Scotland: Call for action to prevent non-communicable diseases

One in five preventable premature deaths in Scotland are caused by non-communicable diseases (NCDs). As part of the public health priorities for the COVID-19 pandemic recovery, several Scottish public health organizations are calling for immediate and urgent action to prevent these diseases, which are caused in particular by tobacco, alcohol, soft drinks, and certain toxic foods.

As the 2021/22 parliamentary year begins, public health organisations have come together to call on the Scottish Government to respond urgently to prioritise public health.[1]While the fight against alcohol, tobacco, and overweight/obesity was the subject of action strategies in 2018 in Scotland, their implementation was slowed or even interrupted by the Covid-19 pandemic. In particular, the associations want to better regulate advertising and marketing concerning alcohol, junk food, and e-cigarettes, and they are calling for tax increases and a minimum unit price for alcohol.

The associations point out that, in addition to the health aspect, these NCDs caused by tobacco, alcohol, overweight, and obesity have serious consequences for the Scottish economy. Taking these different factors into account, estimates of the economic cost range between £5.6 billion and £9.3 billion each year.

The weight of tobacco in non-communicable diseases in Scotland

Non-communicable diseases (NCDs), such as cardiovascular and lung diseases, cancers, and diabetes, are the leading cause of death and disability in Scotland. In 2020, these NCDs were responsible for over 40,000 deaths, or over 62% of all deaths in Scotland.

Although smoking prevalence is declining across all regions of the UK, it remains highest in Scotland where 19% of the population aged 16 and over currently smoke.[2]Tobacco-related mortality accounts for just under a quarter of all these NCD deaths (9,360 deaths), a figure that remains very high despite its decline in recent years. According to a recent study published in BMC Public Health[3], smoking has not been the leading cause of preventable death in Scotland since 2014: obesity and excess body fat caused more deaths in Scotland than smoking. This is due to the success of tobacco control policies implemented in the country, which have significantly contributed to a steady decline in smoking prevalence in Scotland and across the UK.[4][5].

Tobacco, an important social marker

Non-communicable diseases also affect the quality of life of Scots and are a key cause of widening health inequalities. Scotland has one of the lowest healthy life expectancies in Western Europe, at just 61.8 years. This figure is 20 years lower in the most deprived communities than in the least deprived.[6]Smokers living in poverty are at significantly increased risk of developing non-communicable diseases and dying prematurely. They are four times more likely to be hospitalized as a result of their smoking, according to the report.

Smoking prevalence varies greatly depending on the individual's social and economic status. The rate is 32 % among the most disadvantaged quintile of the population compared to 6 % among the wealthiest, a gap that has widened since 2017 (27% vs 9%). The same observation is made regarding smoking during pregnancy: 29.3 % of pregnant women in the most disadvantaged neighborhoods are currently smokers at their first prenatal appointment, compared to 4.5 % in the least disadvantaged neighborhoods. Research conducted by Cancer Research UK warns that Scotland may not reach the target of a tobacco-free generation by 2034. Data shows that, if current trends continue, 12% of the population will still be smoking by 2034. The analysis also showed that without strong policy, in most deprived areas, up to 10% of the population could still be smoking by 2050.

Keywords: Scotland, smoking, non-communicable diseases, NCDs, poverty, society, health

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[1] Non-Communicable Disease Prevention: Priorities for 2021/22, ASH Scotland, September 2021, accessed 11 October 2021

[2] Report, The Scottish Health Survey, Scottish Government website, 2019 edition | volume 1 | main report A National Statistics Publication for Scotland 9 November 2020, accessed 11 October 2021

[3] Ho, F.K., Celis-Morales, C., Petermann-Rocha, F. et al. Changes over 15 years in the contribution of adiposity and smoking to deaths in England and Scotland. BMC Public Health 21, 169 (2021). doi.org/10.1186/s12889-021-10167-3

[4] Philip Emeka Anyanwu, PhD, Peter Craig, PhD, Srinivasa Vittal Katikireddi, FFPH, Michael James Green, PhD, Impact of UK Tobacco Control Policies on Inequalities in Youth Smoking Uptake: A Natural Experiment Study, Nicotine & Tobacco Research, Volume 22, Issue 11, November 2020, Pages 1973–1980, doi.org/10.1093/ntr/ntaa101

[5] Tobacco Free Generation, United Kingdom: Effectiveness of tobacco control policies on mortality, February 17, 2021, accessed October 11, 2021

[6] Challenge Poverty Week 2021 - Poverty and Tobacco, ASH Scotland, October 8, 2021, accessed October 11, 2021