The cost of living crisis is on track to drive up premature mortality in Scotland by almost as much as Covid, according to a new analysis.
Modelling by researchers at Public Health Scotland and Glasgow University predicts "large, inequitable mortality increases" which will hit poorest households hardest, despite UK Government interventions such as the Energy Price Guarantee (EPG) and Cost of Living Support Payments.
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They warn that real-term reductions in income as a result of inflation "could result in population-wide premature mortality increases of up to 6.4%, and life expectancy decreases of up to 0.9%".
Rates of premature mortality - dying before the age of 75 - previously rose by 7.4% between 2019 and 2020, when the Covid pandemic was blamed.
Even after mitigations including the EPG - a government-funded discount which reduced the average dual-fuel household gas and electricity bill to £2,500 per year - and Cost of Living Support payments of £650 for households in receipt of means-tested benefits, the analysis still forecasts an 8% increase in premature mortality for people living in the most deprived fifth of areas compared to 2% for the those in the least deprived areas.
This is equivalent to an estimated 68 additional premature deaths annually for every 100,000 people under-75 in the most deprived areas, and an extra six per 100,000 in the least deprived areas
Under an unmitigated scenario where no financial support had been put in place, the modelling predicts that the fall in income would have translated into a 23% increase in premature mortality for those living in the poorest areas - an extra 192 deaths per 100,000 - and 4% (an extra 11 per 100,000) for those in the least deprived postcodes.
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Writing in the journal, BMJ Public Health, the authors said: "The targeted Cost of Living Support payments are progressive as they provide most benefit to households in the most deprived areas.
"However, they are insufficient to offset the greater falls in real incomes and potential increased mortality for these households.
"Health inequalities will widen as low-income groups bear higher health impacts for a given change in income."
Prices rose steeply during 2021 and 2022 - at the fastest rate since the 1970s - as a result of factors including restricted supplies of oil, gas, wheat and cooking oil, primarily due to the war in Ukraine, and a surge in global demand as Covid restrictions were rolled back particularly in relation to international travel.
The researchers added that the situation in the UK was also complicated by Brexit, which had "reduced the availability of labour to meet rising demand".
Poorer households spend a larger share of their income on energy and food, so their spending power was disproportionately reduced. Falls in income are also known to adversely impact on health.
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The researchers estimate that price inflation as of October 2022 - were it unmitigated by any interventions such as EPG - would have ranged from 14.9% for the least deprived households to 22.9% for the most deprived.
However, even accounting for EPG, it remained highest - at 15.7% - for the most deprived compared to 11.7% for the least deprived households.
The most recent estimate for the Consumer Price Index (CPI) puts UK inflation at 6.7% overall in the 12 months to August 2023, indicating that prices are contining to rise albeit at a slower rate.
The authors add: "The population is experiencing high price inflation rates; poorer households are experiencing the highest rates, as they spend a greater proportion of their income on energy.
"Households in the most deprived areas of Scotland would have seen the biggest relative reduction in income in real terms, but the partially targeted Cost of Living Support payments will give some protection.
"The payments partially mitigate the impacts of price increases but households in the most deprived areas will still be around £1400 (5.3%) worse off in real terms on average.
"Without the Cost of Living Support payments we estimate that income inequality would widen; the addition of Cost of Living Support reduces income inequality slightly.
"Our modelling predicts large, inequitable mortality increases.
"Even with mitigation by the EPG and Cost of Living Support payments, real-terms income reductions could result in population-wide premature mortality increases of up to 6.4%, and life expectancy decreases of up to 0.9%.
"This compares with an increase in premature mortality in Scotland of 7.4% between 2019 and 2020 – an effect that has been largely attributed to Covid-19 deaths."
The researchers acknowledge certain limitations to their modelling. For example, their price inflation estimates did not include home ownership costs - such as maintaining a property - and the comparatively higher spend on gas and electricity in Scotland compared the the UK average, meaning that this expenditure "may be an underestimate".
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