Scotland's People Annual Report: Results from 2013 Scottish Household Survey: Revised October 2015

9 Health and Caring

INTRODUCTION AND CONTEXT

Improving health is one of the Scottish Government's five strategic objectives:^[86] 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 assess progress towards achieving these 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) is used to monitor progress towards this target.

Although other sources of data on health in Scotland exist, such as the Scottish Health Survey (SHeS)^[87], 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, which is used to produce estimates of healthy life expectancy. These measures are both explored in this chapter, alongside prevalence of long-standing illness and the provision of unpaid care and support.

The section on adult smoking shows trends in smoking prevalence between 1999 and 2013 and includes patterns by age, sex and deprivation. General health measures are summarised, including analysis of the influence of factors such as housing tenure, household income and area deprivation.

Main Findings

• Twenty-three per cent of adults were current smokers in 2013, in line with the proportion in the two previous years following a longer term downward trend.
• More men than women smoke (25 per cent and 22 per cent, respectively), with the gap widest (nine percentage points) between the ages of 35 and 44 years.
• Adults in the 15 per cent most deprived areas of Scotland were considerably more likely than those in the rest of Scotland to be current smokers (40 per cent and 20 per cent respectively).
• Around one third of households in Scotland (34 per cent) contained at least one person with a long-standing illness, health problem or disability.
• Social rented households were more likely to contain someone with a long-standing health problem or disability than owner occupier households (55 per cent compared to 29 per cent, respectively) or private rented households (20 per cent).
• Three quarters of adults (74 per cent) reported that their own health is either 'very good' or 'good', compared to 7 per cent saying their health is either 'bad' or 'very bad'.
• People living in the 15 per cent most deprived of areas in Scotland were more likely to say their health is ‘bad’ or ‘very bad’ compared to those living elsewhere (14 per cent, compared with 6 per cent).

SMOKING

In 2013, the Scottish Government’s 5 year tobacco control strategy, Creating a Tobacco-Free Generation^[88] set a target to reduce smoking prevalence in Scotland to less than 5 per cent by 2034. The Strategy sets out a range of measures to support young people to choose not to smoke, to protect people from second hand smoke and continue to support those who do smoke to quit. The actions taken by the Scottish Government to tackle the harm caused by tobacco include legislation to prohibit smoking in public places which came into effect in March 2006, raising the age of sale for tobacco from 16 to 18 in 2007, implementation of a tobacco retail register in 2011, a ban on self-service sales from vending machines in 2013, and the introduction of a tobacco display ban in shops from 2013.

The Scottish Household Survey is currently the preferred source for statistics on smoking prevalence among adults in Scotland. The Integrated Household Survey (IHS) provides a set of estimates of smoking prevalence in Scotland, Wales, England and Northern Ireland on a fully comparable basis.^[89]

Additionally, the Scottish Health Survey, Health Survey for England, Health Survey for Northern Ireland, and the Welsh Health Survey provide useful estimates of smoking prevalence in each UK country. The surveys are run separately with different sampling methodologies. Smoking prevalence statistics taken from these various sources are partially comparable.

Figure 9.1: Whether respondent smokes, by year

1999-2013, Adults (2013 base: 9,920)

As shown in Figure 9.1, the smoking has rate declined from 30.7 per cent of adults in 1999 to 23.1 per cent in 2013. The rate has remained at around 23 per cent each year since 2011.

More men than women reported being current smokers (25 per cent and 22 per cent respectively), with the gap widest (nine percentage points) between the ages of 35 and 44 years. Smoking prevalence drops markedly in the older age groups (older than 60 years). Among the 60-74 year old group, the proportion smoking is 19 per cent, reducing to 8 per cent among those aged 75 or over. (Figure 9.2)

Figure 9.3 shows the variation in smoking behaviour by economic status. Smoking prevalence is highest among those who are unemployed and seeking work (55 per cent), those who are unable to work due to short-term ill-health (47 per cent) and those who are permanently sick or disabled (46 per cent).

Figure 9.2: Percentage of respondents who smoke, by age and gender

2013 data, Adults (base: 4,450; minimum: 380)

Figure 9.3: Percentage of respondents who smoke, by economic status

2013 data, Adults (base: 9,920; minimum: 70)

Figure 9.4 illustrates the relationship between smoking prevalence and area deprivation^[90]. Adults in the 15 per cent most deprived areas of Scotland were considerably more likely than those in the rest of Scotland to say that they are current smokers (40 per cent and 20 per cent, respectively). Looking across from the 20 per cent most deprived to the 20 per cent least deprived areas shows a trend of generally decreasing smoking prevalence. Although the pattern is broadly similar to that in previous years, prevalence in the 20 per cent most deprived areas appears to have increased slightly from its lowest rate (36 per cent) in 2012 to 39 per cent in 2013.

