health in adults decreased with age, from 88% among those aged 16-24 to 53% among those aged 75 and over.
• Half of all adults reported having a long-term condition (50%), the highest proportion in the timeseries. Almost two in five adults (39%) reported having a long-term condition that limited their activities.
• Over four in five adults (81%) who reported living with a long-term condition experienced at least one impairment as a result, most frequently related to mobility (32%), stamina/breathing/fatigue (28%) and/or mental health (26%).
• The proportion of adults with doctor-diagnosed diabetes rose to 8%, the highest level recorded.
• Prevalence of cardiovascular diseases, diabetes and IHDs increased with age, with highest prevalence among adults aged 75 and over (42%, 20% and 20% respectively).

In 2023/2024 combined:

• Fifteen per cent of adults reported being unpaid carers, a proportion which was higher among females (17%) compared with males (12%).
• Among those who provided unpaid care, mean WEMWBS scores ranged from 45.5 among those providing 20-34 hours of unpaid care per week to 49.4 among those providing unpaid care for up to four hours per week.

2.2.1     The prevalence of children reporting ‘very good/good’ general health has remained relatively consistent since 2008

In 2024, 70% of adults self-reported their general health to be ‘very good/good’, a proportion at the lowest end of range recorded since 2008 (70%-77%), five percentage points lower than in 2021 (75%), but not significantly different to the proportion recorded in 2022 or 2023.

While the proportion of males who self-reported their general health to be ‘very good/good’ decreased from 76% in 2023 to 72% in 2024, this proportion has shown some variation across the timeseries (ranging from 71%-77%). The proportion of females who reported being in ‘very good/good health’ in 2024 has remained unchanged since 2022, (69%) with the proportion at the lowest end of the range recorded since 2008 (69%-77%).

As in previous years, the vast majority of children were reported to have ‘very good/good’ health in 2024 (94%), a proportion that remained in the range recorded since 2008 (93%-96%).

Figure 2A, Table 2.1

2.2.2     The prevalence of self-reported ‘very good/good general health’ in adults decreased with age in 2024

As in previous years, the proportion of adults who reported their general health to be ‘very good/good’ decreased as age increased from 88% of those aged 16-24 to 53% of those aged 75 and over. Similar patterns were recorded by sex. However, males were more likely than females to indicate that their health was ‘very good/good’ particularly those aged 25-34 (84% and 75% respectively) and those aged 55-64 (67% and 59% respectively).

Figure 2B, Table 2.2

2.2.3     The prevalence of long-term conditions continued to increase in 2024

In 2024, half (50%) of adults reported living with a long-term condition, the largest proportion recorded since the timeseries began in 2003 (40%-50%).

Almost two in five adults in 2024 (39%) reported living with at least one long-term condition that limited their activities to some capacity, again the highest proportion since 2003. Across the timeseries higher proportions of females compared with males have reported living with a limiting long-term condition, a pattern that continued in 2024 (42% and 35% respectively).

Figure 2C, Table 2.3

2.2.4     Over four in five adults with a long-term condition reported experiencing one or more impairments as a result of their condition

In 2024, around four-fifths of adults (81%) who reported living with a long-term condition reported that this caused them some form of impairment, a proportion that was higher among females (83%) compared with males (78%).

The three most common impairments adults reported due to long-term conditions in 2024 were to their mobility (32%), stamina/breathing/fatigue (28%) and/or mental health (26%). No significant variations were recorded by sex.

A greater proportion of younger adults than older adults reported impairment to their mental health (38-50% of those aged 16-44 compared to 4% of those aged 75 or over). Those aged 16-34 were also more likely to report being impaired socially or behaviourally (18%-20%) compared with those aged 35 and over (1%-9%). Older adults reported higher prevalence of impairment to mobility (41%-48% of those aged 65 and over compared with 16%-18% of those aged 16-34).                         

Table 2.4

2.2.5     Eight per cent of adults reported a doctor or healthcare professional diagnosis of diabetes in 2024, the highest proportion across the timeseries

The prevalence of doctor-diagnosed diabetes rose to 8% in 2024, the highest recorded proportion in the timeseries and an overall increase from 4% in 2003.

In 2024, 16% of adults reported living with any CVD, a proportion that remained within the 14%-16% range recorded since 2003.

The prevalence of any IHD or stroke remained at 7% in 2024, within the range 7%-9% recorded since 2003.

Males were significantly more likely to report having any CVD or diabetes compared with females in 2024 (23% and 18% respectively).

Table 2.5

2.2.6     The prevalence of cardiovascular diseases, diabetes and IHD increased with age, peaking among adults aged 75 and over

As in previous years, the prevalence of any CVD among adults increased with age in 2024 from 4% among those aged 16-24 to 42% among those aged 75 and over.

The prevalence of doctor diagnosed diabetes followed a similar, although less pronounced pattern, increasing from 0%-2% of adults aged 16-44 to 20% of adults aged 75 and over. Type 2 diabetes remained the most frequently diagnosed type among all adults (7% in 2024), a proportion that rose from 0-1% among those aged 16-34 to 18% among those aged 75 and over.

In 2024, the prevalence of IHD among adults aged 75 and over (20%) was significantly higher than among adults aged 16-74 (0%-9%).

Table 2.6

2.2.7     Around a fifth of adults with diabetes managed their condition with insulin

In 2024, around a fifth (22%) of adults with diabetes managed their condition with insulin. Of these, 23% reported using an insulin pump. No significant differences were recorded by sex.

It should also be noted that low base sizes for the usage of insulin pumps mean that results should be treated with caution.                                                                                 

Table 2.7

2.2.8     Females provided more hours of unpaid care than males in 2023/2024 combined

In 2023/2024 combined, 15% of adults reported being unpaid carers, a proportion which was significantly higher among females (17%) compared with males (12%).

Around a fifth (18%) of unpaid carers reported providing care for 50 hours or more per week. This was higher among females (21%) compared with males (13%). There was also a significant difference by age, with unpaid carers aged 75 and over significantly more likely to provide care for 50 or more hours per week (39%) compared to the other age groups (5%-21%). Table 2.8

2.2.9     Mental wellbeing was lower among those providing 20-34 hours of unpaid care a week compared with those providing up to four hours

In 2023/2024 combined, mental wellbeing, recorded as mean WEMWBS scores, ranged from 45.5 among those providing 20-34 hours of unpaid care per week to 49.4 among those providing unpaid care for up to four hours per week. Differences by sex were not significant.

Figure 2D, Table 2.9

Table List

Table 2.1  Self-assessed general health, 2003 to 2024, by sex

Table 2.2  Self-assessed general health, 2024, by age and sex

Table 2.3  Prevalence of long-term conditions, 2003 to 2024, by sex

Table 2.4  Impairments due to long-term conditions, 2024, by age and sex

Table 2.5  Cardiovascular disease and diabetes prevalence, 2003 to 2024, by sex

Table 2.6  Cardiovascular disease and diabetes prevalence, 2024, by age and sex

Table 2.7  Insulin and insulin pump use for diabetes management, 2024, by sex

Table 2.8  Caring prevalence and hours spent each week providing help or unpaid care, 2023/2024 combined, by age and sex

Table 2.9  Mental wellbeing (WEMWBS mean scores) (age-standardised), 2023/2024 combined, by hours carers spent providing help or unpaid care each week and sex

References and footnotes