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Background: Worrying changes in life expectancy trends have been observed recently in the UK, largely attributed to austerity policies introduced over the last decade. To incorporate changes to quality, rather than just length of, life, our aim was to describe trends in healthy life expectancy (HLE) for the relevant period. Methods: In the absence of available long-term trends, we calculated new estimates of HLE for Scotland for the period 1995–2019, using standard HLE methodologies based on mortality and national survey data, and stratified by sex and socioeconomic deprivation. Results: Overall, male and female HLE increased markedly between 1995 and 2009, but then decreased by approximately 2 years between 2011 and 2019. A decline was observed for the most and least deprived groups, but this was larger for those living in the 20% most deprived areas, where the decrease was 3.5 years. Conclusions: Our findings are further evidence of changing levels of pre-pandemic population health in the UK. An increasing body of UK and international evidence have attributed these changes to UK Government austerity policies. There is an urgent need, therefore, to reverse cuts to social security and protect the income and health of the poorest across all of the UK.

Background: While the heterogeniety of pain progression has been studied in chronic diseases, it is unclear the extent to which patterns of pain progression among people in general as well as across different diseases impacts on social, civic and political engagement. We explore these issues for the first time. Methods: Using data from the English Longitudinal Study of Ageing, latent class growth models were used to estimate trajectories of self-reported pain in the entire cohort, and within subsamples reporting diagnoses of arthritis and cancer. These were compared at baseline on physical health (e.g., BMI, smoking) and over time on social, civic and political engagement. Results: Very similar four trajectory models fit the whole sample and arthritis subsamples, whereas a three trajectory model fit the cancer subsample. All samples had a modal group experiencing minimal chronic pain, and a group with high chronic pain that showed slight regression (more pronounced in cancer). Biometric indices were more predictive of the most painful trajectory in arthritis than cancer. In both samples the group experiencing the most pain at baseline reported impairments in social, civic and political engagement. Conclusions: The impact of pain differs between individuals and between diseases. Indicators of physical and psychological health differently predicted membership of the trajectories most affected by pain. These trajectories were associated with differences in engagement with social and civic life, which in turn was associated with poorer health and well-being.

This book reveals the extent, types, investigation, enforcement and governance of international corruption. Providing a unique international coverage, it reveals the limits of current anti-corruption strategies and explores the involvement of western democratic states in corruption.

BACKGROUND: The mortality impact of COVID-19 has thus far been described in terms of crude death counts. We aimed to calibrate the scale of the modelled mortality impact of COVID-19 using age-standardised mortality rates and life expectancy contribution against other, socially determined, causes of death in order to inform governments and the public. METHODS: We compared mortality attributable to suicide, drug poisoning and socioeconomic inequality with estimates of mortality from an infectious disease model of COVID-19. We calculated age-standardised mortality rates and life expectancy contributions for the UK and its constituent nations. RESULTS: Mortality from a fully unmitigated COVID-19 pandemic is estimated to be responsible for a negative life expectancy contribution of −5.96 years for the UK. This is reduced to −0.33 years in the fully mitigated scenario. The equivalent annual life expectancy contributions of suicide, drug poisoning and socioeconomic inequality-related deaths are −0.25, −0.20 and −3.51 years, respectively. The negative impact of fully unmitigated COVID-19 on life expectancy is therefore equivalent to 24 years of suicide deaths, 30 years of drug poisoning deaths and 1.7 years of inequality-related deaths for the UK. CONCLUSION: Fully mitigating COVID-19 is estimated to prevent a loss of 5.63 years of life expectancy for the UK. Over 10 years, there is a greater negative life expectancy contribution from inequality than around six unmitigated COVID-19 pandemics. To achieve long-term population health improvements it is therefore important to take this opportunity to introduce post-pandemic economic policies to 'build back better'.

Background: The mortality impact of COVID-19 has thus far been described in terms of crude death counts. We aimed to calibrate the scale of the modelled mortality impact of COVID-19 using age-standardised mortality rates and life expectancy contribution against other, socially determined, causes of death in order to inform governments and the public. Methods: We compared mortality attributable to suicide, drug poisoning and socioeconomic inequality with estimates of mortality from an infectious disease model of COVID-19. We calculated age-standardised mortality rates and life expectancy contributions for the UK and its constituent nations. Results: Mortality from a fully unmitigated COVID-19 pandemic is estimated to be responsible for a negative life expectancy contribution of −5.96 years for the UK. This is reduced to −0.33 years in the fully mitigated scenario. The equivalent annual life expectancy contributions of suicide, drug poisoning and socioeconomic inequality-related deaths are −0.25, −0.20 and −3.51 years, respectively. The negative impact of fully unmitigated COVID-19 on life expectancy is therefore equivalent to 24 years of suicide deaths, 30 years of drug poisoning deaths and 1.7 years of inequality-related deaths for the UK. Conclusion: Fully mitigating COVID-19 is estimated to prevent a loss of 5.63 years of life expectancy for the UK. Over 10 years, there is a greater negative life expectancy contribution from inequality than around six unmitigated COVID-19 pandemics. To achieve long-term population health improvements it is therefore important to take this opportunity to introduce post-pandemic economic policies to 'build back better'.

