Scotland's People Annual report: Results from 2009 Scottish Household Survey

10 Health and Caring

Introduction and Context

Improving health is one of the Scottish Government's five strategic objectives: ⁵⁹Help 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 45 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 has been set in relation to smoking: ' Reduce the percentage of the adult population who smoke to 22% by 2010'. The Scottish Household Survey ( SHS) will be used to monitor progress towards this target.

Although other sources of data on health in Scotland exist, such as the Scottish Health Survey ( SHeS), 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 2008 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.

Smoking in Adults

Figure 10.1 shows the trend in proportion of adults saying they smoke between 1999 and 2009, with smoking among adults seeing a gradual decline from 30.7% in 1999 to 24.3% in 2009. This compares against the target of reducing the proportion smoking to 22% by 2010.

Figure 10.1: Whether respondent smokes by year

1999-2009 data, Adults (2009 base: 12,509)

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

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 that the smoking rate declined every year between 1999 and 2009, except in 2007 where there was a slight increase. The average reduction across the period is around half a percentage point each year. If this average reduction continued, the 2010 figure is likely to be around 23.5%, above the 22% target.

Analysis of the number of cigarettes smoked each day suggests that respondents tend to provide estimates based on typical cigarette pack sizes. The number of cigarettes smoked by adults in 2009 is typically between 10 and 20, with a median value of 15.

Figure 10.2 shows the proportion of men and women who smoke, along with the prevalence of smoking in different age groups. Typically, more men than women smoke (26% and 23% respectively). Younger men more commonly smoke than younger women, with the gap widest (eight percentage points) between the ages of 25 and 34 years. This relationship is reversed among those aged 60 years and up, with a higher prevalence of female smokers to male smokers ( e.g. of those aged 60 to 74, 20% of females smoke compared to 17% of males). Men smoke more, on average, smoking a median of 15 cigarettes, compared with a median of 12 a day for women, no change on the estimates from 2007/2008. Males smoking more cigarettes amongst smokers is true across all age groups.

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

2009 data, Adults (minimum base: 12,509)

Younger people more commonly smoke through 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 a little over 1 in 10 among those aged 75 or over. The average number of cigarettes peaks at a later age, with those aged 16 to 24 years smoking a median of 10 cigarettes per day, compared with 15 among those aged between 35 and 74 years, dropping to 10 again among those aged 75 years or older.

Figure 10.3 shows the variation in smoking behaviour by economic status, with those still at school least commonly smoking (3%) followed by those permanently retired from work and those in Higher or Further Education (both 16%). The adults who most commonly smoke are those unable to work due to short-term ill-health (59%) those unemployed and seeking work (51%) and those who are permanently sick or disabled (48%).

Figure 10.4 illustrates the relationship between smoking prevalence and area deprivation. ⁶⁰ 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 (41% 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. Less than one in ten adults living in the 10% least deprived areas of Scotland smoke, compared to 43% in the most deprived areas.

Figure 10.3: Percentage of respondents who smoke by economic status

2009 data, Adults (base: 12,509)

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

2009 data, Adults (base: 12,498)

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' (65% and 78% respectively) while 11% 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

2009 data, Adults (base: 12,509)

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. ⁶¹

Figure 10.6 shows that about a third of households in Scotland (32%) 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' ⁶² (52%) and 'single pensioner' households (53%) doing so compared with only 16% of small family households.

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

2009 data, Households (base: 14,190)

In Figure 10.7 around 45% 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 12%. 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 disablity by net annual household income

2009 data, Households (base: 13,671)

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 (28%) and those who rent from the private sector (19%) are less likely to contain someone with long-standing health problems or disabilities than those living in the social rented sector (51%) 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 (38%, compared with 28% of ill or disabled men). Men are more prevalent in the slightly younger group, with 22% of ill or disabled men in the 60-69 age group compared with 18% of ill or disabled women.

There is evidence of a greater concentration of males with health issues or disabilities in their youth. A total of 11% males aged less than twenty years, compared with 5% 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 disablity by tenure of household

2009 data, Households (base: 14,190)

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

2009 data, Household members with a disability and/or long-term illness (base: 5,685)

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, one in four single pensioners and one in five older smaller households have care needs. Looking across different types of household, it can be seen that over half (51%) of those households with care needs contain only one adult ⁶³ 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

2009 data, Households (base: 12,331)

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 exclusively from outside the household but for both household types there is an element of unmet need.

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

Percentages, 2009 data

Households	Single adult	Small adult	Single parent	Small family	Large family	Large adult	Older smaller	Single pensioner	All
Care provided within household (informal)	0	8	7	5	10	13	19	0	7
Care provided from outside the household (informal and formal)	12	3	5	2	2	3	6	23	8

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 21% of households with a net annual income of £20,000 or below contain someone who requires regular help, compared with around one in ten with incomes between £20,001 and £30,000, and around 5% of households with an annual income above £30,000 (Figure 10.11).

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

2009 data, Households (base: 11,950)

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 more likely to 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, 2009 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*
Care provided within household (informal)	5	4	9	11	9	8	4	2	7
Care provided from outside the household (informal and formal)	10	13	13	9	5	3	2	1	7

In Table 10.3, just one in ten owner occupiers and less than one in ten private renters have someone in the household with care needs, compared with one in four social renters.

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

Column percentages, 2009 data

Households	Owner occupied	Social rented	Private rented	Other	Total
Yes	11	25	7	14	13
No	89	75	93	86	87
Total	100	100	100	100	100
Base	8,547	2,482	1,134	168	12,331

In Table 10.4, social renters are the most prevalent household type to contain a carer providing care within the household (about one in ten). In Scotland overall, around 7% of households contain someone providing care within the home.

