Scotland’s Wellbeing: Delivering the National Outcomes

1. Introduction

2. Evidence of progress towards the National Outcomes

3. Data and future developments

4. References

2. Evidence of progress towards the National Outcomes

2.1 Scotland's people and reputation

Scotland's population is increasing, with migration as the driver. Scotland is an attractive destination for both overseas and domestic visitors who are attracted by vibrant, diverse and unique culture, natural and built heritage, ancestry, history, landscape, wildlife and nature, and outdoor life, food and drink[3].

Scotland's population has been increasing with immigration helping to mitigate the depopulating effects of a long-term decrease in the rate of natural population growth. The latest estimate of Scotland's population (on 30 June 2018) is 5,438,100, the highest ever with an increase of 13,300 people (0.2%) over the last year. However, in the two years since 30 June 2016, Scotland's population growth has slowed from 0.6% to 0.2% annual growth, driven by a reduction in net migration as well as a natural population decrease. In the year to mid-2018, there were 7,700 more deaths than births contributing to depopulation, which was offset by positive net migration of 20,900 people. Migration is the driver of all of Scotland's recent population growth, and it is projected that 100% of population growth in the future will be from immigration, from both overseas and the rest of the UK. Scotland has become more ethnically diverse, in the decade to 2011 Scotland's minority ethnic population doubled from 2% to 4% of the total population, while white non-British groups also increased from 3% to 4% of the population.[4] The most recent survey data from 2017 suggests that this increasing trend has continued.[5]

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Scotland's population is ageing, with a greater increase in the population of older age groups than younger age groups over the last 20 years. Since 1998, the largest increase has been in the 75 and over age group (+31%), whereas the population of children aged 0-15 has declined the most (-8%). Whilst the population aged 16-24 has increased over the last 20 years, it has shown a longer-term decreasing trend and is projected to decrease further by 2023.

The way that Scotland is perceived is likely to be influenced by a host of factors both at home and internationally. They include experiences of visitors to Scotland, Scotland's cultural and natural heritage, landscapes, film and media portrayals of Scotland, significant political events, the profile and activities or our universities, academic networks and diaspora, Scotland's support of developing countries, and Scotland's image as a democratic, economically stable and prosperous country. Since 2008, in a measure that aims to capture this diverse range of influences on reputation, Scotland's reputation score has steadily improved. In 2018 Scotland ranked 16th out of the 50[6] countries in the Nation Brands Index, scoring most strongly on dimensions for 'tourism', 'governance' and 'people'.

Scotland's most positive dimension in terms of rank in 2018 was Tourism[7], which placed Scotland 12th out of the 50 countries, with 'natural beauty' and 'historic buildings and monuments' being perceived as the strongest characteristics for Tourism. 'Fascinating' and 'exciting' were the most common experiences associated with visiting Scotland.

Scenery and landscape, and history and culture are the core motivators for overnight visits to Scotland. Fifty per cent of overnight visitors surveyed in VisitScotland's Visitor Survey indicated that scenery and landscape was a motivator behind their decision to visit Scotland, rising to 71% for European visitors. In 2018, there were around 15.3 million overnight visitors to Scotland of which 3.5 million were from overseas. Expenditure by overnight and day visitors to Scotland was valued at around £10 billion, which generated around £13 billion of economic activity in the wider Scottish supply chain and contributed around £7 billion to Scottish GDP (in basic prices). This represented about 5% of total Scottish GDP. In 2018 there were around 206,000 people employed in the tourism sector[8, 9, 10].

Between 2004 and 2017, time spent on Scottish outdoor recreation[11] increased by 94%, from 412 million hours to 798 million hours respectively. This trend was driven by visitor numbers, which increased 168%, from 204 million visits to 547 million visits over the same period. In 2017, UK outdoor recreation was valued at £6.7 billion. Scottish visits are estimated at 10% of this (£650 million) and between 2009 and 2017, Scottish outdoor recreation was estimated to have increased 79%, from £365 million in 2009 to £650 million in 2017.

2.2 Scotland's natural and economic resources

A sustainable and inclusive economy is essential to Scotland's wellbeing.

