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Why do Scots Die Younger?
29 May 2012
New research published in Public Health states political context may
form underlying cause
Glasgow, UK, May 29, 2012 - Life expectancy in Scotland is markedly
lower compared to other European nations and the UK as a whole. But
what are the reasons for this higher mortality? An explanatory
framework, synthesising the evidence is published this month in Public
Higher mortality in Scotland is often attributed to higher rates of
deprivation, smoking, alcohol consumption and poor diet. However such
explanations are not sufficient to understand why Scotland is so very
different compared to other areas. A group of researchers found that no
single cause was likely to explain the higher mortality, but the authors
assert, as a result of their research, that it may be attributable to a
range of factors influenced by the political direction of past decades.
In synthesising this evidence the group of researchers identified
candidate hypotheses based on a literature review and a series of
research dissemination events. Each hypothesis was described and
critically evaluated by a set of epidemiological criteria.
Hypotheses identified and tested included: artefactual explanations
(e.g. migration); 'downstream explanations' (e.g. genetics, individual
values), midstream explanations (e.g. substance misuse, family, gender
relations) and; upstream explanations (e.g. climate, inequalities,
de-industrialisation and 'political attack').
The results showed that between 1950 and 1980 Scotland started to
diverge from elsewhere in Europe and this may be linked to higher
deprivation associated with particular industrial employment patterns,
housing and urban environments, particular community and family
dynamics, and negative health behaviour cultures.
The authors suggest that from 1980 onwards the higher mortality can be
best explained by considering the political direction taken by the
government of the day, and the consequent hopelessness and community
disruption that may have been experienced. Other factors, such as
alcohol, smoking, unemployment, housing and inequality are all
important, but require an explanation as to why Scotland was
"It is increasingly recognised that it is insufficient to try to
explain health trends by simply looking at the proximal causes such as
smoking or alcohol. Income inequality, welfare policy and unemployment
do not occur by accident, but as a product of the politics pursued by
the government of the day. In this study we looked at the 'causes of the
causes' of Scotland's health problems," said Dr Gerry McCartney, lead
author of the study and consultant in public health at NHS Health
This article is "Why the Scots Die Younger: Synthesising the Evidence"
by McCartney G, Collins C, Walsh D, Batty GD; Public Health (2012)
 Life expectancy for areas in Scotland. Edinburgh: National Records
of Scotland. Available at: