This week is European Public Health Week. In the intricate fabric of public health discourse, few issues resonate as profoundly as health inequalities, and none are starker than the shocking rise in drug deaths reported over the past few years.

Disparities, often rooted in socioeconomic factors, manifest in various forms, with drug-related mortality serving as a poignant indicator of systemic societal and economic failures.

As policymakers and practitioners grapple with the multifaceted dimensions of dealing with this health crisis, new work, funded by the Health Foundation, has looked at the life course of those cohorts most affected by drug poisonings to see if we can learn the lessons of history and prevent such crises emerging again.

Scotland's socioeconomic landscape in the latter half of the 20th Century was shaped by decades of industrial decline and economic restructuring. This radical transformation disproportionately affected communities across Scotland, and evidence that draws the line between those populations who lost their livelihoods have shown up in poor economic and health statistics as those cohorts have aged. But what about young people in those communities who were emerging into the labour force once the wave of de-industrialisation had passed?

The Herald: Scotland's drug death toll is the highest in UKScotland's drug death toll is the highest in UK (Image: free)


Generations before then had been able to start out with a job that allowed them to build some resilience. And although job precarity and unemployment is difficult to deal with at any age, we know that long term youth unemployment has long lasting implications.

Indeed, previous generations of single adults were faring better than other parts of the population. For those born between 1940 and 1965, incomes for single adults were between 10% and 20% higher than the population average. By the time the cohort born in 1970 turned 21, relative incomes were roughly on par with the population average. Since then, relative incomes have continued to fall and now single adults have incomes below the average for the population.

The falling behind of incomes over time is one issue. But what stands out most from the data is the stark drop off between those born in the 1960s and those born in the 1970s. Living standards that that were available in 1981 when the 1960s cohort came of age were not available 10 years later when the 1970s cohort were starting out in their adult lives. And it is this same cohort of young men, born in the 1970s who have contributed to the epidemic of drug poisonings that have led Scotland to have the highest rate of drug deaths anywhere in Europe.

For males, rates of drug deaths in Scotland were fairly steady during the 1980s and increased rapidly throughout the 90s and 2000s, reaching what was hopefully their peak in 2020. The biggest increases in death rates during the 90s and early 2000s were among young males, but now 35 to 54 year olds have the highest rates to date – particularly those born in the 1970s and in their 40s at the time of our data.

While men bear the brunt of Scotland's drug crisis, the burgeoning mortality rates among women in the same cohorts are still concerning. Rates for females remained fairly steady throughout the 80s and 90s and early 2000 and did not start to rise until around 2011. And again, the increase in deaths in females were mainly driven by 35 to 54-year-olds.

Beyond the statistics lie human stories of resilience and vulnerability, demanding compassionate responses and systemic reforms. Scotland's struggle with drug-related mortality highlights a challenge many economies have faced, albeit to a lesser extent.


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As policymakers and practitioners confront the multifaceted dimensions of public health, the imperative for bold, inclusive interventions are clear. But there also needs to be more work by the research community, across disciplines, to provide the evidence needed to address the root causes of health disparities comprehensively. Our work brought together economists, statisticians and epidemiologists from the Universities of Strathclyde and Glasgow to jointly identify insights from the data to make links that might not have been joined together.

More work needs to be done to understand the causal extent of the relationship over the life course, and which elements are most important – for example, does being in a secure tenancy matter more than earnings for long term health outcomes?

These insights are important for building the most effective policy solutions going forward. In reality however, it is likely to be a mixture of factors, with the stark drop off in fortunes from one generation propelling young people born in the 1970s into one of the worst health crises we have ever experienced in Scotland.

Next month, new data is released on drug related deaths in Scotland. We hope that the peak has already been reached and the figures will continue to fall. Whatever the figures, it is likely most of the discussion in Scottish Parliament and beyond will focus on the success, or otherwise, of public health interventions that have been put into place in recent years to save lives at the point of crisis. We hope, along with this, there is consideration of the underlying socio-economic drivers that led to these crises manifesting in the first place. It is this type of forward thinking that will be required to prevent history repeating itself.

Emma Congreve is the Deputy Director of the Fraser of Allander Institute at the University of Strathclyde.