Scotland's People Annual Report: Results from 2011 Scottish Household Survey

10 Health and Caring

Introduction and Context

Improving health is one of the Scottish Government's five strategic objectives:^[71] Help people to sustain and improve their health, especially in disadvantaged communities, ensuring better, local and faster access to health care.

This is supported by the national outcome: 'we live longer, healthier lives'. A series of national indicators and targets has been devised to help assess progress towards achieving these national outcomes and strategic objectives. A number of these indicators are directly related to health and health-related behaviours. For example, the following target was set in relation to smoking: 'Reduce the percentage of adults who smoke'. The Scottish Household Survey (SHS) was used to monitor progress towards this target.

Although other sources of data on health in Scotland exist, such as the Scottish Health Survey (SHeS)^[72], the long time-series and relatively large sample sizes available from the SHS mean that it is currently better placed than other surveys to monitor progress towards the smoking reduction target and to provide data on self-assessed health status to proxy healthy life expectancy. These measures are both explored in this chapter, alongside the prevalence of long-standing illness or disability in households in Scotland and arising need for regular care and support.

The section on adult smoking looks at trends in smoking prevalence between 1999 and 2011 and examines the influence of age, sex and deprivation. The health and caring experiences of men and women are examined, as well as consideration of who is providing such care. The influence of other factors such as housing tenure, household income and area deprivation is also explored. Finally, some analysis on life satisfaction is presented.

Main Findings

• Less than one quarter (23%) of adults smoked in 2011 which continues a general downwards trend in the proportion of adults who smoke. The 2011 proportion is a 7.4 percentage point reduction on 1999.
• Typically, more men than women smoke (25% and 22% respectively). Younger men more commonly smoke than younger women, with the gap widest (five percentage points) between the ages of 25 and 44 years.
• Adults in the 15% most deprived areas of Scotland are considerably more likely than those in the rest of Scotland to say that they are current smokers (40% and 21% respectively).
• A third of households in Scotland (34%) contain at least one person with a long-standing illness, health problem or disability. Owner occupier households (30%) and those who rent from the private sector (21%) are less likely to contain someone with long-standing health problems or disabilities than those living in the social rented sector (53%) or other tenure type.
• While 13 per cent of all households contain at least one person who requires regular help or care, around one in four single pensioners (23%) and one in five older smaller households (22%) have care needs.
• Just one in ten owner occupiers (10%) and less than one in ten private renters (7%) have someone in the household with care needs, compared with one in four social renters (25%).
• Three quarters of adults (75%) say their own health is either 'very good' or 'good', compared to 6% of those saying it is 'bad' or 'very bad'.
• People living in the 15% most deprived of areas in Scotland are more likely to say their health is poor compared with those living elsewhere (11%, compared with 5%).

Smoking in Adults

Legislation to prohibit smoking in public places came into effect in late March 2006. The primary intention of the legislation was to reduce the harm from environmental tobacco smoke in the general population and, in particular, among employees exposed to smoke in the course of their work (e.g. bar workers). The legislation might, as an additional consequence, have encouraged some people to give up smoking, though there is no apparent change in the overall trend through that period.

Figure 10.1 shows the trend in proportion of adults saying they smoke between 1999 and 2011, with smoking among adults seeing a gradual decline from 30.7% in 1999 to 23.3% in 2011.

Figure 10.1: Whether respondent smokes by year

1999-2011 data, Adults (2011 base: 12,886)

This question is only asked of three quarters of the sample.

Figure 10.1 shows that the smoking rate declined every year between 1999 and 2011, except in 2007 where there was a slight increase. The average reduction across the period is around half a percentage point each year.

There are apparent differences in the proportion of men and women who smoke, along with the prevalence of smoking in different age groups (Figure 10.2). Typically, more men than women smoke (25% and 22% respectively). Younger men more commonly smoke than younger women, with the gap widest (five percentage points) between the ages of 25 and 44 years. Younger people more commonly smoke though there is a pronounced drop in smoking prevalence among those aged over 60 years. Among the 60-74 year old group, the proportion smoking is down to 1 in 5, reducing to 1 in 10 among those aged 75 or over.

