3Scotland’s ageing population
61.Scotland, like much of the UK and Western Europe, has an ageing population. Compared with the UK as a whole it has a higher median age (the age where half the population is above that age and half below) and a similar proportion of people aged over 75. National Records of Scotland told us that “Scotland’s median age is currently almost two years higher than the UK” and that this “is projected to rise from 41.9 years to 45.2 years by 2039 compared with 40.0 years to 42.9 years for the UK as a whole”.70 In Scotland, the number of people aged 75 of over is predicted to rise by 85% between 2014 and 2039, while the rise for the whole of the UK is 89%. The age profile of Scotland’s population varies between council areas. This will mean that some areas will be disproportionately affected by the needs of an ageing population.
Figure 6: Population change in population over 75 over the next 25 years
Source: National Records of Scotland, ‘Population Projections for Scottish Area’, accessed 17 November 2016
62.Over the next 25 years the number of pensioners in Scotland will increase by 28%, compared with a rate of 33% in the UK as a whole. The proportion of the population who are of working age will, however, decrease relative to those who are pensioners, both in Scotland and the UK. This change will be more pronounced in Scotland. The current and predicted age structure in Scotland can be seen in the graph below.
Figure 7: Population projections for Scotland (males and females by age group)
Source: Office for National Statistics, ‘National Population Projections’, accessed 17 November 2016
Population health
63.An ageing population means that a higher proportion of people are likely to suffer from chronic health conditions which means poorer health outcomes for Scotland’s population as a whole. Alongside an ageing population, Scotland has long had a lower average life expectancy than the UK as a whole, particularly in urban areas. The Glasgow Centre for Population Health told us that “there is no sign of a narrowing of the gap in life expectancy between Scotland and the UK (which is about 2 years lower for Scottish men and 1.7 years lower for women [in 2012–14]) or between Glasgow and Scotland (4 years lower for Glaswegian men and 2.4 years for women)”.71 National Records Scotland has found that “the gap between life expectancy in Scotland and England has widened slightly over the last 30 years”.72
64.Discussing the difference in life expectancy within areas of Scotland, Professor Bell gave us the following example:
The one [example] that is used most frequently in relation to Scotland is from Jordanhill to Bridgeton in Glasgow. I have forgotten how many stops there are on that line, but over the course of it life expectancy drops by 14 years. It goes from 75.8 for males in Jordanhill to 61.9 for males in Bridgeton, and for women 83.1 down to 74.6.73
He went on to make the following comparison with London, showing similar patterns in life expectancy but with smaller differences:
I then took the Jubilee line trip that I quite frequently make from Canning Town to Westminster. In Canning Town, average life expectancy for both genders is 75, so it is about the same at is in Jordanhill, and it increases to 82 in Westminster, so you have a seven-year gap along the Jubilee line and a 14-year gap within Glasgow. There is clearly an argument that health inequalities in Scotland are as great or greater than they are anywhere else in the UK.74
Healthy life expectancy
65.A person’s healthy life expectancy (HLE) is also an important demographic measure. It is the length of time an individual can expect to live free of chronic or debilitating disease. This may change at a different rate to changes in overall life expectancy, which could in turn affect social welfare and health costs (for example if overall life expectancy rises but HLE does not). The Scottish Finance Committee’s Report on Demographic change and ageing population concluded that “HLE is key with regards to what the fiscal pressures of an ageing population will be”.75
66.According to National Records Scotland, “the most recent annual estimates for Scotland are for boys born in 2014 to live 77.4 years on average, 60.3 of these in a ‘healthy’ state. Girls born in 2014 would be expected to live 81.4 years on average, 62.6 of these years being healthy”.76 There are considerable variations in life expectancy and HLE at birth in Scotland among different geographical and socio-economic groupings. For example, when comparing the projected HLE for those born between 2009 and 2013 the male HLE at birth in the least and most deprived areas in Scotland, the figures were 71.5 and 53.4 years respectively (a difference of 18.1 years). For females, the figures were 72.9 and 56.1 years respectively (a difference of 16.7 years).