Scotland's economy continued to expand in 2018, with latest GDP data showing growth of 1.3% in 2018. GDP growth over the year was relatively broad based across the main industry sectors and continued a pattern of stronger growth, compared to 2015 and 2016. This stronger output performance has been reflected in Scotland's recent labour market performance. More robust output growth, alongside the continued strength in the labour market, is reflected in Scotland's productivity performance. In 2018, Scottish labour productivity grew 3.8%, its fastest pace since 2010, and rebounded from a fall of 0.3% in 2017[12].

There are a number of drivers underpinning the pattern of stronger output growth in 2017 and 2018. Firstly, stronger global economic growth, combined with the depreciation of sterling, have provided a boost to Scottish exports. Over the past decade, the Scottish economy has made notable progress on international trade. The value of Scotland's international exports (goods and services) increased by 58% between 2007 and 2017 from £20.6 billion to £32.4 billion[13]. Secondly, the rise in the oil price from 2016, coupled with restructuring in the North Sea industry, has provided a boost to confidence and activity in the sector, as part of its transition from the oil price shock in 2014.

Between 2013 and 2017, there was year-on-year growth in Scotland's registered business stock per 10,000 adults. However, the latest data show that Scotland's registered business stock fell slightly from 176,400 businesses in 2017 to 176,295 businesses in 2018[14]. This coupled with adult population growth, has resulted in the rate of registered businesses per 10,000 adults decreasing from 391 in 2017 to 390 in 2018. In 2018, 1.0% of all registered businesses were high growth, a decline of 17% from the 2017 rate of 1.2%[15]. This is the first time in the last five years that there has been a fall in the high growth business share[16]. There has also been a reduction in business innovation activity over the latest period for which data are available – with the share of businesses innovation active decreasing from 50.4% in the 2012-14 period to 45.0% in the 2014-16 period.[17] The decline in business innovation activity is due to a reduction in wider business practice innovation (organisational/marketing innovation), rather than product or process innovation.

Scotland still remains an attractive location for Foreign Direct Investment (FDI). In 2017, Scotland attracted 116 new FDI projects (London was the only UK region to attract more projects)[18]. Such investment provides an important source of highly skilled employment and innovative activity. Alongside this, Scotland's Gross Expenditure on Research & Development (GERD) has risen by 42.7% in real terms since 2007 to £2.53 billion, representing 1.63% of GDP in 2017[19].

Inclusive Growth combines increased prosperity with greater equity; that creates opportunities for all and distributes the benefits of increased prosperity fairly. Between 2007 and 2018, productivity[20] in Scotland grew at an average annual rate of 0.7% per year. But economic performance varies considerably across regions. There is a 70% gap in productivity between Scotland's most and least productive regions. There is also an imbalance between people within Scotland. Compared to those with the bottom 40% share of income, the top 10% of the population in Scotland had 27% more income in 2015-18, compared to 24% in 2014-17. Income inequality had been fluctuating since the beginning of this data collection in the mid-nineties, and, after the most recent low point in 2012-15, has been steadily increasing.

Sustainable growth looks to the future and also places emphasis and value on the natural environment, such as Scotland's natural capital. Scotland's natural capital has shown signs of recovery for five consecutive years and is now at its highest level since 2000 after decades of decline between the 1950s and 1990s. This was due to human activities such as increases in peat drainage and uses of pesticides[21]. The Natural Capital Asset Index (NCAI) measures the quality and quantity of habitats in Scotland, according to their potential to deliver different ecosystem services now and into the future. The NCAI in Scotland increased from 101.3 in 2016 to 101.9 in 2017[22]. The breakdown of headline results by habitat type[23] shows that all broad habitat types are increasing, but that there are declines in some components such as the quality of designated woodlands and upland bird populations.

There has been an increase in the percentage of regions with acceptably low levels of contaminants found in marine systems, from 80% in 2015 to 83% in 2017. Build-up of these contaminants can adversely affect marine organisms, and more broadly marine ecosystems. It can also adversely affect human health if the contaminants enter the food chain and reduce the benefits that society derives from the marine environment.

The state of Scotland's natural capital contributes to our health, environment and to our wider sense of wellbeing. Natural Capital is also a driver of economic activity. The Scottish Environment Protection Agency estimates that Scotland's environment contributes over £20 billion annually to Scotland's economy[24]. Scotland's natural capital accounts show that the asset value of Scottish Natural Capital was estimated to be £273 billion[25] in 2015, 34% of the UK total. A quarter of the value was from non-material benefits not directly captured in GDP; namely carbon sequestration, pollutant removal and recreation.