Figure 10.3 shows the variation in smoking behaviour by economic status, with those still at school least commonly smoking (2%) followed by those permanently retired from work (14%). The adults who most commonly smoke are those unable to work due to short-term ill-health (55%), those unemployed and seeking work (49%) and those who are permanently sick or disabled (48%). These overall patterns remain unchanged from the estimates reported from 2010.

Figure 10.2: Percentage of respondents who smoke by age and gender

2011 data, Adults (base: 12,886; minimum: 449)

Figure 10.3: Percentage of respondents who smoke by economic status

2011 data, Adults (base: 12,886; minimum: 87)

Figure 10.4 illustrates the relationship between smoking prevalence and area deprivation.^[73] Adults in the 15% most deprived areas of Scotland are considerably more likely than those in the rest of Scotland to say that they are current smokers (40% and 21% respectively). Looking across from the 10% most deprived to the 10% least deprived areas shows a trend of generally decreasing smoking prevalence rates. Around one in ten adults living in the 10% least deprived areas of Scotland smoke, compared to 40% in the most deprived areas. Comparisons to estimates from 2010 suggest smoking rates in the most deprived areas are decreasing more than those in the least deprived areas.

Figure 10.4: Percentage of respondents who smoke by Scottish Index of Multiple Deprivation

2011 data, Adults (base: 12,874; minimum: 1,074)

Figure 10.5 compares the self-assessed health status of non-smokers and smokers. Smoking causes and exacerbates a number of chronic respiratory diseases and cardio-vascular disease, and can worsen the health of people with long-term conditions such as asthma. Smokers are less likely than non-smokers to describe their health as 'good' or 'very good' (66% and 78% respectively) while 10% of smokers say their health is 'bad' or 'very bad' compared with 5% of non-smokers. The determinants of self perceived health are examined further towards the end of the chapter.

Figure 10.5: Percentage of respondents who smoke by self perception of health

2011 data, Adults (base: 12,886; minimum: 3,129)

Long-standing Illness or Disability

The SHS asks participants whether anyone in their household, including children, has: "Any long-standing illness, health problem or disability that limits your/their daily activity or the kind of work that you/they can do? By disability as opposed to ill-health, I mean a physical or mental impairment, which has a substantial and long-term adverse effect on their ability to carry out normal day to day activities."

The question is therefore a subjective measure of long-standing illness, disability and health problems and is not subject to any verification. In addition, this wording does not capture all forms of disability covered by the legal definition within the Disability Discrimination Act 2005, though this is being explored for future years of the survey.^[74]

Figure 10.6 shows that around a third of households in Scotland (34%) contain at least one person with a long-standing illness, health problem or disability. This figure covers all members of the household, including children. Households comprised of older people are more likely to contain someone with a long-standing health problem or disability, with over half of 'older smaller'^[75] (53%) and 'single pensioner' households (56%) doing so compared with only 18% of small family households.

Figure 10.6: Households where someone in the household has a long-standing illness, health problem or disability by household type

2011 data, Households (base: 14,358; minimum: 766)

In Figure 10.7 just under half of households with net annual incomes between £6,001 and £15,000 contain someone with a long-standing illness, health problem or disability. The corresponding figure for households with a net annual income of over £40,000 is 17%. These findings are partly explained by the income profile of older households, which suggest that older smaller households and single pensioner households have lower income than other households.

Figure 10.7: Households where someone in the household has a long-standing illness, health problem or disability by net annual household income

2011 data, Households (base: 13,837; minimum: 703)

Household income in the SHS is that of the highest income householder and their partner only. Includes all adults for whom household income is known or has been imputed. Excludes refusals/don't know responses.

