Medical care

“Everyone has the right to a standard of living adequate for the health and well being of himself and his family, including food, clothing, housing, medical care and the necessary social services”1 This essay will consider the extent to which the Health service has been successful in modifying social inequalities in Scottish society. In doing so it is also essential to compare and contrast contemporary Scottish society with historical Scotland.

For this reason the changing trends and continuing patterns, which have materialized within Scottish society, will be examined. Moreover this essay will argue that whilst there have been vast improvements in the overall health of the Scottish people, Scotland still lags behind the rest of Britain and indeed, as will be shown, most of the Western world. In addition, this paper will examine the extent to which these health disparities are caused by a social divide rather than a geographical one.

Throughout the literature there is much evidence to support the fact that Scotland has remained a poorer and less healthy society than England during the course of the twentieth century.2 In the past Scotland’s National Health Service budget per head has been considerably higher than that of England and Wales. Yet despite the greater expenditure on healthcare and resources, the Scottish people’s historical health records are extremely poor in comparison to South of the border, with their English counterparts experiencing far healthier and longer lives.

At present, as Scotland now enters into the opening stages of the twenty-first century it is becoming apparent that this impoverished unhealthy trend is not exclusive to the previous century, but also very much a feature of the current one.3 The continuation of the poverty gap between England and Scotland is partly due to the cruel cycle which poverty creates. For once a nation or indeed an individual enters into this vicious spiral of deprivation escapism is severely limited.

In general terms however, over the past two decades the health of the Scottish people has improved immensely, with Scottish men and women now living on average approximately 25 years longer than previous generations.5 In addition mortality rates caused by contagious diseases have drastically decreased. Furthermore, there continues to be a reduction in premature death rates caused by Scotland’s two biggest killer diseases – cancer and coronary heart disease.6 However, these overall advancements mask the broadening health inequalities between the Scottish social classes and rich and poor areas in its society.

The cultural attitudes and unhealthy lifestyles of many Scots play a critical role in relation to the health of the Scottish nation. A huge contributing factor in the past to poor health was the unhealthy lifestyles that many Scottish people were living.8 Yet despite the increased awareness of health issues and promotion of physical fitness, this harmful trend appears to be continuing within Scottish society. The statistics for Scotland are extremely depressing when compared to other industrialised countries.9 Tobacco smoking in Scotland claims the lives of approximately 13,000 men and women in Scotland every year.

The number of adults smoking in Scotland continues to be far higher than in England and Wales and many other industrialised countries. Studies carried out by the Scottish Household survey found that 28% or just over a quarter of Scottish adults were smokers.10 Comparisons drawn along social class lines reveal that smokers are disproportionately found at the lower end of the spectrum. Less than 25% of men and women where found to be smokers in social classes I and II, this compared with social classes IV and V where it was shown that approximately 50% of both males and females smoked, a figure more than double that of the higher classes.

Moreover the vast majority of these smokers were disproportionately concentrated in deprived inner city urban areas. There have been more positive research findings whereby Scottish smoking rates have decreased from 50% in 1974 to 31% in 1991. However, smoking has been and remains to be one of Scotland’s major public health problems and presents the greatest challenge to the Health Service. In addition, lack of exercise, the over consumption of alcohol and poor diet all remain to be central characteristics of Scottish society. The drinking culture in Scotland is a huge causal factor in Scotland’s disturbingly poor health statistics.

The extremely poor diet of the Scottish people has proven to be amongst the worst recorded in the Western world. This lack of nutritious food has severely impacted upon the nation’s health. A considerable amount of the food consumed by the Scottish population consists of extremely high quantities of saturated or animal fats and was very low in dietary fibres.12 The Scottish Health Survey 1998 found that there were wide variations in dietary habits across the social class spectrum.


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