The Scottish Health Survey 2024 - volume 1: main report

Introduction

Victoria Wilson

Policy Context

As a study of public health, the Scottish Health Survey (SHeS) plays an important role in assessing health outcomes, health risks and the extent of health inequalities in Scotland and how these have changed over time. While some positive changes have been recorded, Scotland continues to record a significantly lower life expectancy compared to other countries in the UK and Western Europe, as well as continued disparity in health outcomes between those living in the most and least deprived areas[i]. Improving the health and wellbeing of Scotland’s population continues to be a key challenge at both the local and national level.

In June 2025, the Scottish Government published the Population Health Framework which sets out what more can be done to mitigate against the social and economic drivers of ill health and health inequalities to build a Scotland that positively supports health and wellbeing. The Framework is based on five key interconnected prevention drivers of health and wellbeing:

• Prevention Focused System
• Social and Economic Factors
• Places and Communities
• Enabling Healthy Living
• Equitable Access to Health and Care

The National Performance Framework (NPF)[ii] contains eleven National Outcomes that link with several of the United Nation’s Sustainable Development Goals[iii], including several health outcomes. Underpinning the outcome focused exclusively on health - ‘we are healthy and active’ - are a number of National Indicators. SHeS is used to monitor progress towards indicators relating to mental wellbeing, healthy weight, health risk behaviours, physical activity, child wellbeing and happiness, and food insecurity.

Following the latest statutory review of the National Outcomes, and the subsequent Scottish Parliament inquiry, the Scottish Government has committed to a period of reform of the National Performance Framework. The current 11 National Outcomes are still in operation as is the duty (Community Empowerment Act) on public bodies ‘to have regard’ to them. The National Outcomes and Indicators will not be updated until the reform project has concluded.

New topics on menopause and eating behaviours and feelings related to food that could be indicative of a possible eating disorder were included in the survey in 2024. Menopause refers to the time when menstrual periods stop due to loss of hormones produced by the ovaries, with around 400,000 individuals in Scotland of menopausal age[iv]. The impact of (peri)menopause can extend beyond the individual, affecting work, relationships, family life and social interactions[v]. The Women’s Health Plan[vi] outlines the Scottish Government’s commitment to improving health outcomes and services for all individuals who menstruate/ have menstruated and is accompanied by initiatives including specialist menopause services in all health boards, NHS resources, practitioner guidance and an NHS menstrual health policy[vii],[viii],[ix]. 

Eating disorders can have a significant impact on an individual’s physical health and/or their ability to function fully in day-to-day life, as well as their mental wellbeing and that of others around them[x],[xi]. The National Specification for the Care and Treatment of Eating Disorders in Scotland, published in November 2024, is a response to the 2021 National Review of Eating Disorder Services. It aims to address two key areas of focus – consistency and clarification of responsibilities in service provision, setting out a baseline of service provision that is person-centred, safe and effective, reducing and preventing gaps in care provision with clear protocols and a service structure that fulfils these values[xi].

The SHeS series

SHeS has been carried out annually since 2008 and prior to this was carried out in 1995[xii], 1998, and 2003. Due to disruption to the survey at the onset of the pandemic, the survey data collected in 2020 was published as experimental statistics and was not comparable with the time series[xiii].  This data has not been included in the survey trends.  

Commissioned by the Scottish Government Health Directorates, the SHeS series aims to provide regular information on aspects of the public’s health and factors related to health which cannot be obtained from other sources. The SHeS series was designed to:

• estimate the prevalence of health conditions in Scotland
• estimate the prevalence of certain risk factors associated with these health conditions and to document the pattern of related health behaviours
• look at differences between regions and subgroups of the population in the extent of their having these particular health conditions or risk factors, and to make comparisons with other official statistics for Scotland and England
• monitor trends in the population's health over time
• make a major contribution to monitoring progress towards health targets

Each survey in the SHeS series includes modules of questions on health conditions and health risk factors together with height and weight measurements and, for a proportion of households measurement of blood pressure and waist circumference and a saliva sample. Some question modules vary from year to year. Each year the main sample is augmented by an additional boosted sample for children.

