Scottish Health Survey - topic report: UK comparisons

SUMMARY

INTRODUCTION

This report draws on data from the most recently published health surveys conducted in the four countries in the UK:

• The 2008 Scottish Health Survey ( SHeS)
• The 2008 Health Survey for England ( HSE) (2006 for the CVD data)
• The 2008 Welsh Health Survey ( WHS)
• The 2005/6 Northern Ireland Health and Social Wellbeing Survey ( NIHWS)

The report has two aims. Firstly, to update the information from previous SHeS reports about how Scotland fares relative to its nearest and largest neighbour, England. Secondly, it expands on these previous analyses by also comparing Scotland with Wales and Northern Ireland. The report looks at three broad areas: general health and wellbeing, including long-term conditions; smoking and alcohol consumption; diet, physical activity and obesity for the adult population aged 16 and over.

Responsibility for public health and NHS services is devolved to the administrations in Scotland, Wales and Northern Ireland. Health services therefore differ between the countries in many important respects. For example, policies relating to waiting times, patient choice, prescription charges, social care costs and governance arrangements all vary. However, advice on healthy living does not vary to the same extent. Uniform advice exists about sensible alcohol consumption, the recommended amount of physical activity and fruit and vegetable consumption, and the dangers of smoking.

It is therefore particularly interesting to compare the prevalence of health behaviours and outcomes in all countries in relation to the advice and recommendations in place across the UK. This summary highlights the aspects of adult health where Scotland's results were different to those in one or more of the other three countries in the UK.

GENERAL HEALTH AND WELL-BEING

Self-assessed general health was very similar in Scotland, England, and Northern Ireland. Women in Scotland were more likely to have a limiting long-term condition than women in England. Men in Wales were more likely to have a limiting long-term condition than men in Scotland. Mental health was similar in Scotland and England, but better in Scotland than in Northern Ireland for men and women. The prevalence of any cardiovascular disease ( CVD) or diabetes (combined) was higher in women in Scotland than in Northern Ireland, and was also higher in women in Scotland than in England. Other examples of cardiovascular disease were also higher among women in Scotland than in England.

Key findings:

• The prevalence of limiting long-term conditions in women was higher in Scotland (28%) than in England (25%). Men in Wales (26%) had higher rates of limiting long-term conditions than men in Scotland (23%). These differences were marginally significant.
• 12% of men and 17% of women in Scotland had a high GHQ12 score (indicating possible psychiatric disorder), the rates in Northern Ireland were significantly higher (16% for men and 21% for women). Scotland and England had similar rates of high GHQ12.
• Conversely, having a GHQ12 score of zero (indicating psychological wellbeing) was significantly more likely in Scotland (64% of men and 58% of women) than in Northern Ireland (60% of men and 51% of women).
• The difference between the rates of ischaemic heart disease ( IHD) among men in Scotland (6.9%) and Northern Ireland (8.3%) was marginally significant.
• The prevalence of any CVD condition or diabetes among women in Scotland (15.5%) was higher than the comparable rates for women in England (13.0%) or Northern Ireland (12.8%). This was also true of any CVD condition.
• IHD was also slightly higher among women in Scotland (6.2%) than in England (4.0%), as was the rate of IHD or stroke combined.

ALCOHOL CONSUMPTION AND SMOKING

Alcohol consumption and smoking rates were higher in Scotland than England for both men and women. More women in Scotland smoked than in Wales.

Key findings:

• Men in Scotland (25%) were less likely than those in England (30%) to have drunk within the Government guidelines on their heaviest drinking day in the last week. The same was true for women (21% in Scotland versus 26% in England).
• A slightly higher proportion of men in Scotland than England drank more than 4 units of alcohol on their heaviest drinking day in the last week (44% versus 41%. This difference was marginally significant.
• A significantly higher proportion of women in Scotland than England drank more than 3 units on their heaviest drinking day in the last week (36% versus 32%), or more than 6 units (18% versus 15%).
• Mean daily unit consumption was higher among men in Scotland (6.2 units) than men in England (4.3 units), the same was true for women (3.5 units versus 2.2).
• 27% of men in Scotland smoked compared with 24% in England. The equivalent figures for women were 25% and 20%. Women in Scotland were also more likely to smoke than women in Wales (25% versus 22%).
• The proportion of men who had never smoked was similar in Scotland (45%), Wales (45%) and England (44%). In contrast, it was significantly lower in Northern Ireland (38%).
• The rates of women never having smoked were 48% in both Scotland and Northern Ireland, compared with significantly higher rates in England (53%) and Wales (52%).

DIET AND OBESITY

Fruit and vegetable consumption was significantly lower in Scotland than in England for both men and women. A higher proportion of men and women were overweight including obese in Scotland than in England or Northern Ireland. A higher proportion of women were obese in Scotland than in England or Northern Ireland but there were no significant differences in the prevalence of obesity among men.

Key findings:

• Men in Scotland consumed 3.1 portions of fruit and vegetables a day compared with 3.5 in England. The corresponding figures for women were 3.4 and 3.8 portions, respectively.
• 20% of men and 24% of women in Scotland ate the recommended five or more portions a day compared with 25% of men and 29% of women in England.
• The prevalence of overweight including obesity ( BMI 25 or more) in men was significantly higher in Scotland (68.5%) than in Northern Ireland (64.1%).
• In women, overweight including obesity prevalence was significantly higher in Scotland (61.8%) than in England (56.9%) or Northern Ireland (54.0%).
• Obesity prevalence ( BMI 30 or more) in women was also significantly higher in Scotland (27.5%) than in England (24.9%) or Northern Ireland (23.5%).

CONCLUSION

This summary has drawn out the key aspects that differed between Scotland and other countries in the UK. It should also be noted that there were aspects where there were few or no differences between the countries. For example, rates of physical activity in Scotland and England were the same. In addition, where differences were found, many tended to be small. However, some of the biggest differences were found in relation to smoking, diet and alcohol consumption. This suggests that Scotland's comparably poorer health outcomes, for example its lower levels of life expectancy, can in part be attributed to factors that are amenable to interventions. Finally, as readers of the Appendix will note, although the four countries in the UK collect similar information about their populations' health status, minor differences in question wording, and some major differences in survey format, make it quite difficult to conduct a comparative study such as this on a very comprehensive scale. The health and behaviours of people in the four countries of the UK may well be more similar - or even more diverse - than this report shows.