Key Points

  • Scotland is a much healthier place in which to live in the 21st century than it was in the 19th and 20th centuries as measured by rates of mortality.
  • Causes of death today are significantly different than those in the middle of the 20th century.
  • Despite that, Scotland has higher rates of mortality than most other west European countries, and rates of improvement have been slower. There has even been a significant increase in some, notably chronic liver disease, in the last twenty years.
  • Explanations for Scottish mortality rates have focused on social class effects which continue to generate significant inequalities in health.
  • There also seem to be ‘ecological’ effects such that Glasgow and Clydeside do significant worse in terms of ‘excess mortality’ than comparable cities and towns.
  • Explanations for these effects are tentative and hypothetical, and include differential out-migration, and epigenetic differences embedded in the population over time.