HEALTH inequalities in Scotland "have been magnified during the pandemic" and must be urgently tackled, the chief medical officer has warned.
In his first annual report as CMO, Dr Gregor Smith, said the impact of Covid has been "substantially higher" among the elderly, those with pre-existing conditions, and the obese.
People in the most deprived areas of Scotland were more than twice as likely to die from the disease compared to the most affluent, while those of South Asian or Chinese ethnicity "had substantially higher mortality rates" compared to white people "even after adjusting for other factors".
READ MORE: What can Scotland learn from Ireland's surge in life expectancy?
Dr Smith noted that other, indirect effects of the pandemic on health are still emerging, with children and young people "disproportionately impacted by disruption to education and loss of employment in the hospitality sector".
Loss of employment and income, which also do long-term harm to health, have been "most profound for people in lower-skilled and lower-paid jobs, and those working in certain sectors such as tourism and hospitality".
He added: "Emerging evidence suggests that Covid-19 has exacerbated many pre-existing inequalities and exposed the vulnerability of some of our population to adverse shocks."
Dr Smith, a GP who was previously the deputy CMO, stepped in after his predecessor Dr Catherine Calderwood resigned in April last year following criticism that she had travelled from Edinburgh to her family's second home in Fife in breach of Covid rules.
The report notes that the pandemic has occurred at a time when life expectancy was already stalling across the UK, USA, and in parts of Europe.
However, Scotland's health inequalities are the worst in western and central Europe and life expectancy had actually been falling even before Covid in the poorest neighbourhoods, where men are living 13 years less on average than those in the wealthiest postcodes.
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Drug deaths, cuts to public services and welfare spending during austerity, and declining real-terms income have been blamed for the trend, but other factors such as people ageing with multiple complex conditions, decelerating improvements in cardiovascular disease (CVD) mortality, and periodic bad flu seasons could also be at play.
It has also occurred at a time of increasing demand on the NHS and social care services, which have struggled with "unprecedented financial pressures".
Predicting the impact of the pandemic on life expectancy "is difficult for several reasons", said Dr Smith.
He wrote: "The large numbers of deaths that Covid-19 has caused, or hastened, among people with pre-existing conditions and frail older people may be counter-balanced by fewer deaths in the future.
"Some of our excess deaths could be offset by fewer deaths from air pollution and transport accidents."
READ MORE: 'World first' Scottish study shows vaccines slashing household transmission
However, the effect on mortality rates of increased unemployment or untreated illness - with a report last week estimating that 7000 people in Scotland are living with undiagnosed cancer - are yet to be seen.
The report did highlight some unexpected health benefits of the pandemic for children awaiting life-saving kidney transplants.
There are eight to 10 paediatric kidney transplants a year in Scotland, at the Royal Hospital for Children in Glasgow.
Most transplant centres in the UK closed completely amid uncertainties about the virus, but Scotland kept the list open for high-risk children.
This "led to Scotland receiving many more kidney offers than usual and enabled successful transplantation of all high-risk children", said Dr Smith.
"When it became clear that there was a lower risk of serious illness from COVID-19 in children, the transplant centre began to carry out transplants for all children.
"By the end of August, every child on the waiting list in Scotland was successfully transplanted. The transplant list was empty for the first time in more than 20 years."
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