Scottish Government

10 Health and Caring

INTRODUCTION AND CONTEXT

Improving health is one of the Scottish Government's five strategic objectives: ⁵³Help people to sustain and improve their health, especially in disadvantaged communities, ensuring better, local and faster access to health care.

This is supported by the national outcome: "we live longer, healthier lives". A series of 45 national indicators and targets has been devised to help assess progress towards achieving these national outcomes and strategic objectives. A number of these outcomes and indicators are directly related to health and health-related behaviours. For example, the following target has been set in relation to smoking: Reduce the percentage of the adult population who smoke to 22% by 2010. The Scottish Household Survey will be used to monitor progress towards this target.

Although other sources of data on health in Scotland exist, such as the Scottish Health Survey, the long time-series and relatively large sample sizes available from the Scottish Household Survey mean that it is currently better placed than other surveys to monitor progress towards the smoking reduction target and to provide data for derivation of other national indicators (such as the use of self-assessed health for the derivation of healthy life expectancy).

This chapter examines:

• The prevalence of long-standing illness or disability in households in Scotland,
• Regular care and support needs across the whole population,
• Adults' perception of their health status (self-assessed health), and
• The prevalence of smoking among adults, including the number of cigarettes smoked.

These issues are explored in detail by looking at the influence of age, gender, household type, tenure, net annual household income and area deprivation. The section on adult smoking also looks at trends in smoking prevalence between 1999 and 2007.

LONG-STANDING ILLNESS OR DISABILITY

The SHS asks participants whether anyone in their household, including children, has:

"Any long-standing illness, health problem or disability that limits your/their daily activity or the kind of work that you/they can do? By disability as opposed to ill-health, I mean a physical or mental impairment, which has a substantial and long-term adverse effect on their ability to carry out normal day to day activities."

The question is therefore a subjective measure of long-standing illness, disability and health problems and is not subject to any verification. In addition, this wording does not capture all forms of disability covered by the legal definition within the Disability Discrimination Act 2005, though this is being explored for future years of the survey. ⁵⁴

Table 10.1 shows that about one-third (34%) of households in Scotland contain at least one person with a long-standing illness, health problem or disability. This figure covers all members of the household, including children. As would be expected, households comprised of older people are more likely to contain someone with a long-standing health problem or disability, with over half of 'older smaller' ⁵⁵ (54%) and 'single pensioner' households (52%) doing so. In contrast, only 16% of small family households and 22% of single parent households contain someone with a long-standing illness, health problem or disability.

TABLE 10.1: WHETHER ANYONE IN THE HOUSEHOLD HAS A LONG-STANDING ILLNESS, HEALTH PROBLEM OR DISABILITY BY HOUSEHOLD TYPE
Column percentages, 2007 data

Table 10.2 demonstrates that between 43% and 49% of households with net annual incomes below £15,000 contain someone with a long-standing illness, health problem or disability. The corresponding figure for households with a net annual income of over £40,000 is 15%. As shown in Chapter 6, a majority of 'single pensioner' and 'older smaller' households have incomes below £15,000 so the pattern evident in Table 10.2 will, in part, be related to the fact that older people are more likely than other age groups to live in households with low annual incomes.

TABLE 10.2: WHETHER ANYONE IN THE HOUSEHOLD HAS A LONG-STANDING LIMITING ILLNESS, HEALTH PROBLEM OR DISABILITY BY NET ANNUAL INCOME
Column percentages, 2007 data

* Includes all adults for whom household income is known or has been imputed.
Household income in the SHS is that of the highest income householder and their partner only.

Owner occupier households (29%) and those who rent from the private sector (22%) are less likely to contain someone with long-standing health problems or disabilities than those living in the social rented sector (53%) (see Table 10.3). The discussion above in relation to disability, health status and income noted that low income households are particularly likely to contain older people, amongst whom long-standing illness and disability is more prevalent than for other age groups. However, the same is not true in relation to housing tenure. Older people are more likely to be owner occupiers than people in other age groups, so the association between disability and health status and living in the social rented sector is likely to be explained by factors other than just the age of the householders.

TABLE 10.3: WHETHER ANYONE IN THE HOUSEHOLD HAS A LONG-STANDING LIMITING ILLNESS, HEALTH PROBLEM OR DISABILITY BY TENURE*
Column percentages, 2007 data

* Revised October 2008

Figure 10.1 presents the health and disability status of all individuals within the surveyed households by age and gender. It shows that men (18%) and women (19%) have very similar levels of long-term illness, health problems or disability overall, although these figures vary by age group. As pointed to in Table 10.1, these conditions are much more common among people in older age groups. For example, just 5% of boys and 3% of girls under the age of 10 have a long-standing illness, health problem or disability compared with 52% of women and 48% of men aged 70 and over.

