Podcast series from the MRC/CSO Social and Public Health Sciences Unit, University of Glasgow.
Anna Pearce:
Hello and welcome to this special edition of 15 Minutes on Health Inequalities, which we're recording as part of European Public Health Week. I'm Anna Pearce from the MRC/CSO Social and Public Health Sciences Unit at the University of Glasgow, and today I'm going to be chatting with colleagues about a piece of work that we recently carried out. Pulling together trends in drug deaths and related social factors in Scotland. So this builds on reports that our institutions carried out a couple of years ago as part of the Health Foundation's independent review of health inequalities in Scotland. So just to introduce my colleagues with us today...
Denise Brown:
Hi. My name is Denise Brown and I'm also a researcher at the MRC/CSO Social and Public Health Sciences Unit at the University of Glasgow.
Anna Pearce:
And we also have...
Emma Congreve:
Hi, I'm Emma Congreve. I'm an economist at the Fraser of Allander Institute, based at the University of Strathclyde.
Anna Pearce:
Great, thanks both. Really good to have you here today. So one of the key messages from the original University of Glasgow report, which was documenting trends in health inequalities over the past 20 years, was that young to middle-aged men are faring especially badly in Scotland. So for example, they're most likely to die early, to die from drug related deaths and to not attend medical appointments, and this was especially the case if they lived in the most deprived areas. So this was very much a group that we had identified for further research. So Emma, do you want to mention the relevant findings that you'd found in your sort of, I guess we call them a sister report, didn't we?
Emma Congreve:
Yeah. So we did a a report looking at the last 20 years of socioeconomic trends in Scotland and we didn't look at men, in particular in a lot of detail, but there were some findings that came out that looking across different topics, such as earnings and and participation in the labour market, where employment rates for young men had noticeably sort of got worse relative to the rest of the population over that time and also some, you know, looking at some of the education and educational attainment that there were some trends coming through there in terms of differences in terms of outcomes for men, well, young men compared to young women. So it very much felt like there was more to look at for this particular group, particularly when we see the the outcomes that happen later on in people's lives. And there's the really troubling statistics on drug deaths so that made us as a team want to do a little bit more to think about maybe going a bit further back in time as well. So we went back to the 60s and started to try and think about what's happened over that whole time, what are the intersections that have happened in the socioeconomic sense and how can we see maybe that coming across into these poor health outcomes that we're seeing as young men get towards their late 30s and 40s.
Anna Pearce:
And so, Denise, you previously published the related work as well, looking at causes of death among young men in Scotland. And actually we'd drawn upon this work in our original report. And so that was feeding into to our key messages around to young men. Do you wanna say a bit more about what you you found in that piece of work?
Denise Brown:
Yeah. So that analysis specifically focused on deaths from drugs, alcohol and suicide of young males aged 15 to 44 years old. And we saw that suicides nearly doubled between 1980 and 2000 and were at the time the dominant cause of death from around 1985 to 2012. Drug deaths increased rapidly from around 1992 and in 2013 overtook suicide as a single leading cause of mortality for this age group.
Emma Congreve:
So Denise, in this new piece of work we wanted to look into this a bit more and we were, we've tried to to sort of chunk up the population into birth cohorts and different age groups. So are you able to say a little bit more about what we found in the new analysis and through looking through that lens?
Denise Brown:
So if we make for the latest analysis, we examine drug deaths of males and females in Scotland aged 15 years and older. For males, rates of drug deaths in Scotland were fairly steady during the 1980s and increased rapidly throughout the 90s and 2000s, reaching what is hopefully their peak in 2020. The increases in rates during the 90s and early 2000s were driven by deaths of younger males, but they're now mainly driven by deaths of 35- to 54-year-olds. Rates of drug deaths generally are much lower for females. They're currently around half that of males. Rates for females remained fairly steady throughout the 80s and 90s and early 2000 and didn't start to rise until around 2011. And again, the increase in deaths in females were mainly driven by 35- to 54-year-olds. So today, for both males and females, we've observed drug deaths to be highest overall for those born in the 1970s and aged in their 40s. Emma, can you describe some of the main socioeconomic trends you examined and how these linked to the trends in drug deaths over the same period?