Owner occupier households (30%) and those who rent from the private sector (21%) are less likely to contain someone with long-standing health problems or disabilities than those living in the social rented sector (53%) or other tenure types (Figure 10.8). The discussion above noted that many pensioners and single pensioners in particular have low incomes. However, although they can have lower incomes, older people are more likely to be owner occupiers than people in other age groups, so the association between disability, health status and living in the social rented sector is likely to be explained by factors other than just the age of the householders.

Figure 10.9 shows the age and gender profile of those with a long-term health issue or disability. The gender split of those with a long-term health issue or disability is 54% female and 46% male overall, with proportionately more ill or disabled women than men in the over 70 age group (37%, compared with 29% of ill or disabled men).

There is evidence of a greater concentration of males with health issues or disabilities in their youth. Around one in ten males aged less than twenty years, compared with around one in five of females are reported as having a disability or long-term illness.

Figure 10.8: Households where someone in the household has a long-standing illness, health problem or disability by tenure of household

2011 data, Households (base: 14,358; minimum: 233)

Figure 10.9: Household members with a long-standing limiting illness, health problem or disability by age and gender

2011 data, Household members with a disability and/or long-term illness (base: 31,836; min: 1,672)

Care needs within the home

This section looks at the care needs of household members in Scotland, including children's needs. Figure 10.10 shows that while 13% of all households contain at least one person who requires regular help or care, close to one in four single pensioners (23%) and older smaller households (22%) have care needs. Looking across different types of household, it can be seen that just over two-fifths (43%) of those households with care needs contain only one adult^[76] so such households are more likely to need care from outside the household.

Figure 10.10: Households containing someone who needs regular help or care by household type

2011 data, Households (base: 12,016; minimum: 766)

Table 10.1 shows how the required care is being provided, which can either be provided by someone inside the household, from a person outside the household or a combination of both. As would be expected for single adult and single pensioner households the care is provided from outside the household.

Table 10.1: Households containing someone who needs regular help or care by household type

Percentages, 2011 data

Households	Single adult	Small adult	Single parent	Small family	Large family	Large adult	Older smaller	Single pensioner	All	Base
Care provided within household (informal)	0	5	7	6	13	13	19	0	7	14,358
Care provided from outside the household (informal and formal)	10	2	4	2	3	4	8	20	7	14,358

There is also a significant pattern between needing care and household income, with the highest income households being the least likely to contain someone in need of regular care or help. Between 15% and 19% of households with a net annual income of £20,000 or less contain someone who requires regular help, compared with around one in ten with incomes more than £20,000 and just 4% of households with an annual income above £40,000 (Figure 10.11).

Figure 10.11: Households containing someone who needs regular help or care by net annual household income

2011 data, Households (base: 11,634; minimum: 487)

Household income in the SHS is that of the highest income householder and their partner only. Includes all adults for whom household income is known or has been imputed. Excludes refusals/don't know responses.

When looking at the provision of care it is of interest that for the lower income households with a net annual income of £15,000 or below, a higher percentage of households receive the required care from outside the household, whilst for net annual incomes above £15,000 care is slightly more likely to be provided within the home (Table 10.2).

Table 10.2: Households containing someone who needs regular help or care by net annual household income

Percentages, 2011 data

Households	£0 - £6,000	£6,001 - £10,000	£10,001 - £15,000	£15,001 - £20,000	£20,001 - £25,000	£25,001 - £30,000	£30,001 - £40,000	£40,001+	All	Base
Care provided within household (informal)	5	5	8	11	9	7	6	4	7	14,358
Care provided from outside the household (informal and formal)	10	12	12	9	5	3	2	2	7	14,358

Table 10.3 shows that just one in ten owner occupiers (10%) and less than one in ten private renters (7%) have someone in the household with care needs, compared with one in four social renters (25%).