Addressing Scotland’s ageing population and population health
Growing the population
67.Both Scotland and the rest of the UK face similar challenges when it comes to an ageing population. Responsibility for health and local government in Scotland is devolved and the responsibility of the Scottish Government. As noted earlier in this report, the Scottish Government believes that the best way to deal with Scotland’s ageing population is through population growth. This, in its view, will provide both a larger tax base to pay for services and more people to carry out essential jobs. The Scottish Government has stressed the importance of population growth, stating that it is:
A key contributor to, and a consequence of, a more vibrant society and a more dynamic economy. It is also particularly vital to maintaining the sustainability of many of our rural and coastal communities. Scotland, like many countries, is projected to experience a significant demographic shift over the next few decades. […] Therefore, in order to prevent adverse impacts on Scotland’s economic growth performance it is important that we continue to attract more people of working age to Scotland and make the best use of our potential labour supply through increasing employment.77
68.Other witnesses suggested policies focused on improving health outcomes could be more useful. For example, Population Matters were of the view that:
Long term policy solutions that do not rely on increased population growth are necessary here, such as increasing the state pension age, and healthcare policies that aim to minimise the number of years that older people suffer from chronic illnesses, so they can live healthier, more productive lives.78
The Institute and Faculty of Actuaries suggested that:
Governments can influence mortality rates by their health policies and public health campaigns. Both of these can be targeted at specific parts of the population e.g. anti-smoking legislation, campaigns to reduce childhood obesity and healthy living campaigns for older people.79
69.Derek Young from Age Scotland praised the Scottish Government for having their Active and Healthy Ageing Action Plan which encourages people to manage their own health. He said that:
If you have a positive outlook, if you believe that you are valuable and valued, that greatly increases your quality of life and your self-perceived health, especially since that reflects on the healthy life expectancy statistics. You begin to see an effect there.80
Welfare System
70.There is a clear link between the poverty and deprivation in an area and the levels of life expectancy and healthy life expectancy. The Glasgow Centre for Population Health suggested a conscious effort to address these differences needed to be made. In written evidence they told us:
Clearly government priorities and funding can be vitally important in addressing poor health trajectories and reducing health inequalities. […] At a practical level, it approaches that aim to promote equal opportunity in education and employment are important, as are efforts to reduce income and wealth inequality, for example, through progressive taxation, support for a living wage, etc. A welfare system that is adequately funded and protects the most vulnerable in society is also necessary. […] Policy to address low life expectancy needs to be multifaceted, requires political will and will require effective joint-working between the UK and Scottish Governments.81
71.The Glasgow Centre for Population Health went on to emphasise the need to ensure that there were sufficient resources for deprived areas when tackling the challenges of an ageing and unhealthy population. They said that:
Taking account of demographic change alone in terms of age and ethnicity will not be sufficient in ensuring resources match need, and any distribution of resource should take account of both poverty/deprivation and need accumulated over many years.82
72.The Scottish Government has criticised the UK Government’s benefit reforms for failing to address the issue of a lower life expectancy, particularly in the most deprived areas of Scotland. The Minister for International Development and Europe told us that:
A lot of the factors that affect life expectancy are, in fact, things to do with deprivation, income and, crucially for many people in Scotland that means the reforms that were put in place to the benefit system. We do have concerns about the direction of benefit reform. I am not going to try to extrapolate from that an impact on life expectancy. I am not in a position to do that. However, I do feel that for many of the communities I have mentioned, which have the lowest life expectancy, the benefits reforms have been far from helpful.83
73.Scotland has a lower life expectancy compared with the rest of the UK and this trend is predicted to continue in the future. The UK and Scottish Governments must work together in areas of shared policy, and where they have specific UK-wide or devolved responsibilities in areas, to help improve life expectancy in Scotland.
73 Q11
74 Q11
75 Scottish Parliament, Finance Committee, 2nd Report, 2013 (Session 4): Demographic change and an ageing population, SP Paper 265, para 27
77 Scottish Government, ‘Purpose Target: Population’, accessed 18 November 2016
80 Q47
83 Q297
28 November 2016