Changing places? A comparative analysis of area-based health trends in Scotland through the 1980s and 1990s.

摘要

OBJECTIVES: Have places in Scotland with the worst/best levels of health and the worst/best experience of health determinants changed since the early 1980s? Twenty-year trends and local-level changes in a selection of health-related indicators were examined to answer this question. STUDY DESIGN AND METHODS: Routine data for seven health-related indicators, principally derived from Scottish government 'social justice milestones', were collated and analysed at postcode-sector level across four 5-year periods covering the 1980s and 1990s. Analysis was carried out by decile, deprivation quintile, individual postcode sector and for selected 'regeneration areas'. RESULTS: There was little change in the ranking of areas with the worst and best health in Scotland over the 20-year period. The worst and best initial deciles remained in those positions throughout, while analysis by deprivation showed that the most disadvantaged areas had become relatively worse over the period. The regeneration areas, with one exception, showed little long-term improvement across the indicators. However, a number of postcode sectors across Scotland did buck this overall trend. CONCLUSIONS: This study confirmed the enduring nature of health differences between areas in Scotland, and provided further evidence of widening health inequalities between affluent and deprived areas. The positive experiences of a small number of areas may warrant further investigation since they may hold important lessons for area-based health improvement. The research highlights the potential of this type of analysis to monitor and evaluate area-based initiatives.