Table 10.3: Households containing someone who needs regular help or care by tenure of household

Column percentages, 2011 data

Households	Owner occupied	Social rented	Private rented	Other	Total
Yes	10	25	7	19	13
No	90	75	93	81	87
Total	100	100	100	100	100
Base	8,146	2,484	1,208	178	12,016

In Table 10.4, social renters are the most prevalent household type to contain an unpaid carer providing care within the household (11%). In Scotland overall, around 7% of households contain someone providing unpaid care within the home.

Table 10.4: Households containing someone who provides regular unpaid help or care within the household by tenure of household

Column percentages, 2011 data

Households	Owner occupied	Social rented	Private rented	Other	Total
Yes	6	11	4	8	7
No	94	89	96	92	93
Total	100	100	100	100	100
Base	9,379	3,285	1,461	233	14,358

Looking at the provision of unpaid care by adults in Scotland, just over 88% of adults don't provide any unpaid care. Table 10.5 also shows that 8.5% provide unpaid care solely outside of the household and 3.0% provide unpaid care solely inside of the household. By taking those people who do not provide any unpaid care out of the analysis, it can be seen that 72% of adult carers solely provide care to someone outside the household, with 25% providing care solely within the household and just 3% providing care inside and outside the household.

Table 10.5: Provision of unpaid care by adults

Column percentages, 2011 data

Adults
Don't provide unpaid care	88.2
Provide unpaid care outside the household	8.5
Provide unpaid care inside the household	3.0
Both	0.4
Total	100
Base	12,893

Columns may not add to 100% due to rounding.

Self Perception of Health

Three quarters of adults (75%) say their own health is either 'very good' or 'good', compared to 6% of those saying it is 'bad' or 'very bad' (see Table 10.6). There is little difference in self perception of health between males and females. There are differences in health when looking at age however, with those 60 and above much more likely to say their health is in general 'bad' or 'very bad' (around one in ten adults aged 60 and over).

Table 10.6: Self perception of health by gender and age

Column percentages, 2011 data

Adults	Male	Female	16 to 24	25 to 34	35 to 44	45 to 59	60 to 74	75 plus	All
Very Good/Good	76	74	86	86	82	73	65	51	75
Fair	19	20	12	11	14	20	26	37	19
Bad/Very Bad	5	6	2	2	4	7	9	11	6
Total	100	100	100	100	100	100	100	100	100
Base	5,555	7,331	1,020	1,740	2,053	3,216	3,126	1,731	12,886

There is a relationship between income and perceived health - one in which age may be a contributory factor though - with one in ten of those with a net annual household income of £15,000 or less saying they have 'bad' or 'very bad' health compared with 2% or less where income in excess of £30,000 (Table 10.7).

Table 10.7: Self perception of health by net annual household income

Column percentages, 2011 data

Adults	£0 - £6,000	£6,001 - £10,000	£10,001 - £15,000	£15,001 - £20,000	£20,001 - £25,000	£25,001 - £30,000	£30,001 - £40,000	£40,001+	All
Very Good/Good	62	61	64	70	77	81	85	89	75
Fair	28	29	26	22	18	16	13	9	19
Bad/Very Bad	10	10	10	7	5	3	2	1	6
Total	100	100	100	100	100	100	100	100	100
Base	642	1,606	2,580	2,002	1,536	1,077	1,507	1,517	12,467

Household income in the SHS is that of the highest income householder and their partner only. Includes all adults for whom household income is known or has been imputed. Excludes refusals/don't know responses.

Looking at tenure (Table 10.8), those adults who live in the social rented sector are more likely to say their health in general has been 'bad' or 'very bad' (13%) as compared to those from owner occupied households or the private rented sector (4%).