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

Column percentages, 2009 data

Households	Owner occupied	Social rented	Private rented	Other	Total
Yes	7	10	4	6	7
No	93	90	96	94	93
Total	100	100	100	100	100
Base	9,530	3,112	1,329	219	14,190

Looking at the provision of unpaid care by adults in Scotland, around 87% of adults don't provide any unpaid care. Table 10.5 also shows that 9.2% provide unpaid care solely outside of the household and 3.3% 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 71% of adult carers solely provide care to someone outside the household, with 25% providing care solely within the household and just 4% providing care inside and outside the household.

Table 10.5: Provision of unpaid care by adults

Column percentages, 2009 data

Adults
Don't provide unpaid care	87.1
Provide unpaid care outside the household	9.2
Provide unpaid care inside the household	3.3
Both	0.5
Total	100
Base	12,543

Self Perception of Health

In 2009 the question on self perception of health changed from asking " over the last 12 months would you say your health has on the whole been…" (good / fairly good / not good) to " how is your health in general, would you say it was…" (very good / good / fair / bad / very bad). As such, analysis from 2009 may not be directly comparable to those from previous years.

Three quarters of adults (75%) say their own health is either 'very good' or 'good', compared to 7% 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, 2009 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	84	86	81	73	65	52	75
Fair	18	19	14	12	14	19	25	35	19
Bad/Very Bad	6	7	2	3	4	8	10	13	7
Total	100	100	100	100	100	100	100	100	100
Base	5,423	7,087	1,028	1,685	2,165	3,091	2,916	1,625	12,510

There is a relationship between income and perceived health - one in which age may be a contributory factor though - with around 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, 2009 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	69	62	62	70	74	82	85	88	75
Fair	23	26	27	21	20	14	13	11	19
Bad/Very Bad	9	12	12	9	6	4	2	1	7
Total	100	100	100	100	100	100	100	100	100
Base	629	1,669	2,448	1,846	1,386	1,104	1,516	1,481	12,079

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' (14%) as compared to those from owner occupied households or the private rented sector (around 5%).

Table 10.8: Self perception of health by tenure of household

Column percentages, 2009 data

Adults	Owner occupied	Social rented	Private rented	Other	All
Very Good/Good	79	58	80	67	75
Fair	17	28	16	21	19
Bad/Very Bad	5	14	4	12	7
Total	100	100	100	100	100
Base	8,352	2,814	1,149	195	12,510

Table 10.9 also shows that people living in the 15% most deprived of areas in Scotland ⁶⁴ are around twice as likely to say their health is poor compared with those living elsewhere (12%, compared with 6%). When considering differences in perception of health by deprivation deciles (from the 10% most deprived areas to 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, 2009 data

Adults	15% most deprived	Rest of Scotland	10% most deprived									10% least deprived
			1	2	3	4	5	6	7	8	9	10	Scotland
Very Good/Good	64	77	62	68	67	72	77	77	77	80	82	85	75
Fair	24	18	25	22	23	21	18	17	18	16	15	12	19
Bad/Very Bad	12	6	13	10	10	7	5	5	5	5	3	3	7
Total	100	100	100	100	100	100	100	100	100	100	100	100	100
Base	1,787	10,712	1,181	1,223	1,289	1,308	1,365	1,334	1,458	1,208	1,111	1,022	12,499

Figure 10.12 shows that smokers are less likely than non-smokers to describe their health as good, with 5% of non-smokers describing their health as 'good' or 'very good' as against 11% 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 3% saying it was 'bad' or 'very bad'. In contrast, 15% 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 disablity and whether has done physical activity in the past four weeks

2009 data, Adults (minimum base: 2,884)

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 dissatisfied?". 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. Fifteen 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

2009 data, Adults (base: 9,018)

There are some differences in life satisfaction when looking at variables of interest such as age and gender. Females are more likely to say they are extremely satisfied with their life than males are (17% and 13% respectively). When looking at differences by age, there is evidence that those from the older age groups have more polarised views; around one in five of those aged 60 and over say they are extremely satisfied with their life, compared to at most 15% from the other age groups. At the same time, those aged 75 and over (whilst having a higher propensity of saying they are extremely satisfied) are also likely to providing a rating of five (neither satisfied nor dissatisfied).

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

Column percentages, 2009 data

Adults	Male	Female	16 to 24	25 to 34	35 to 44	45 to 59	60 to 74	75 plus	All
0 - Extremely dissatisfied	0	1	1	0	0	1	0	0	1
1	0	0	0	0	0	0	0	0	0
2	1	1	0	1	1	1	0	0	1
3	1	1	1	1	2	1	1	1	1
4	3	2	2	2	2	3	2	2	2
5	7	7	6	7	8	6	7	11	7
6	7	8	7	7	8	8	6	7	7
7	20	18	18	23	21	19	14	17	19
8	31	31	30	31	31	32	30	30	31
9	17	16	21	15	15	15	18	14	16
10 - Extremely satisfied	13	17	15	14	12	13	21	18	15
All	100	100	100	100	100	100	100	100	100
Base	3,753	4,974	707	1,149	1,530	2,228	2,013	1,100	8,727

There are other differences when you consider socio-economic issues such as economic status or level of deprivation, though nothing to any great effect. Such differences can be examined by looking at the median score provided, though the full analysis for this is not presented within this report.

Some of the key differences noted are:

• Those adults who are permanently sick or disabled provide a lower median score (seven) than other economic status groups;
• Living in the 15% most deprived areas, on average, sees median scores slightly lower (eight) than compared to the less deprived areas (nine);
• Similarly, there is evidence that those who live within social rented housing have lower median score (eight) than other tenure types; and,
• Median scores for those with either a disability, an illness or health problem or neither of these are all nine, whilst those with both a disability and an illness or health problem are lower at eight.