Figure 9.4: Percentage of respondents who smoke, by Scottish Index of Multiple Deprivation (SIMD) 15 per cent most deprived and quintiles

2013 data, Adults (base: 9,920; minimum: 850)

Figure 9.5 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 were less likely than non-smokers to describe their health as 'good' or ‘very good’ (64 per cent and 77 per cent, respectively) while 12 per cent of smokers said their health is ’bad’ or ‘very bad’ compared with 6 per cent of non-smokers. The determinants of self perceived health are examined further towards the end of the chapter.

Figure 9.5: Percentage of respondents who smoke, by self-perception of health

2013 data, Adults (base: 9,920; minimum: 2,370)

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 verification. This wording does not capture all forms of disability covered by the legal definition within the Disability Discrimination Act 2005.

Figure 9.6 shows that around a third of households in Scotland (34 per cent) contained 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 were more likely to contain someone with a long-standing health problem or disability, with around half of 'single pensioner' (54 per cent) and 'older smaller'^[91] (50 per cent) households doing so, compared to 17 per cent of small family households.

Figure 9.6: Households where someone in the household has a long-standing illness, health problem or disability, by household type

2013 data, Households (base: 10,650; minimum: 590)

Figure 9.7 shows that the proportion of households which contain someone with a long-standing illness, health problem or disability decreases as the net annual household income (of the highest income householder and their spouse or partner) increases. More than two-fifths (45 per cent) of households with an income of £20,000 or less have 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 15 per cent. These findings are partly explained by the income profile of older households, which shows that older smaller households and single pensioner households have lower income than other households.

Figure 9.7: Households where someone in the household has a long-standing illness, health problem or disability, by net annual household income

2013 data, Households (base: 10,320; minimum: 320)

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.

Social rented households (55 per cent) are more likely to contain someone with a long-standing health problem or disability than owner occupier households (29 per cent) and private rented households (20 per cent) (Figure 9.8). The proportion of social rented households containing someone with a long-standing health problem or disability is significantly higher than the proportion of owner occupied households which do, even though proportionately more owner occupied households are either single pensioner or older smaller households (36% of owner occupied households compared to 31% of social rented households are single pensioner or older smaller households). Figure 9.9 shows the age and gender profile of those people with a long-standing illness, health problem or disability. Overall, 18 per cent of males have a long-standing illness, health problem or disability compared to 20 per cent of females. There is some evidence of a greater concentration of males with long-standing illnesses, health problems or disabilities in their youth, with a slightly higher proportion of males than females aged below thirty reported as having a long-standing illness, health problem or disability.

Figure 9.8: Households where someone in the household has a long-standing illness, health problem or disability, by tenure of household

2013 data, Households (base: 10,650; minimum: 220)

Figure 9.9: Household members with a long-standing limiting illness, health problem or disability, by age within gender

2013 data, Household members with a disability and/or long-term illness (base: 23,480; min: 11,430)

CARE PROVISION

This section looks at whether household members in Scotland look after or give any regular help or support to other family members, friends, neighbours or others because of either long-term physical, mental ill-health or disability, or problems related to old age.

Following work comparing results on unpaid caring prevalence with those in the Scottish Health Survey and Scottish Crime and Justice Survey, the survey question has been changed from April 2014. The Scottish Health Survey is currently the preferred source for statistics on overall prevalence of unpaid caring in Scotland.

Table 9.1 shows the proportion of households, by tenure of household, which contain an unpaid carer. Social rented households (15 per cent) or owner occupied (13 per cent) households were more likely to contain an unpaid carer than private rented (7 per cent) or other (8 per cent) households.