Table 10.8: Self perception of health by tenure of household

Column percentages, 2011 data

Adults	Owner occupied	Social rented	Private rented	Other	All
Very Good/Good	80	56	81	72	75
Fair	16	31	14	21	19
Bad/Very Bad	4	13	4	7	6
Total	100	100	100	100	100
Base	8,364	3,011	1,301	210	12,886

Table 10.9 shows that people living in the 15% most deprived of areas in Scotland^[77] are more likely to say their health is poor compared with those living elsewhere (11%, compared with 5%). When considering differences in perception of health by deprivation deciles (from the 10% most deprived areas to the 10% least deprived), we see a gradual increase in the proportion saying their health is good. Around two thirds of adults living in the 30% most deprived areas in Scotland say their health is 'good' or 'very good', which compares against over four fifths for those in the 30% least deprived areas.

Table 10.9: Self perception of health by Scottish Index of Multiple Deprivation

Column percentages, 2011 data

Adults	← 10% most deprived									10% least deprived →
	1	2	3	4	5	6	7	8	9	10	Scot- land
Very Good/Good	64	64	68	73	73	77	78	82	84	84	75
Fair	25	27	23	21	20	18	18	15	13	13	19
Bad/Very Bad	11	10	9	6	7	5	4	3	3	3	6
Total	100	100	100	100	100	100	100	100	100	100	100
Base	1,200	1,213	1,316	1,441	1,433	1,390	1,207	1,421	1,179	1,074	12,874

Adults	15% most deprived	Rest of Scotland	Scotland
Very Good/Good	63	77	75
Fair	26	18	19
Bad/Very Bad	11	5	6
Total	100	100	100
Base	1,843	11,031	12,874

Figure 10.12 shows that smokers are less likely than non-smokers to describe their health as good, with 78% of non-smokers describing their health as 'good' or 'very good' as against 66% for smokers. However, it is unclear how smoking works alongside age - since older people less commonly smoke but more commonly report not having good health, while smokers tend to be younger but also tend to report less good health.

It is also evident that differences exist in self perception of health depending on whether people have undertaken any physical activity in the past four weeks. The vast majority of adults who have undertake some form of physical activity (82%) consider their health to be 'good' or 'very good', with only 2% saying it was 'bad' or 'very bad'. In contrast, 16% of those people who have undertaken no physical activity the past four weeks described their health as 'bad' or 'very bad'.

Figure 10.12: Self perception of health by smoking, illness or disability and whether has done physical activity in the past four weeks

2011 data, Adults (base: 12,886; minimum: 2,823)

Life Satisfaction

At the start of 2009, the following question on life satisfaction was introduced in to the SHS: "All things considered, how satisfied are you with your life as a whole nowadays on a scale where 0 means extremely dissatisfied and 10 means extremely satisfied?". It should be noted that the concept of life satisfaction, or happiness, refers to a cognitive sense of satisfaction with life, and does not simply refer to an absence of negative experiences.

Figure 10.13 shows that the majority of adults are generally satisfied with their life as a whole nowadays. Sixteen per cent of adults are extremely satisfied with their life, whilst the highest grouping was for those rating their level of satisfaction at eight (29%).

Figure 10.13: Satisfaction with life as a whole nowadays

2011 data, Adults (base: 9,597)

There are some differences in life satisfaction when looking at variables of interest such as age and gender. When looking at differences by age, there is some evidence that suggests those people aged between 35 and 59 having a lower a average life satisfaction score (around 8.5) compared to other age groups. In particular, the 60 to 74 age group had the highest average life satisfaction score of 8.9 which in part may reflect the relative freedom offered by retirement and not being stressed by work activities.

Table 10.10: Satisfaction with life as a whole nowadays by gender and age

Column percentages, 2011 data

Adults	Male	Female	16 to 24	25 to 34	35 to 44	45 to 59	60 to 74	75 plus	All
0-3	3	3	2	3	3	4	2	2	3
4-6	17	17	14	16	18	18	15	18	17
7-10	80	81	84	82	79	78	83	80	81
Mean	8.6	8.7	8.8	8.6	8.5	8.5	8.9	8.7	8.7
All	100	100	100	100	100	100	100	100	100
Base	8,082	10,429	1,535	2,478	3,083	4,570	4,458	2,387	18,511