The 2024 survey was undertaken by the Scottish Centre for Social Research (ScotCen), who worked in collaboration with the MRC Epidemiology Unit at the University of Cambridge on the collection, analysis and reporting of the Intake24 data.

The 2024 survey

Interviews for all sample types for the 2024 survey were undertaken using a primarily in-home face-to-face approach with a telephone contingency for respondents who were not willing to have an interviewer in-home. The Community Health Index (CHI) was again used to identify households with children for the child boost, significantly improving the sample efficiency and response.

Further details on the fieldwork approach can be found in Chapter 1 of the Scottish Health Survey 2024 - volume 2: technical report.

The SHeS series now has trend data going back over two decades and providing time series data remains an important function of the survey. The impact of COVID-19 restrictions means that caution should be applied when comparing the 2021 survey data, which were collected via a telephone approach, with other SHeS surveys. Further details on the fieldwork approach in 2021 and information on the differences between the 2021 survey data and previous years can be found in the Scottish Health Survey 2021- volume 2: technical report.

Topics

Cardiovascular disease (CVD) and related risk factors remains the principal focus of the survey. The main components of CVD are ischaemic heart disease (or coronary heart disease) and stroke, both of which remain clinical priorities for the NHS in Scotland[xiv],[xv], particularly in light of the impact of the COVID-19 pandemic. CVD is one of the leading causes of death in Scotland. A key risk factor for CVD is hypertension (high blood pressure) where the additional pressure on the blood vessels, the heart and other organs can lead to chronic or even life-threatening conditions[xvi].

Many of the key behavioural risk factors for CVD are in themselves of particular interest to health policy makers, public health professionals and the NHS; poor diet, obesity, lack of physical activity, smoking and levels of alcohol consumption are all the subject of specific strategies targeted at improving Scotland’s health. SHeS includes detailed measures of all these factors which are reported on separately in Chapters 6-10. The other five chapters focus on health conditions and experiences which have the potential to influence health outcomes - Mental Health and Wellbeing (Chapter 1), General Health, Cardiovascular Disease and Caring (Chapter 2), Perimenopause and Menopause (Chapter 3), Respiratory Conditions (Chapter 4) and Dental Health (Chapter 5).

Sample

SHeS is designed to yield a representative sample of the general population living in private households in Scotland every year.

The survey design also means that estimates at NHS Health Board level and Local Authority level are available, usually by combining four consecutive years of data. NHS Health Board and Local Authority estimates based on the 2021, 2022, 2023 and 2024 surveys combined have been published within the survey dashboard at the same time as this report.

Those living in institutions, who are likely to be older and, on average, in poorer health than those in private households, were outwith the scope of the survey. This should be borne in mind when interpreting the survey findings.

A total of 8,931 addresses in the main sample (main sample version A and main sample version B) were issued for the whole of the 2024 fieldwork period. A total of 2,288 CHI-linked Child Boost addresses were also issued for this period.

Fieldwork

For the main sample, all adults aged 16 and over in responding households were eligible for interview. To ease respondent burden, for child interviews for both the main and the child boost samples a maximum of two children were interviewed at each household. If a household contained more than two children, then two were randomly selected for interview.

Data collection involved a main computer assisted personal (CAPI) or telephone (CATI) interview, and paper self-completion questionnaire.

No height and weight measurements or biological measures could be taken for interviews conducted by telephone. For these interviews, participants were therefore asked to estimate their own height and weight during the interview.

The key differences between the main version A and version B interviews were a slightly longer interview for version A to cover the rotating modules (those not asked every year) and a slightly longer self-completion for version B to cover the depression, anxiety, self-harm and attempted suicide questions and additional bio measurements (blood pressure, waist circumference and saliva samples).

Adults aged 16 and over were also invited during the interview to complete dietary recalls via the dietary recall system Intake24 (https://intake24.co.uk/). Participants were asked to provide verbal consent, which was recorded in CAPI and were given a leaflet with some key information about Intake24 included. Those who agreed were invited to complete two dietary recalls, either independently or via a phone call with ScotCen’s telephone unit.

More information on fieldwork is available in the Scottish Health Survey 2024 - volume 2: technical report.