In this commentary we explore the potential for the devolved Scottish Government to achieve its stated aim of narrowing health - and broader societal (including economic) - inequalities within both the restrictions of limited devolved powers, and in the context of post-pandemic uncertainty. We do so by focussing on two questions: first, where were we with regards to inequalities policy in Scotland before the pandemic? And second, what are the likely implications of the pandemic for inequalities, and inequalities policymaking, in the country?

BACKGROUND: 'Adverse childhood experiences' (ACEs) are associated with increased risk of negative outcomes in later life: ACEs have consequently become a policy priority in many countries. Despite ACEs being highly socially patterned, there has been very little discussion in the political discourse regarding the role of childhood socioeconomic position (SEP) in understanding and addressing them. The aim here was to undertake a systematic review of the literature on the relationship between childhood SEP and ACEs. METHODS: MEDLINE, PsycINFO, ProQuest and Cochrane Library databases were searched. Inclusion criteria were: (1) measurement of SEP in childhood; (2) measurement of multiple ACEs; (3) ACEs were the outcome; and (4) statistical quantification of the relationship between childhood SEP and ACEs. Search terms included ACEs, SEP and synonyms; a second search additionally included 'maltreatment'. Overall study quality/risk of bias was calculated using a modified version of the Hamilton Tool. RESULTS: In the ACEs-based search, only 6 out of 2825 screened papers were eligible for qualitative synthesis. The second search (including maltreatment) increased numbers to: 4562 papers screened and 35 included for synthesis. Eighteen papers were deemed 'high' quality, five 'medium' and the rest 'low'. Meaningful statistical associations were observed between childhood SEP and ACEs/maltreatment in the vast majority of studies, including all except one of those deemed to be high quality. CONCLUSION: Lower childhood SEP is associated with a greater risk of ACEs/maltreatment. With UK child poverty levels predicted to increase markedly, any policy approach that ignores the socioeconomic context to ACEs is therefore flawed.

Background:While the heterogeniety of pain progression has been studied in chronic diseases, it is unclear the extent to which patterns of pain progression among people in general as well as across different diseases impacts on social, civic and political engagement. We explore these issues for the first time.Methods:Using data from the English Longitudinal Study of Ageing, latent class growth models were used to estimate trajectories of self-reported pain in the entire cohort, and within subsamples reporting diagnoses of arthritis and cancer. These were compared at baseline on physical health (e.g., BMI, smoking) and over time on social, civic and political engagement.Results:Very similar four trajectory models fit the whole sample and arthritis subsamples, whereas a three trajectory model fit the cancer subsample. All samples had a modal group experiencing minimal chronic pain, and a group with high chronic pain that showed slight regression (more pronounced in cancer). Biometric indices were more predictive of the most painful trajectory in arthritis than cancer. In both samples the group experiencing the most pain at baseline reported impairments in social, civic and political engagement.Conclusions:The impact of pain differs between individuals and between diseases. Indicators of physical and psychological health differently predicted membership of the trajectories most affected by pain. These trajectories were associated with differences in engagement with social and civic life, which in turn was associated with poorer health and well-being.

Date of Acceptance: 10/07/2015 The Chief Scientist Office of the Scottish Government Health and Social Care Directorates funds HERU. The survey was jointly funded by NHS Health Scotland and the Glasgow Centre for Population Health. The views expressed in this paper are those of the authors only and not those of the funding bodies. The investigator team for the overall survey comprises David Walsh, Gerry McCartney, Sarah McCullough, Marjon van der Pol, Duncan Buchanan and Russell Jones. ; Peer reviewed ; Postprint

This paper examines the association between housing tenure mix and health outcomes for urban residents. The analysis used Cox's proportional hazard regression modelling with a range of health measures from two waves of the Scottish Health Survey plus linked hospital morbidity records for the survey respondents. There was no consistent pattern in health outcomes according to housing tenure mix. For specific health issues, particular types of neighbourhood had significantly different (worse) outcomes: areas with a sizeable social renting sector for self-reported health; areas with a sizeable social- or private-renting sector for accidents; and areas dominated by social renting for alcohol-related illnesses. There are indications that adjustments to the tenure mix of social housing areas might lead to improvements in some health outcomes: improved mental health and reduced smoking, via a reduction in area deprivation; and reduced alcohol-related illnesses due to possible effects of tenure mix on material context and culture.