People living in the most deprived parts of Scotland are still most likely to report being teetotal, according to a report giving a snapshot of the nation’s health.

Almost a quarter of those from the poorest areas (24%) said they didn’t drink alcohol, compared to 12% in the most affluent areas.

Men and women living in the least deprived parts of the country were also more likely to report drinking more than 14 units per week in 2021 – 29% compared with 20% in the poorest areas.

However, of those who reported ‘hazardous’ drinking, levels were highest in the most deprived areas.


Overall, the prevalence of harmful drinking was highest among those aged between 45 and 74 and was around twice as high among men, while women aged 55-64 reported the heaviest consumption.

The Scottish Government’s annual health survey notes that existing inequalities mean that the burden of alcohol-related mortality is greatest among those living in the most deprived areas.

In 2021 1,245 people died from alcohol-specific causes in Scotland, the highest number of deaths since 2008.

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Covid restrictions continued to affect alcohol sales in pubs, clubs and restaurants with 85% sold in supermarkets and off-licenses.

The number of people reporting harmful drinking has declined steadily since 2003 – from 34 per cent to 23.

A total of 4,557 adults and 1,600 children took part in the survey, which also interviewed Scots about physical activity, diet, weight, general health and Covid vaccine uptake.


This year, interviews were carried out over the phone rather than in person due to the pandemic and experts say this would have had an impact on responses.

Public health expert Professor Linda Bauld, said there was an “implausibly” large drop in smoking reported, from 17% in 2019 to 11% last year.

Dr David Walsh, public health programme manager at Glasgow Centre for Population Health, said self-reported consumption data was notoriously unreliable.

He said there had always been a paradox around alcohol consumption versus harm.

He said: “Consumption has always been recorded as greater among ‘higher’ socioeconomic positions but harm is worse among the poorest.

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“Various things are at play: partly what epidemiologists refer to as effect modifiers i.e. the effect of the same amount of alcohol on health is made worse by other factors [such as] poverty and associated stressors.

“The way alcohol is consumed and the type of drinks differs across social groups and price matters. Some of the falls in alcohol deaths in recent times have been shown to be associated with declining income following the recession.

“Price is also why Mininum Unit Pricing (MUP) was brought in, because it’s effective.”

Alcohol Focus Scotland called for further restrictions “on the aggressive marketing of alcohol”.

Alison Douglas, chief executive, said: “This should be backed by further investment in support and treatment services to ensure anyone who needs help can the right support when they need it.”

The survey also found that mental wellbeing amongst adults has declined in the past year and more than one in five Scots may be suffering from a psychiatric disorder. 

The average Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS) score was significantly lower in 2021 than in 2019 (48.6 and 49.8 respectively).

This followed a decade in which levels had remained fairly constant.
Five per cent of adults reported having Long Covid and the most common symptom was tiredness.

Almost one in ten adults (9%) said they were worried that they would run out of food due to lack of money or resources during the previous 12 months.


Rates of smoking continued to be much higher in the most deprived areas (24%) compared to the least deprived areas (5%) and 30% said they were “living with obesity” while 67% was classified as overweight.

Professor Linda Bauld, chair of public health in The Usher Institute at Edinburgh University, said: “The results of the 2021 Scottish Health Survey are important and it’s testament to the team at ScotCen that the survey managed to run in 2021 during the pandemic.

“However, the shift to an entirely telephone-based survey will have had an impact on responses to some questions.

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“For example, there is an implausibly large drop in smoking reported (from 17% of adults in 2019 to 11% in 2021) that is unlikely to be real.

“A similar but less dramatic drop was found in England during the pandemic in the Annual Population Survey.

“It will be important to compare these types of changes through time and with other surveys to get a fuller picture.”

A spokeswoman for Public Health Scotland said: “It’s well understood that surveys relying on self-report will tend to underestimate consumption at a population level, for a variety of reasons, including accuracy of recall and under-representation of those drinking at harmful and hazardous levels.

“Surveys provide valuable information on who within the population is drinking at what levels.

“Sales data does provide a more accurate picture of consumption at a population level but can only provide an average figure.”