In 2017, five times as much electricity was produced from renewable sources in Scotland than was produced in 2000. 2018 was another record year, where an estimated 74.6% of gross electricity consumption came from renewable sources.[26] Air quality in Scotland has improved significantly over recent decades, in large part due to tighter industrial controls and more stringent vehicle and fuel standards. Between 1990 and 2016 (the latest year for which figures are available), nitrogen oxide emissions decreased by 72%, fine particulate matter (PM10) by 64% and sulphur dioxide by 94%.[27] While the amount of waste generated by households in Scotland has remained similar between 2013 (2.41 million tonnes of household waste generated) and 2017 (2.46 million tonnes of household waste generated), waste from all sources recycled in Scotland has increased from 53.2% in 2014 to 58.9% in 2017.[28]

There has been an overall reduction in Scotland's carbon footprint. In 2015, Scotland's carbon footprint was 76.5 million tonnes of carbon dioxide equivalent (MtCO2e). This is the same as the 2014 figure (76.5 MtCO2e) and 21.8% lower than the peak levels in 2007 (97.7 MtCO2e).

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In 2016, Scottish Greenhouse gas emissions, after adjustment for trading in the EU Emissions Trading System (EU-ETS), were 45% lower than in 1990. They were 2.5% higher than 12 months earlier, but total adjusted emissions met the annual target.

Transport contributes to over a third (37% in 2016) of Scotland's greenhouse gas[29], with the road sector accounting for the largest proportion of these. In combination, cars, lorries, vans, buses and motor cycles accounted for 9.8 MtCO2e (mega-tonnes of CO2 equivalent) of the overall transport emissions in 2016 (68% of total transport emissions) which compared to 9.2 MtCO2e and 62% in 1990. However, a higher uptake of Electric Vehicles (EVs) and reduction in the use of petrol/diesel cars and vans will contribute to reducing Greenhouse Gas Emissions. In 2018, a total of 3,538 new ultra-low emissions vehicles[30] were registered in Scotland. This is an increase of 39% since 2017. Of these, 1,051 were battery electric cars and 2,253 were plug in hybrid cars. The market share of newly registered ultra-low emissions vehicles of all new vehicles registered in 2018 was 1.5%, compared to 1.0% in 2017 and has increased since 2014 (0.3%). The Carbon Account for Transport shows that Scottish transport emissions are now around 14 MtCO2e; below the 2007 peak of around 15 MtCO2e but well above the aim of a decarbonised transport system.

Active travel supports us to be a healthy and active nation. Walking and cycling for short everyday journeys is shown to be a strong contributor to improving health and wellbeing. This is largely due to the physical, mental and social benefits of regular activity. The resultant environmental benefits of active travel also means fewer vehicles and less polluted environments which has additional health and wellbeing benefits. In 2017, the proportion of all adults who either walk, cycle or use public transport to commute to work was 31%. This figure has remained fairly static over recent years.

The average weekly household spend on transport and vehicles in 2016-18 is around 14%. This figure has remained fairly static over the previous 10 years.

Men are far more likely to travel to work by bike than women and younger age groups are more likely to use the bus than other age groups. People in households with lower incomes are far more likely to walk or use the bus to travel to work, than those in households with higher incomes.

Although there are positive trends in reducing GHG emissions and increasing our Natural Capital, the state of biodiversity[31] is more complex. One measure of biodiversity, the abundance of terrestrial breeding birds shows an increase in biodiversity, from 110.3 in 2016 to 119.0 in 2017, compared to a reference value of 100 in 1994. However, there are still Scottish species at risk of extinction, due to pressures such as human activities and climate change. Scotland is home to 1/3 of the EU's breeding seabirds of international importance and their status is an important indicator for assessing the state of the marine environment. The average breeding numbers of 12 species of breeding seabirds in Scotland have declined. By 2016, breeding numbers of these species were 62% of their 1986 level[32].

In 2019, 79% of natural features on protected nature sites were assessed as being in favourable condition. This is an increase of 3 percentage points from the 2007 baseline of 76%. Invasive alien species are the main reason for natural features being in unfavourable condition, representing 21% of all negative pressures in 2019.