Emma Congreve:
Yeah. So we obviously know quite a lot about different factors that have happened as a result of the deindustrialization in Scotland over that period of time we've been looking at. And obviously a lot of focus about what happened to, you know, the workforce as we went through those periods in the 80s and 90s. So we were really keen to investigate you know what, what cohorts that was affecting when you were looking at how it came through into people's incomes through earnings and also other factors to do with support from the state, from Social Security spending and also a really important aspect of of peoples living standards comes from how much they're needing to spend on housing. It's a big significant cost and it's something we always tend to look at when we're we're thinking about incomes and low income households for example. We wanted to have a look at some data that we pieced together from the early 60s to the present day. And so this is data that we don't think has been brought together in this way for Scotland before. It utilises data that's been available for a long time. Firstly from survey of of household expenditure and then following that from the households below average income data set that comes from the Family Resources Survey. So we've pieced together as best we can a time series over that whole period. And we've looked specifically at single adults within that data. So we're not able to do too much more around characteristics. So we've looked, we've looked at both men and women within that, but these single adults, particularly as they are emerging out of childhood and adolescence into the sort of the, the real world and getting that kind of financial independence, we thought that would be a really interesting age group to look at - so in their sort of early 20s. Then seeing what was going on at that time of their lives in the socioeconomic statistics. And we were keen to see what overlap there was in terms of groups and who are most affected by drug poisonings later on. So what we found was that after the process of deindustrialization, people who were sort of emerging into the workforce in the 90s, the late 80s and the 90s, were those that were entering the workforce where there were, you know fewer of those relatively well-paid skilled jobs around. So we were finding in the data that whilst from up until around the 80s and 90s earnings for single adults were usually above the average for the population. That started to change after that period and we've now got to the point where average incomes for single adults are well below the average for the population. And so there's been a total shift there in income. This is relative income so relative to other parts of the population. So absolute incomes may have increased in line with inflation, sometimes above inflation. But when you look at it compared to other people in society, be their family, families with children or pensioners, then single adults, particularly in those younger age groups, feel to have lost out a bit, a bit as well. So actually bringing it all together in our conclusions, we found that it was cohorts that were again, similar to what Denise says, it's cohorts born in the 1970s are those that seem to have been most affected by that shift in relative incomes. And when they entered adulthood in the early 1990s, this was a time when income for single adults had dropped significantly compared to previous cohorts and relative to the rest of the population.
Anna Pearce:
Thanks Emma. So I'm going to take us back to the the drug deaths again and thinking about those trends. One of the really striking things for Scotland is just how much higher they are in comparison to the other UK countries. So we didn't do a formal comparison of this for the drug deaths analysis, but there is some work out there already been done. Can you sort of briefly describe that, Denise?
Denise Brown:
Yeah so as you explained, our analysis was based on Scottish deaths only, but there has been previous work comparing drug related mortality across Scotland, England and Wales. Work by David Walsh and colleagues and in 20/21 showed similar trends as Scotland's as we have described here, but they also showed rates of drug deaths to be higher in Scotland than in England for both males and females and interestingly their work showed that rates for females in Scotland were higher than for males in England and that this has been the case since around 2011 when drug deaths started to rise more sharply for Scottish females.
Anna Pearce:
Yeah and I think that's the kind of gender cross country comparison is an interesting one. You know, we've highlighted young to middle-aged men as being a a worrying group in terms of drug deaths, which of course they are, but we don't want to lose sight of the fact that drug deaths are also incredibly high for women in Scotland as well, particularly comparing to the other countries. So I think we are all in agreement that with this work, you know there's been more questions than answers arising from it, which is, you know, had always been our intention. It's very much hypothesis building and Emma as lead on this piece of work, do you wanna say a bit more about that? Or whether there's anything that you plan to look at in the future?
Emma Congreve:
Yeah, there's clearly lots that feel they've opened up in terms of possibilities for future research. I mean, one thing we could do more on with the income data is to do some more comparisons ourselves with the rest of the UK. And we started to do a little bit of that, but and it does seem to be some interesting things going on and differences compared to Scotland and the rest of the UK for that cohort but it's one of those things that will take time and a bit a bit more resources to really sort of unpick. But I mean like the key thing that came out of this is that we've done some new and quite exciting descriptive analysis. But what we really want to be able to do is to draw causal links between the socioeconomic data and the health data to actually understand if we're observing maybe similar cohorts, particularly there's these cohorts born in the 1970s facing sort of socioeconomic difficulties in their early 20s relative to earlier cohorts. And then facing really poor health outcomes in terms of drug poisonings later on in their life compared to previous cohorts. But yeah is that...is one causing the other? Or is it just a bit of a coincidence? And whilst you know we can formulate hypothesis on that, we need to do quite a lot of further work to find ways to test that causally.
Anna Pearce:
Thanks. So in all of these podcasts, we like to think about the implications of the work for health inequalities, so that has been a bit of a theme throughout this conversation. But Emma, would you like to say anything else on this?
Emma Congreve:
Well, it's been a great project for us. Firstly the first independent review by the Health Foundation and this work we've done since in working across different disciplines. So I come from an economic and very you know very used to analysing socioeconomic data. But often feel a bit kind of unsure about how then to talk about health data with that same kind of level of expertise and confidence. So being able to to think about better ways to bridge that gap, so to collaborate with experts on both sides is something that I think we can only benefit from in Scotland. So I'm hoping that, yeah, there'll be more like this to come in future.
Anna Pearce:
Yeah, same. We've really, really enjoyed this collaboration with you and found it valuable having insights with such a sort of mixed set of expertise. So I think you've said a lot really Emma already in terms of speaking to what this means for health inequalities, but I suppose I would just sort of reiterate that drug deaths make a really big contribution to the large inequalities and premature deaths and life expectancy that we see in Scotland and as Denise has explained for us already, that has been getting worse over the last past few decades. So this sort of piece of work that we've been speaking to today points to some of the upstream factors described by Emma that could be behind these trends. And so it highlights areas of future research and next steps and doing some more interesting causal analysis around this. So I think that's us out of time now. So I'd like to thank you both, Denise and Emma, for this really interesting conversation. And thanks to everybody listening. Please look to the podcast notes where you can find: more information on all of us, links to the report that we've been discussing today, the other publications that have been mentioned around that. And thanks again.