Table 9.1: Households containing someone who provides regular unpaid help or care to others, by tenure of household

Column percentages, 2013 data

Households	Owner occupied	Social rented	Private rented	Other	All
Yes	13	15	7	8	12
No	87	85	93	92	88
Total	100	100	100	100	100
Base	6,730	2,440	1,270	220	10,650

SELF ASSESSED HEALTH

Self-reported health is an important measure of the overall health of people in Scotland. Poor self-reported health is a good predictor of mortality, and is strongly correlated with area deprivation. Self-reported health data from the Scottish Household Survey is used in calculations of healthy life expectancy, which is reported as part of the Scottish Government’s Population purpose target.^[92]

Just under three quarters of adults (74 per cent) of adults said their own health is either ‘very good’ or 'good', compared to 7 per cent of those saying it is ‘bad’ or ‘very bad’ (see Table 9.2). The proportion of adults who report ‘good’ or ‘very good’ health declines with age, with those 60 and above much more likely to say their health is in general ‘bad’ or ‘very bad’ (around one in eight adults aged 60 and over).

Table 9.2: Self perception of health, by gender and age

Column percentages, 2013 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	73	87	85	81	73	63	52	74
Fair	17	19	11	12	14	19	26	33	18
Bad/Very Bad	7	8	2	4	5	9	11	15	7
Total	100	100	100	100	100	100	100	100	100
Base	4,450	5,470	830	1,350	1,450	2,590	2,400	1,300	9,920

There is a relationship between income and perceived health - one in which age may be a contributory factor - with one in eight (12 per cent) of those with a net annual household income of £20,000 or less saying they have ‘bad’ or ‘very bad’ health compared with 2 per cent of those whose income is in excess of £30,000. (Table 9.3).

Table 9.3: Self perception of health, by net annual household income

Column percentages, 2013 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	64	60	63	66	72	79	84	88	75
Fair	24	25	25	24	19	16	13	11	18
Bad/Very Bad	12	15	12	10	9	5	3	1	7
Total	100	100	100	100	100	100	100	100	100
Base	300	1,010	1,860	1,530	1,180	910	1,250	1,580	9,620

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.

Those adults who live in the social rented sector were more likely to say their health in general is ‘bad’ or ‘very bad’ (17 per cent) as compared to those in owner occupied households (4 per cent) or the private rented sector (5 per cent). (Table 9.4)

Table 9.4: Self perception of health, by tenure of household

Column percentages, 2013 data

Adults	Owner occupied	Social rented	Private rented	Other	All
Very Good/Good	79	57	82	64	74
Fair	17	25	14	18	18
Bad/Very Bad	4	17	5	18	7
Total	100	100	100	100	100
Base	6,250	2,300	1,160	210	9,920

Table 9.5 shows that people living in the 15 per cent most deprived of areas in Scotland^[93] were more likely to say their health is ‘bad’ or ‘very bad’, compared with those living elsewhere (14 per cent, compared with 6 per cent). When considering differences in perception of health by deprivation deciles (from the 10 per cent most deprived areas to the 10 per cent least deprived), we see a gradual increase in the proportion saying their health is good or very good, from 64 per cent in the most deprived areas to 84 per cent in the least deprived areas. There is a corresponding decrease in the proportion who report bad or very bad health by deprivation decile, from 14 per cent in the most deprived areas to only 2 per cent in the least deprived areas.

Table 9.5: Self perception of health, by Scottish Index of Multiple Deprivation (SIMD) deciles

Column percentages, 2013 data

Adults	←10% most deprived									10% least deprived→	Scotland
	1	2	3	4	5	6	7	8	9	10
Very Good/Good	64	66	69	68	73	75	79	82	83	84	74
Fair	22	23	21	23	21	18	15	14	13	14	18
Bad/Very Bad	14	11	10	9	7	6	6	4	5	2	7
Total	100	100	100	100	100	100	100	100	100	100	100
Base	980	920	910	1,110	1,120	1,030	1,100	1,000	910	850	9,920

Adults	15% most deprived	Rest of Scotland	Scotland
Very Good/Good	63	76	74
Fair	23	18	18
Bad/Very Bad	14	6	7
Total	100	100	100
Base	1,450	8,470	9,920

Figure 9.10 shows that smokers were less likely than non-smokers to report good general health, with 77 per cent of non-smokers describing their health as ‘good’ or ‘very good’ compared to 64 per cent of smokers. 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 undertaken some form of physical activity (82 per cent) consider their health to be ‘good’ or ‘very good’, with only 3 per cent saying it was ‘bad’ or ‘very bad’. In contrast, 23 per cent of those people who have undertaken no physical activity the past four weeks described their health as ‘bad’ or ‘very bad’.

Figure 9.10: Self perception of health, by smoking, illness or disability and whether has done physical activity in the past four weeks

2013 data, Adults (base: 9,920; minimum: 2,370)