There is growing evidence to show that spending time outdoors increases mental wellbeing and health. In 2017, 65% of adults reported living within a 5 minute walk of their nearest green or blue space, unchanged from 2016[33]. This compares with 68% in 2013. Accessibility to green and blue space[34] is an important factor in its use, both in terms of its proximity to people's homes and the ease of physical access. Those living in small towns or rural areas are more likely to live closer to green or blue space than those living in urban areas. In 2017, the largest difference was between those living in remote rural areas, where 76% of adults reported living within a 5 minute walk of their nearest green or blue space, compared with 59% for those living in large urban areas. A higher proportion of people who live within 5 minutes of their nearest green or blue space report using it at least once a week compared to people who live a 6-10 minute walk away (46% compared to 24%).

2.3 Fair and equitable working society

A diverse labour market that respects both the rights and responsibilities of employers and workers can drive success, wellbeing and prosperity for individuals, businesses, organisations and society, and contributes to inclusive growth.

Unemployment in Jan-Mar 2019 fell to 3.2%, its lowest rate on record.Scotland's employment rate, for 16-64 year olds, at 75.4% in Jan‑Mar 2019, is higher than 10 years earlier (73.1%)[35]. Evidence shows a continued "hollowing out" of the labour market whereby middle-skilled jobs (e.g. administrative roles, sales, secretarial) are declining, with automation being one contributory factor[36]. Most increases in employment have been in medium-high and high skilled roles, including research, engineering, science, ICT and technical professions.

Although employment rates overall are increasing, there are differences by age group. The employment rate for young people aged 16-24 in 2018 (57.2%), was lower than it was ten years previously (60.7%), partly reflecting the impact of the global financial crash and recession on service sector employment and increased numbers of 16-24 year olds participating in further education. However, the unemployment rate of 16‑24 year olds reached a record low in Oct-Dec 18 and has remained low since, currently sitting at 6.6% (Jan-Mar 19), the lowest rate on record[37].

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There is still disparity between the rates of employment between men and women, reflected by the gender employment gap. The gap decreased from 10.5 percentage points in 2008 to 6.9 percentage points in 2017 and has increased slightly over the year to 7.6 percentage points in 2018[38].

Addressing the gender pay gap and the complex factors that interact to sustain women's disadvantage in the workplace is crucial to delivering fair work in Scotland, delivering inclusive economic growth and helping to tackle child poverty. Since 1998 there has been a significant reduction in the gender pay gap from 19.1% to 5.7% in 2018[39].

In 2018, the employment rate for the minority ethnic population aged 16‑64 was 55.4%, which is lower than the white population which had an employment rate of 75.1%. This is a gap in employment rates between minority ethnic and white people aged 16 to 64 years of 19.7 percentage points. Over time, the white population has consistently had an employment rate which exceeds the minority ethnic population. The minority ethnic employment gap was much higher for women than men in 2018; for women the minority ethnic employment gap was 26.8 percentage points and for men it was 11.2 percentage points[40].

One measure of employee voice is collective agreement coverage: the proportion of employees whose pay and conditions are agreed in negotiations between the employer and a trade union. In 2017, 35% of employees had collective agreement coverage, which has decreased from 40% in 2007.

In-work poverty remains a problem, with 65% of children in relative poverty after housing costs in 2015-18 living in a family where at least one adult is in work. The real Living Wage[41] is currently £9.00 per hour, and is based on cost of living. Around two thirds of working adults living in poverty were paid below the real living wage, between 2014-17[42]. There has been little to no change since 2012 in the percentage of employees earning less than the living wage. Almost a fifth of employees in Scotland in 2018 (19.4%) were earning less than the living wage. Women were more likely (22.4%) to be earning less than the living wage than men (16.0%). A large share of workers with gross hourly pay below the real living wage have qualifications below degree level (85% compared to 70% of all working adults). Low-paid workers are also more likely to work part-time and less likely to have a permanent contract. Low-paid workers are younger (with a median age of 34 years old) compared to the general working population (41 years old). By occupation, over half of low-paid workers are in either 'elementary' (25%), sales and customer service (17%), or caring, leisure and other service occupations (16%)[43].

In 2015‑18, 12% of children were living in combined material deprivation and low income after housing costs[44]. Child material deprivation measures how many children are in families that have below average incomes and can't afford things that most people think are essential such as keeping their home warm in winter, and replacing or repairing broken household appliances. Children in lone parent households, with a mother aged under 25, in minority ethnic households, or with a disabled family member, all have a higher than average risk of material deprivation.

