1. Why is mortality higher in Scotland than in England and Wales? An update of the 'Scottish Effect' work using 2011 Census data Rosalia Munoz-Arroyo Lauren Schofield

2. Bespoke Specialist Services (BSS) Income generation structure More flexible access to cost-effective bespoke specialist information

3. What Services do we offer? Consultancy Services Survey work (Patient Experience Survey, SALSUS) Staff Placements (SG, NHS Board) Contact: fiona.russell@nhs.net

5. Example of recently completed work An update of the 'Scottish Effect' work

6. Overview Results of new national analyses for 2011 (update of previous paper 1981 – 2001) ‘Scottish effect’ –By deprivation decile –By sex and age group –Specific causes

7. Excess mortality Higher mortality observed in Scotland (compared to elsewhere in the UK) over and above that explained by differences in socio- economic deprivation Also referred to as the ‘Scottish Effect’

8. Methods Directly standardised mortality rates (by age, sex and deprivation decile) for census years 1981 - 2011 Carstairs deprivation (ward/pc sector) -four standardised census variables Male unemployment, lack of car ownership, low social class and overcrowding Deprivation scores used to categorise into deprivation deciles by population

13. Specific causes Respiratory Disease Cerebrovascular Disease Ischaemic Heart Disease Malignant Neoplasms Lung Cancer Intentional self-harm and events of undetermined intent Additional causes External causes Alcohol related deaths Drug poisoning

18. Conclusions Excess increasing over time Affects all levels of deprivation, but highest among comparisons of most deprived, increasing over time Seen for many different causes of death Additional work – alternative measures of deprivation, new smaller, more comparable geography David Walsh (GCPH) and Gerry McCartney (Health Scotland) large piece of work synthesise explanations of ‘Scottish Effect’