What's happened to life expectancy in Scotland - and why?

For more than a century, life expectancy at birth - not just in Scotland, but UK wide - has steadily, at times rapidly, improved. The constant upward march seemed to be a given.

Between 1915 and 2015, average UK life expectancy surged from 52 to nearly 81 years.

READ MORE: Cost of living crisis predicted to cause Covid-level surge in premature mortality

There was only one notable dip - coinciding with the First World War and the Spanish flu pandemic around 1918 - but everything from routine childhood vaccinations against previously deadly diseases such as measles and polio to the advent of the NHS, the welfare state, improved nutrition, better housing and sanitation, and advances in medical science translated into ever-increasing longevity.

Life expectancy at birth UK, 1765-2015 (Image: Statista)

Then something began to change.

The NRS report summed up the trend in Scotland, stating that - having increased fairly continuously from the early 1980s to the early 2010s - in 2012-2014 "the trend changed and life expectancy stopped increasing and began to plateau".

To put that into some context, between 2000-2002 and 2012-2014 (the NRS use the average of a three-year period to track long-term trends), male life expectancy was growing by around 16 weeks per year and by 10 weeks per year for females.

After rising continually for decades, life expectancy in Scotland plateaued before beginning to fall over the past three years (Image: NRS)

Between 2012-2014 and 2017-2019, life expectancy stalled completely for both men and women at 77.1 and 81.1 years respectively. Not one single week was gained, for either sex, over that five year period.

Then Covid arrived, swiftly followed by the worst cost of living crisis since the 1970s, and the downward spiral began: as of 2020-2022, male life expectancy has fallen by around 31 weeks while females have lost nearly 21 weeks.

At this point, it is worth clarifying exactly what we mean by "life expectancy". Although it tends to be couched in terms of "to what age a baby born today could be expected to live", that misunderstands it.

READ MORE: Deaths in Scotland are on the rise - so what's the cause? 

Life expectancy provides a snapshot of mortality rates at a particular point in time and then imagines what would happen if those circumstances remained fixed throughout a person's life.

This is highly unlikely, however, given changes - for better or worse - in medicine, science, legislation, the economy, environment and so on.

In reality, then, life expectancy tells us what is happening to population health now - not when you're going to die.

So how do we explain the recent and, in historic terms, highly unusual decline?

Mortality rates in Scotland increased sharply during the first Covid wave in Spring 2020 and again during winter of 2020/21 as a more transmissible strain began to spread just as the vaccine rollout began (Image: NRS)

It is undoubtedly true that the both the Covid pandemic and more recent spiralling levels of inflations have been major contributors.

Between 2019 and 2020, the rate of premature mortality in Scotland - the number of people dying before the age of 75 per 100,000 people in that age band - rose by 7.4%.

A sudden increase in people dying at a younger age inevitably translates into a shortening of life expectancy.

The biggest driver behind that year-on-year change was, of course, Covid - a novel disease which swept the globe and claimed millions of lives until vaccines were able to put the brakes on its lethality if not its transmission; the virus has been more prevalent than ever over the past 18 months but the case-fatality ratio has massively reduced.

Next came the cost of living crisis, which is predicted to have nearly as big an impact on premature mortality as Covid did.

According to modelling published this week by researchers from Public Health Scotland and Glasgow University, the real-terms fall in income caused by inflation will result in a 6.4% increase in Scotland's premature mortality rate despite government-funded mitigations such as the Energy Price Guarantee and £650 Cost of Living Support payments for the poorest households.

Increasing mortality from alcohol and drug misuse over the past decade will also have fed into Scotland's declining life expectancy.

All of this, of course, also came hot on the heels of a decade of austerity-driven public spending cuts triggered by the credit crunch.

Predicted impact of inflation on premature mortality in Scotland by deprivation level, adjusting for Govt-funded mitigations (Image: BMJ Public Health)

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

This might give the impression that the squeeze in life expectancy has been the victim of worldwide pressures beyond our control: a viral pandemic, the 2008 economic downturn, surging inflation as the war in Ukraine reduced supplies of gas, wheat and cooking oil at the same time as a rollback on Covid restrictions increased demand for international travel.

But Scotland only needs to look to Republic of Ireland to see that the situation could be quite different.

Figures published in August reveal that life expectancy in Ireland continued to grow in 2022 as it has done nearly every year since 1995.

Life expectancy for men in Ireland is the highest in the EU at 80.8 years - a gain of almost three years since 2008. Women have added two years to their life expectancy over the same period.

There is no single explanation, but one factor - summed up by Professor Richard Layte, a sociologist and health researcher at Trinity College Dublin, in an interview with the Herald back in 2020 - is that public spending cuts in Ireland post-credit crunch were much less "savage" than in other parts of Europe "where whole areas of public health and social welfare were just cut off".

How well both countries' healthcare systems are recovering from Covid is another factor.

In Scotland, roughly one in every 36 people are waiting for an inpatient or day case procedure on the NHS compared to one in 60 in Ireland, while the number who have been waiting over 18 months is 7,703 in Ireland versus 17,201 in Scotland.

Given that both countries had similarly strict lockdowns, this speaks more to differentials in healthcare staffing and resources, demographics (15% of people in Ireland are over 65 versus 20% in Scotland), and wider public health factors such as comparatively higher levels of deprivation and chronic disease which left Scotland (and the UK) badly exposed when Covid struck.

If we want to arrest the decline in life expectancy, tackling inequality is the best place to start.