Living in poverty for a significant period of time brings sustained challenges to health and wellbeing. Between 2013-17, 11% of people in Scotland were living in persistent poverty[45] after housing costs. Persistent poverty is more prevalent among children (17%) than working age adults (10%) or pensioners (10%). Households in poverty also spend a much higher proportion of their incomes than other households on everyday essentials such as housing, food, energy and indirect taxes, meaning that rises in the cost of living disproportionately impact on low income households.

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Lack of money leads to food insecurity. Food insecurity was measured for the first time in 2017, which showed that 8% of adults experienced food insecurity in the past 12 months, as defined as being worried that they would run out of food due to lack of money or resources[46]. Worrying about running out of food was more common among those in the lowest income quintile (25% compared with 0% in the highest income quintile) and amongst younger people aged 16-44 (13% compared with 0% aged 75+). Organisations responding to food insecurity have reported supporting an increasing number of households in recent years[47]. In 2017, food banks in areas of full Universal Credit rollout had seen a 17% average increase in referrals for emergency food, more than double the national average of 6.6%. A small scale study[48] in Glasgow found a strong association between food insecurity and deteriorating health. Study participants who developed mental health problems between 2011 and 2015 were two-and-a-half times more likely to experience food affordability difficulties, than those whose mental health was unchanged.

The extent of homelessness, as measured by applications to Local Authorities, decreased between 2010 and 2015 but has since plateaued. There were 35,838 applications in the 12 months preceding September 2018. While this was a 1.3% increase from the number of applications in the 12 months preceding September 2017, it was 38% less than the 57,706 applications in the 12 months to end September 2010. As of 30th September 2018 there were 10,955 households in temporary accommodation in Scotland, including 3,315 with children[49].

2.4 Educated, skilled and realising our full potential

Children's and young people's wellbeing has been widely acknowledged as being a key driver to positive life course trajectories.

Girls outperform boys in educational attainment and children with additional support needs are less likely to achieve passes than those without. Children living in the most deprived areas are less likely to have attained passes than those from the least deprived areas, although the gaps have been closing. In 2009-10, the gap between the proportion of school leavers from the most and least deprived areas with one pass or more at SCQF level 4 or better, was 11.3 percentage points. By 2017‑18 this had narrowed to 6.1 percentage points. Similarly, for one pass or more at SCQF level 5 or better the gap narrowed from 33.3 percentage points in 2009-10 to 20.3 percentage points in 2017-18, whilst for one pass or more at SCQF level 6 or better, the gap narrowed from 45.6 percentage points in 2009-10 to 37.4 percentage points in 2017‑18.

In 2017-18, 69% of female school leavers achieved SCQF level 6 or better, compared to 56% of male school leavers. However, while girls do better at school, women fare less well than men in the labour market. In 2018, 22.4% of female employees earned below the living wage, compared to 16% of male employees.

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The attainment of school leavers and the skill profile of the population have both been improving for some time. Various factors may be contributing to the improved skill profile of the population. At school, more pupils are leaving in S6 than in the past (62.7% of school leavers in 2017-18 compared to 54.9% in 2009-10), giving pupils more time to gain qualifications. The introduction of a range of new vocational qualifications has seen a corresponding increase in the number and proportion of school leavers gaining vocational qualifications, at all SCQF levels. At the same time, school leavers are now more likely to enter positive destinations. In particular, the proportion of pupils entering higher education has increased from 36.2% in 2009-10 to 41.1% in 2017‑18. The number of Higher passes by girls in STEM subjects also increased between 2007 and 2018[50]. Girls achieved more Higher qualifications in mathematics which rose by 7% and chemistry which rose by 13% during the same period (2007-2018).

Positive relationships are an important aspect of children's and young people's wellbeing. This is reflected in the percentage of S2 and S4 pupils who have three or more close friends. In 2015, the majority of pupils (81%) had three or more close friends, with 2% reporting that they had no close friends.[51] However, mental wellbeing has shown a decline in recent years, driven by a change in girls' mental wellbeing.[52] In 2015, girls displayed lower levels of wellbeing than boys. This may be related to substantial gender gaps in measures that drive mental wellbeing, such as participation in sports and pressure of school work. Other factors such as social media use, on which there is currently no national cross-sectional data may also be important. The gender gaps widen particularly among the older teen-ages, and mental wellbeing also decreases between ages 13 and 15 for both boys and girls.