FIGURE 10.1: HOUSEHOLD MEMBERS WITH A LONG-STANDING LIMITING ILLNESS, HEALTH PROBLEM OR DISABILITY BY AGE AND GENDER
2007 data, Adult males (base: 14,505) and females (base: 15,730)

CARE NEEDS WITHIN THE HOME

This section looks at the care needs of household members in Scotland, including children's needs. Table 10.4 shows that 15% of all households contain at least one person who requires regular help or care. As would be expected from the results presented above in relation to long-term illness and disability, households containing older people, such as those classified as 'older smaller' and 'single pensioner' are the most likely to contain people who are in need of regular help or care (21% and 26% respectively).

TABLE 10.4: WHETHER ANYONE IN THE HOUSEHOLD NEEDS REGULAR HELP OR CARE BY HOUSEHOLD TYPE
Column percentages, 2007 data

There was also a similar pattern between care needs and household income (as found for income and long-standing illness, health problems and disability), with the highest income households being the least likely to contain someone in need of regular care or help. Between 18% and 23% of households with a net annual income of £15,001-£20,000 or below contain someone who requires regular help, compared with around 9% of those with incomes between £20,001 and £30,000, and around 5% of households with an annual income above £30,000 (Table 10.5).

TABLE 10.5: WHETHER ANYONE IN THE HOUSEHOLD NEEDS REGULAR HELP OR CARE BY NET ANNUAL INCOME
Column percentages, 2007 data

* Includes all adults for whom household income is known or has been imputed.
Household income in the SHS is that of the highest income householder and their partner only.

Table 10.6 demonstrates that only 11% of owner occupied households and 9% of private rented households contain someone requiring regular help or care, compared with 27% of households in the social rented sector. Although the overall incidence of people needing care is lower than the proportion who report having a long-standing illness, health problem or disability, the pattern shown in Table 10.6 is very similar to that shown above in Table 10.3 (where social rented households were about twice as likely as those in other tenure types to contain someone who had a long-standing illness, health problem or disability).

TABLE 10.6: WHETHER ANYONE IN THE HOUSEHOLD NEEDS REGULAR HELP OR CARE BY TENURE*
Column percentages, 2007 data

* Revised October 2008

SELF-PERCEPTION OF HEALTH

In total, most adults (54%) assessed their own health as 'good', a further 33% reported it to be 'fairly good' while 14% said it was 'not good' (see Table 10.7). Although men and women's perceptions differed, the differences were not huge. Men were more likely than women to rate their health as being 'good' (56% versus 52%), while women were more likely than men to say that their health was 'not good' (15% versus 12%). The most notable difference in Table 10.7 is in relation to age; between 65% and 68% of those within the 16 to 44 age range rated their health as 'good', compared with 29% of those aged 75 and over. Though it is also worth noting that the most common answer given by those in the older age groups was 'fairly good' (39% of those aged 60 to 74 and 44% of those aged 75 and over), with only 19% and 27%, respectively, rating their health as 'not good'.

TABLE 10.7: SELF-PERCEPTION OF HEALTH BY GENDER AND AGE
Column percentages, 2007 data

Table 10.8 demonstrates that people living in the 15% most deprived areas in Scotland ⁵⁶ were around twice as likely to report that their health was 'not good' compared with those living elsewhere (23% versus 12%).

TABLE 10.8: SELF-PERCEPTION OF HEALTH BY SCOTTISH INDEX OF MULTIPLE DEPRIVATION
Column percentages, 2007 data

In addition, Table 10.9 shows that people who rate their neighbourhood negatively are more likely than those who rate their neighbourhood more positively to perceive their health status as 'not good' (22% versus 13%). Table 4.3 in Chapter 4 presents neighbourhood perceptions by area deprivation and shows that people living in the most deprived 15% of areas are more likely to rate their neighbourhood negatively than those in the rest of Scotland. This suggests that the similarity in the patterns evident in Table 10.8 and Table 10.9 will in part be accounted for by the interaction between area deprivation and neighbourhood ratings.

TABLE 10.9: SELF-PERCEPTION OF HEALTH BY RATING OF NEIGHBOURHOOD AS A PLACE TO LIVE
Column percentages, 2007 data

From June 2007, this question was asked of three quarters of the sample. From January to May 2007, it was asked of all random adults.