Survey response

In 2024, across all sample types, interviews were held in 3,737 households with 4,591 adults (aged 16 and over) and 1,986 children (aged 0-15). The number of participating households and interviews in 2024 is presented separately for the main and child boost samples in the tables below. Further details on survey response in 2024 are presented in the Scottish Health Survey 2024 - volume 2: technical report.

When considering the household response rate, households classed as “responding” were those where at least one eligible person opted-in/consented to interview and was interviewed.

It should be noted that fieldwork challenges encountered during 2024 fieldwork impacted on sample coverage. As a result, 2% of addresses were not allocated to an interviewer due to capacity issues with bio trained interviewers and an additional 4% of addresses were allocated but not worked.

Main sample

Participating households	3,001
Eligible households responding	37.0%
Eligible households responding of worked addresses	40.7%
Adult interviews	4,591
Child interviews (main sample only)	830

Child boost CHI-screened sample

Participating households	736
Eligible households responding	44.6%
Eligible households responding of worked addresses	44.8%
Child interviews (child boost sample only)	1,156

Ethical Approval

Ethical approval for the 2024 survey was obtained from the REC for Wales committee (reference number 17/WA/0371).

Data Analysis

Weighting

Since addresses and individuals did not all have equal chances of selection, the data had to be weighted for analysis. The address selection weights were calculated to compensate for unequal probabilities of selection of addresses in different survey strata. Additional weights have been created for use on combined datasets and the Intake24 data. A detailed description of the weights is available in the Scottish Health Survey 2024 - volume 2: technical report.

Weighted and unweighted data and bases in report tables

All data in the report are weighted. For each table in the report both weighted and unweighted bases are presented. Unweighted bases indicate the number of participants involved. Weighted bases indicate the relative sizes of sample elements after weighting has been applied.

Standard analysis variables

As in all previous SHeS reports, data for males and females are presented separately where possible. Many of the measures are also reported for the whole adult or child population. Survey variables are tabulated by age groups and in some cases by Scottish Index of Multiple Deprivation (SIMD) or other variables such as mental wellbeing.

Statistical information

SHeS 2024 used a partially clustered, stratified multi-stage sample design. In addition, weights were applied when obtaining survey estimates. One of the effects of using the complex design and weighting is that standard errors for survey estimates are generally higher than the standard errors that would be derived from an unweighted simple random sample of the same size. Confidence intervals are shown in the data tables and on the survey dashboard, with comments on statistical significance throughout the report having taken the clustering, stratification and weighting into account. Full details of the sample design and weighting are given in the Scottish Health Survey 2024 - volume 2: technical report.

Presentation of trend data

In this report, trends based on the seventeen surveys from 2003 onwards are presented for all adults aged 16 and over. Prior to this the survey eligibility criteria were set at a maximum age of 64 in 1995 and then a maximum age of 74 in 1998. Unless specified otherwise, trends for children are based on the 2-15 years age group from 1998 onwards, and 0-15 years from 2003 onwards.

Presentation of results

Commentary in the report highlights differences that are statistically significant at the 95% confidence level. Statistical significance is not intended to imply substantive importance. A summary of all findings is presented at the beginning of this report and topic-specific summaries can be found within each chapter. Each chapter includes a brief overview of the relevant policy area. These overviews should be considered alongside the higher-level policies noted above and related policy initiatives covered in other chapters. A description of the methods and key definitions are detailed in Chapter 2 of the Scottish Health Survey 2024 - volume 2: technical report. A link to the tables showing the results discussed in the text can be found at the Scottish Health Survey website.

Availability of further data and analysis

As with surveys from previous years, a copy of the SHeS 2024 data will be deposited at the UK Data Archive along with copies of the combined datasets for 2022/2024, 2022/2023/2024, 2023/2024 and 2021/2022/2023/2024. The survey dashboard, providing analysis by sex, age, area deprivation, equivalised income, long-term conditions, urban/rural and local areas for a large range of measures is also available.

Further breakdowns for smoking, long-term conditions, general health, and caring indicators can be found in the Scottish Survey Core Questions, which asks harmonised questions across the three major Scottish Government household surveys.

Comparability with other UK statistics

Guidance on the comparability of statistics across the UK is included in the introductory section of individual chapters.