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The skills profile of the population[53] is improving over time. The proportion of people with low or no qualifications has declined from 16.3% in 2007 to 11.6% in 2018[54]. However, this improvement is not uniform and several areas of inequality exist. Whilst the proportion of disabled adults with low or no qualifications has decreased over this period, it has lagged behind the non-disabled group (13.8 percentage points difference in 2018). In 2018, 22.7% of disabled people had no or low qualifications, compared to 8.8% of non-disabled people. In 2018, the employment rate for those aged 16-64 who were disabled was 45.6%, compared to 81.1% of non-disabled people. This is a disability employment gap of 35.5 percentage points. The disability employment gap has fallen in recent years and is around 3 percentage points smaller than 2015 (where the gap stood at 38.4 percentage points). In 2015‑18, the poverty rate after housing costs for people in families with a disabled person was 24%. This compares to a rate of 17% in families without a disabled person.

Similarly, adults from the most deprived backgrounds remain less qualified than the least (19.5 percentage points difference in 2018). A historic gender gap, whereby the proportion of adult women with low or no qualifications was higher than men, is closing from a gap of 5.1 percentage points in 2004 to 1 percentage point in 2018.

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Skills underutilisation[55] has increased from 32% in 2015 to 35% in 2017. Some sectors experience higher than average levels of skills underutilisation, notably 'hotels and restaurants' where levels increased from 41% in 2015 to 52% in 2017. 'Wholesale and retail', 'public administration' and 'education' all experience higher than average levels of skills underutilisation. Conversely, other sectors have remained relatively static or experienced a reduction in levels of skills underutilisation, notably 'business services' where levels decreased from 30% in 2015 to 24% in 2017.

From an international perspective, skills mismatch and over-qualification has increased in the UK, EU and US[56, 57], so the broad issue of skills underutilisation is not just a Scottish phenomenon. From a Scotland perspective, however, an important question remains over the extent to which skilled jobs are available and whether supply of skills is growing faster than demand[58]. There are also microeconomic[59] and macroeconomic[60] perspectives to consider concerning the extent to which having a highly-qualified workforce helps to reduce skills gaps: the proportion of establishments in Scotland with at least one skills shortage vacancy (a vacancy that is reported to be hard to fill because applicants lack relevant skills, qualifications, or experience) was 6% in 2017, which has risen from 3% in 2011[61], in spite of the improving skills profile of the population.

2.5 Living Healthy Lives

Health and socio-economic status are inextricably linked and this is well recognised. There are also important differences between equality groups and across geographies. Poor health in early life has been shown to have significant and long-term consequences that reach into adulthood.

Scotland's perinatal mortality rate – the rate of stillbirths and deaths of babies in the first week of life – has reduced by almost 25% in the past decade, from 7.4 per 1000 births in 2008, to 5.7 per 1000 births in 2017. However, there has been little overall change since 2013. In 2016/17, 18% of children had a concern recorded about at least one area of their development at their 27-30 month review. Reporting of developmental concerns was more prevalent among children looked after by their Local Authority, where the proportion rises to 38%.[62]

Significant progress has been made in reducing maternal smoking during pregnancy and child exposure to second-hand smoke. Smoking at the first antenatal appointment fell year on year and almost halved between 1998 (28.7%) and 2018 (14.4)[63] and 6% of children were reported to have been exposed to second-hand smoke in their home in 2017, compared to 12% in 2012[64]. While breastfeeding rates have increased over time, they continue to display a substantial gap by area deprivation. In 2017-18, 60% of babies born to mothers living in the least deprived areas of Scotland were breastfed by the time of their 6-8 week review, compared to 28% of babies born to mothers living in the most deprived areas[65].

Substance use among young people has reduced. Smoking has displayed the largest drop, but alcohol and drug use have also more than halved over the last decade in children. The percentage of S4 pupils who have ever drunk alcohol has steadily decreased since 2004 (86% girls; 83% boys) to 66% in 2015[66]. Drug use by S4 pupils in the last month has gradually decreased since 2002 (20% boys, 23% girls) to 11% in 2015[67].

