1. Is there a Scottish effect for self-reported health? Frank Popham, University of Edinburgh 12th November 2007 Talk based on paper published in BMC Public Health http://www.biomedcentral.com/content/pdf/1471- 2458-6-191.pdf http://www.biomedcentral.com/content/pdf/1471- 2458-6-191.pdf

2. Source: Life expectancy at birth by health and local authorities in the United Kingdom: http://www.statistics.gov.uk/statbase/Product.asp?vlnk=8841 http://www.statistics.gov.uk/statbase/Product.asp?vlnk=8841 Life expectancy at birth: Scotland and England

3. Scottish effect? (1) What is the Scottish effect? –Higher risk of mortality in Scotland compared to England and Wales that is no longer explained by differences in deprivation Carstairs and Morris using data from the early 1980s found the difference between countries was explained by differences in deprivation Hanlon and colleagues repeated the above work using data from the early 1990s and 2000s and found that Scotlands higher mortality could no longer be explained by deprivation

4. Scottish effect? (2) Mitchell and colleagues extended such work using individual level data and focussed on Scotlands higher level of heart disease using 1998 Scottish and English Health Surveys They found that differences in prevalence between Scotland and England could not be explained by traditional risk factors (social class, employment, health behaviours and physical and mental health) Psychosocial interpretations of the Scottish effect have entered Scottish academic and policy discourse. For example Scotlands lack of confidence. Little evidence for this.

5. Self reports of health Self reports of health are a simple yet effective way of measuring population health Evidence from 2001 Census of higher rates of limiting illness and poor general health in Scotland compared to England So, is there a Scottish effect for self reports of health or can differences be explained by socio-economic differences? Self reported health strongly associated with employment and socio-economic position

6. Sample (1) 3% individual SARs from 2001 UK Census –1.85 million people (768,885 in sample) Living in Scotland or England People born in Scotland or England Aged 25 to 64 –Excluded full time students Two measures of self reported health –Longstanding limiting illness –General health (poor = not good)

7. Sample (2) Socio-economic variables –Employment (employed, unemployed (but active), economically inactive) –Housing tenure (owned outright, owned with mortgage, private rent, social rent) –Living or not in deprived household (defined as overcrowded / not self contained or lacking amenities) –Car access (none, one, two and three or more)

8. Country differences

9. Odds ratios for poor general health (age and sex adjusted)

10. Odds ratios for poor general health (plus employment / socio-economic adjusted)

11. Odds ratios for limiting illness (age and sex adjusted)

12. Odds ratios for limiting illness (plus employment / socio-economic adjusted)

13. Employment (1) In analysis stratified by employment a higher likelihood of poor general health and limiting illness for Scots born in Scotland (compared to English born in England) was only seen for the economically inactive True for both men and women

14. Employment (2) Diversion from unemployment to economic inactivity? Scotland's enormous number of incapacity claimants should really be interpreted as the legacy of twenty years of de-industrialisation and job destruction (Fothergill S: Scotland's incapacity benefit claimants Glasgow: Scottish Enterprise; 2006.)

15. Economic inactive men

16. Economic inactive women

17. Conclusions Working age people born and living in Scotland on average report poorer health than their English counterparts This is probably due to differences in employment and socio-economic position between the two countries Evidence suggests it is unlikely that there is a Scottish effect for self reports of health –Further work using Scottish (SLS) and English (LS) longitudinal studies planned Wide within country variations in health

18. Acknowledgements Richard Mitchell This work is based on the SARs provided through the Centre for Census and Survey Research of the University of Manchester with the support of ESRC and JISC. SARs data are Crown copyright.

19. Another SARs publication Popham F, Walker JJ, Mitchell R. Could using general health and longstanding limiting illness as a joint health outcome add to understanding in social inequalities research? J Public Health 2007;29:208-10. http://jpubhealth.oxfordjournals.org/cgi/content/full/ 29/2/208