Life expectancy, excess deaths, and lessons for Scotland

The former is often misunderstood as a prediction for how long someone born today will live.

In reality, what life expectancy does to offer a snapshot of the prevailing conditions on mortality of the time - from healthcare to deprivation - and project what longevity would be if nothing changed.

For example, someone born in the UK 100 years ago, before childhood vaccinations and free universal healthcare, would have had much better life expectancy by the age 40 than they had had at birth.

READ MORE: What can Scotland learn from Ireland's surge in life expectancy?

Until relatively recently, a steady growth in life expectancy was the norm. Between 1981 and 2011, males in Scotland added more than seven years to their life expectancy; females, more than five.

Then things stalled.

Between 2012 and 2019, male and female life expectancy at birth increased by just 146 days - or an extra three weeks per year.

Life expectancy at birth in Scotland has been slowing and is now in decline Source: National Records of Scotland (Image: ll)

In 2020, as the Covid pandemic hit, it fell sharply for both sexes for the first time - a measure largely of the thousands of lives lost to the virus, and our failure to contain it.

By 2020, life expectancy for males in Scotland - at 76.1 - was actually lower than it had been a decade earlier.

The question is what happens now?

The first thing worth noting is that the stagnation of the past decade, long before Covid hit, was not inevitable. You only have to look to the Republic of Ireland to see that.

The UK's nearest neighbour, culturally and geographically, now has the highest life expectancy in Europe for males (the UK ranks 16th; Scotland on its own 19th).

Between 2009 and 2019, Ireland added three years to male life expectancy at birth, continuing the trends of the previous 20 years (Ireland added 6.1 years to male life expectancy between 1989 and 2009). In 2020, it stayed the same.

READ MORE: More than half of Scotland's excess deaths caused by non-Covid illnesses for first time since start of pandemic

Unlike the UK, Ireland has no NHS - but it does have slightly more doctors and hospital beds per head, more CT scanners, and higher health spending, with the poorest third of the population still entitled to free healthcare.

Both countries were badly hit by the credit crunch, but their responses differed.

Ireland reduced some healthcare provision, welfare benefits for parents and young people, and eduction spending, but - as Professor Richard Layte, a sociologist and health researcher at Trinity College Dublin puts it - "none of the reductions that happened in Ireland were savage to the point where those services stopped running".

Life expectancy for males and females in Scotland is below the UK average and in line with Eastern European nations, rather than Western Europe (Source: NRS) (Image: kk)

Evidence from other nations which pursued savage austerity measures, such as Greece, show a corresponding increase in mortality.

In Scotland, the UK Government policies had a disproportionate effect because higher levels of deprivation and chronic disease here mean that a larger share of the population relies on social security and healthcare benefits.

"That leads to a population who are more risk when things do go badly," said Dr Gerry McCartney, a public health expert who has previously spoken to the Herald about the trends.

In an optimistic scenario, the fact that Covid is diminishing in its lethality thanks mainly to vaccines, antivirals and other drug treatments, might have meant that 2020's fall in life expectancy would be quickly reversed.

READ MORE: The Scottish NHS is collapsing - are doctors right to blame the SNP?

Unfortunately, a toxic combination of a crumbling NHS, cost of living emergency, and the looming threat of recession suggest that the prospects for a sudden turnaround are slim to, frankly, nil. If anything, worse is probably to come.

Losing your job, for example, is associated with a staggering 63% increase in premature mortality risk.

Meanwhile, the Office for National Statistics said this week that 18% of 50 to 65-year-olds who have left the UK workforce since the beginning of the pandemic, and not returned, are on an NHS waiting list for elective treatment.

Source: Private Healthcare Information Network (Image: Private Healthcare Information Network)

Unsurprising then that demand for private healthcare is growing - something only likely accelerate the already widening gap in life expectancy between rich and poor.

In Scotland, the number of people self-funding their own operations has climbed by 72%, from 2,850 in January to March 2019 to 4,900 in the first quarter of 2022. Only Wales and the East Midlands have seen faster growth. Hip and knee replacements, hernia repairs, and cataracts surgery top the list.

Despite Covid fading as a direct cause of death, excess mortality remains stubbornly high.

In the six months to September 25, just 41% of Scotland's excess deaths had Covid as the primary cause compared to 81% in 2021.

READ MORE: Fewer operations on NHS Scotland in 2022 than a year ago despite 'recovery' agenda

Nonetheless, excess mortality as a whole has not declined: it continues to run at 10% above the five-year average, just as it did last year (notably, statisticians compare 2022 mortality against 2016-19 plus 2021, while 2021 is compared against 2015-19; 2020 is excluded as an anomaly. However, if 2022 were compared against 2015-19 instead, excess mortality would be even higher).

The bottom line is that thousands more people are dying from all causes - 2,716 since mid-March alone - than can be considered "normal".

Since the beginning of the pandemic, the UK has recorded a total of 2,370 excess deaths per million population compared to 809 per million in Ireland (Source: Our World in Data) (Image: jj)

National Records of Scotland has said there "does not appear to be a single factor behind this increase", with their analysis showing an uptick "across a wide range of illnesses and other causes". Among them were 46 infant deaths - an increase of 12% on the five-year average.

Many hundreds will be linked to logjammed A&E departments, where it is already known that patients who spend six to eight hours waiting to be transferred to a hospital bed are more likely to die in the subsequent 30 days. In July alone, nearly 4,500 spent over 12 hours in A&E.

With warnings of a "twindemic" of Covid and flu this winter, the statistics in the short-term will only get grimmer.

In longer-term though, we should look to Ireland and ask what we can, and should, be doing differently.