Deprivation and gender play key roles in the number of years a person is expected to live in good health. Healthy life expectancy (HLE) in Scotland is the average number of years that a new born baby could be expected to live in good health. Males born in Scotland in 2015-2017 can expect to spend 62.3 years of their life in good health. This is 80.9% of their life expectancy (77.0 years). Females born in Scotland in 2015-2017 can expect to spend 62.6 years of their life in good health. This is 77.3% of their life expectancy (81.1 years). This represents an increase of 0.1 years for males since 2014‑2016 and a decrease of 0.7 years for females since 2014-2016. People in more deprived areas can expect to live shorter lives and spend fewer years in good health. In 2015-2017 the difference in HLE between the 10% most and 10% least deprived areas was 22.5 years for males and 23.0 years for females. Healthy Life Expectancy is also lower for men in 'other urban areas' (60.7 years) compared to remote rural areas (67.0 years). Although women also have a higher HLE in remote rural areas (65.5 years), female HLE was lowest in remote small towns (60.8 years)[68]. There have been methodology changes in the way HLE has been measured over time. However, longer term data suggests that HLE has historically increased over time since the 1980s, but there has been little indication of a continuing improving trend in recent years.

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In 2017, adults identifying their sexual orientation as lesbian, gay, bisexual or other reported differences in several health measures when compared to those identifying as heterosexual. LGBO adults reported a higher prevalence of having a limiting long-term condition (29%) than heterosexuals (23%), reported a higher smoking prevalence (24% compared to 18%), and reported slightly lower mental wellbeing[69, 70].

Premature mortality, defined as death from all causes, aged under 75, is an important indicator of the overall health of the population. Premature mortality was over 30% lower in 2017 than it was in 1999, falling from a rate of 633 per 100,000 people in 1999 to 425 per 100,000 people in 2017. However, premature mortality rates were 4 times higher in the most deprived areas compared to the least deprived.[71] Premature mortality is also most prevalent in large urban areas compared to rural areas, where mortality rates have consistently been lower.

There are dramatic deprivation-related health inequalities in Scotland. In 2017, below average mental wellbeing scores amongst adults were three times higher in the most deprived areas than in the least deprived. Heart attack admissions to hospital for those under 75 are twice as high for the most deprived decile, relative to the least deprived. Alcohol related mortality amongst those aged 45-74 is eight times higher in the most deprived areas compared to the least deprived areas. All-cause mortality for those aged 15‑44 is almost 7 times higher for the most deprived areas relative to the least deprived areas[72].

Over the last few years there has been an increase in deaths from certain causes, for example, an increase in older people dying due to dementia and Alzheimer's disease[73]. There has also been an increase in drug related deaths in recent years. 934 people lost their life to a drug related death in 2017, the highest number ever recorded and more than double the number recorded in 2007[74].

2.6 Community wellbeing in Scotland

Inclusive, empowered, resilient and safe communities are those that are functioning well economically, physically and socially. The places and neighbourhoods where people live and grow-up shape the opportunities people have and can influence their life course, and are increasingly recognised as important for physical and mental health and overall wellbeing.

Getting people connected is key. Evidence supports linkages between broadband and economic outcomes, including links with productivity growth, enterprise creation, international trade and innovation. Access to superfast broadband[75] has increased year on year, in both urban and rural areas. In 2018, 92% of homes and businesses in Scotland had superfast broadband coverage[76]. This is a 51% increase since 2014 (61%).

Between 2007 and 2017 over 9 in 10 adults viewed their neighbourhood as a very or fairly good place to live.[77]. A majority of adults described their neighbourhood as a very good place to live in 2017 (57%). However, those in more deprived areas were less likely to perceive their neighbourhood in the most positive terms. Just under three in ten adults (29%) in the 10% most deprived areas rated their area as a very good place to live, in comparison with 80% in the 10% least deprived areas. People in accessible or remote rural areas were most likely to describe their neighbourhood as a very good place to live (70% and 76% respectively). In comparison, 53% of those living in large urban areas rated their neighbourhood as very good. The percentage of households who report being either "very satisfied" or "fairly satisfied" with their housing has remained stable since 2012, at 92% in 2017[78].