SMOKING IN ADULTS

Reducing the percentage of the adult population who smoke is a national indicator within the Government's performance framework, with a target of 22% by 2010. Figure 10.2 and Table 10.10 show that a little under a quarter of adults now smoke (24.7%). Smoking among adults has gradually declined from 30.4% in 1999 to 24.7% in 2007.

FIGURE 10.2: WHETHER RESPONDENT SMOKES BY YEAR
1999-2007 data, Adults (2007 base: 10,412)

Legislation to prohibit smoking in public places came into effect in late March 2006. The primary intention of the legislation was to reduce the harm from environmental tobacco smoke in the general population and, in particular, among employees exposed to smoke in the course of their work (e.g. bar workers). The legislation might, as an additional consequence, have encouraged some people to give up smoking. Table 10.10 shows that the smoking rate has declined every year since the survey began in 1999. The size of the decline was 1.2 percentage points between 2005 and 2006, the year in which the legislation banning smoking in public places was introduced and when most awareness raising activity about it was carried out.

TABLE 10.10: WHETHER RESPONDENT SMOKES BY YEAR
Column percentages, 1999-2007 data

From June 2007, this question was asked of three quarters of the sample. From January to May 2007, it was asked of all random adults.

Figure 10.3 shows the proportion of adults who smoke in Scotland by age and gender. Smoking is most common among 16 to 24 year old men and this is also the age group where there is the largest difference between men (33%) and women (27%). Smoking decreases slightly among men between the age groups 16-24 and 45-59 (from 33% to 28%) but fluctuates among women with no clear pattern across these age groups, ranging between 25% and 28%. From the age of 60-74 smoking declines more quickly, with around one in five in this age group smoking (20% of men, 21% of women) and a little over one in ten of those aged 75 and over doing so (13% of men, 11% of women).

FIGURE 10.3: WHETHER RESPONDENT SMOKES BY AGE AND GENDER
2007 data, Adult males (base: 4,476) and females (base: 5,932)

Table 10.11 illustrates the relationship between smoking prevalence and area deprivation. Adults in the 15% most deprived areas of Scotland are considerably more likely than those in the rest of Scotland to say that they are current smokers (40% versus 22%).

TABLE 10.11: WHETHER RESPONDENT SMOKES BY SCOTTISH INDEX OF MULTIPLE DEPRIVATION
Column percentages, 2007 data

From June 2007, this question was asked of three quarters of the sample. From January to May 2007, it was asked of all random adults.

Figure 10.4 illustrates the relationship between smoking and deprivation even more starkly. It shows that the proportion of adults who smoke declines steadily as deprivation declines, from 43% in the most deprived 10% of areas to just 12% in the least deprived 10%.

FIGURE 10.4: WHETHER RESPONDENT SMOKES BY SCOTTISH INDEX OF MULTIPLE DEPRIVATION
2007 data (base: 10,412)

The SHS also asks those who say they smoke how many cigarettes they smoke per day. Table 10.12 presents the number of cigarettes smokers reported smoking per day in each year since 1999. There has been a gradual increase in the proportion who smoke fewer than 20 cigarettes per day, from 54% in 1999 to 61% in 2007, with a corresponding decrease (from 45% to 40%) in the proportion of smokers who can be classified as 'heavy smokers', that is smoking 20 or more cigarettes a day.

Since the introduction of legislation prohibiting smoking in public places in 2006, there has been no obvious change in the number of cigarettes current smokers report smoking.

TABLE 10.12: NUMBER OF CIGARETTES SMOKED PER DAY BY YEAR
Column percentages,1999-2007 data

From June 2007, this question was asked of three quarters of the sample. From January to May 2007, it was asked of all random adults.

Table 10.13 compares the self-rated health status of non-smokers and smokers. Smoking causes and exacerbates a number of chronic respiratory diseases and cardio-vascular disease, and can worsen the health of people with long-term conditions such as asthma. The table shows that smokers are less likely than non-smokers to state that their health status is 'good' (46% and 57% respectively). In addition, 18% of smokers perceive that their health is 'not good' compared with 12% of non-smokers. As the prevalence of smoking is lower among older people, the greater propensity for smokers to report their health as 'not good' is unlikely to be due to smokers being older than non-smokers.

TABLE 10.13: SELF-PERCEPTION OF HEALTH BY SMOKING STATUS
Column percentages,2007 data

From June 2007, this question was asked of three quarters of the sample. From January to May 2007, it was asked of all random adults.