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There is also a clear association between people's perceptions of their neighbourhood and feelings of safety. People who assessed their neighbourhood as a very poor place to live were less likely than those who rated their area as very or fairly good to say they felt safe walking alone after dark (35% compared with 84% in 2017)[79]. Feeling safe in a community is fundamental for individual and community resilience. The overall level of crime experienced by adults in Scotland in 2017-18 has fallen by 42% since 2008-09 (and 16% since 2016‑17) to the lowest level ever estimated[80]. The proportion of adults experiencing crime has also fallen from around one in five (20.4%) in 2008-09 to one in eight (12.5%) in 2017-18. However, the likelihood of experiencing crime in 2017-18 was relatively higher for those living in the 15% most deprived areas (18.0%) and people in urban locations (13.4%), with those aged 60 and over least likely to be victims (5.3%). There was no significant difference in the proportion of men and women who were victims of crime overall in 2017-18, although women are more likely than men to experience partner abuse and sexual assault.

Adults in Scotland generally hold positive views on the crime rate in their local area. The proportion of adults saying that their local crime rate had stayed the same or reduced in the past two years was 73% in 2017/18, compared to 76% in 2016/17 and 65% in 2006. In 2017/18, women (69%) and victims of crime (62%) were less likely to believe their local crime rate had stayed the same or fallen (compared to 76% of men and 74% of non-victims, respectively).[81]

Confidence in the justice system varies with age. In 2017-18, 81% of people aged 16 to 24 were confident that the Scottish Criminal Justice System, as a whole, makes sure everyone has access to the justice system if they need it. This compares to 71% for those aged 60 and over. There was no difference between men and women in relation to their perceptions of access to justice in 2017-18. This reflects the narrowing gap between men and women's perceptions of access to the justice system that has taken place since 2008‑09, when women were less confident than men (67% and 72% confident respectively). However, confidence in access to the justice system was lower for disabled people (68%, compared to 77% of non- disabled people) and those in the most deprived 15% areas in 2017-18, where 71% were confident, compared to 76% amongst the rest of Scotland.

There are high and increasing levels of cultural engagement in Scotland. In 2017, 84.5% of people attended and 78.1% participated in a cultural event or activity. However, some groups of society are not engaging in culture, as measured by current surveys, to the same extent as the wider population. People from more deprived areas, those with low levels of academic qualifications, and those with a long-term physical or mental health condition, have lower levels of cultural engagement compared with the national average. In terms of area deprivation, in 2017 there was a 15.9 percentage point difference in cultural attendance[82] between the 20% most and least deprived areas: 76.7% compared with 92.6% respectively. This gap has narrowed since 2014 when the gap was 20.3 percentage points. However, when looking at participation in cultural activities, the gap between the most and least deprived areas has increased[83] in recent years, up from a 18.7 percentage point gap in 2012 to a 24.0 percentage point gap in 2017.

Satisfaction with public services (local health services, schools and public transport) among people who use those services, is generally higher than that of the whole adult population, and is more stable over time. In 2017, satisfaction with both schools (87%) and public transport (76%) was higher among those who use these services, than the corresponding satisfaction level for the whole adult population. However, satisfaction with health services (83%) among users was similar to the whole adult population. Overall, adults living in urban areas and remote small towns were more satisfied with the quality of public services than those in accessible small towns and rural areas. This is mainly due to differences in satisfaction with public transport in remote and rural areas. Satisfaction with public transport in large urban areas was 79%, compared to only 48% in accessible rural areas.

Overall, the trend in satisfaction in public services has declined to 52% in 2017, from its peak of 66% in 2011, driven by a decline in satisfaction with each of the three public services[84]. Local schools have seen the largest fall, from 85% in 2011 to 70% in 2017[85]. While the number of people who were fairly or very dissatisfied with local schools has remained stable over the period, the decline in satisfaction is due to more people expressing a neutral opinion (neither satisfied nor dissatisfied) which has increased from 11% to 25%[86]. The percentage of people who described the overall care provided by their GP practice as "excellent" or "good" was 83% in 2017/18, and has also reduced over time from 90% in 2009/10.[87]

The proportion of people in Scotland agreeing that they can influence decisions affecting their local area is relatively low at 23% in 2017, though it has climbed 3 percentage points from 2007 when the data was first collected. People aged over 75 consistently have the lowest level of agreement that they can influence decisions (16% agreement in 2017). Similarly, those living in the most deprived 15% of areas in Scotland have lower levels of agreement (19% in agreement in 2017).[88] 

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