3. Structural vulnerabilities and deaths of despair in Scotland, 1980-2021

Deaths due to alcohol, drugs and suicides ('deaths of despair') have increased in alarming rates in Scotland since 1980. Today, Scotland has the highest rate of drug deaths in Europe. Here, we explore the socio-economic causes of these trends.

Population level and cohort specific trends in drug mortality in Scotland from 1980-2021 are compared to political and economic changes such as de-industrialisation, recessions and austerity. Focus on regional and cohort specific trends we highlight population groups most vulnerable to economic challenges. For years 2001-2021, we also calculate absolute and relative inequalities in mortality by small-area deprivation. Finally, clustering of health and social factors (e.g. employment, living conditions) among people who die from drugs are explored for the years 2009-2016.

Drug deaths are now the leading cause of mortality and inequalities in mortality among working age men in Scotland. Specific population groups, such as those born in 1965-1974 and 1975-1984 and those living in the most deprived areas have the highest mortality rates from drugs. These mortality trends coinciding with economic challenges, such as the de-industrialisation of 1980s, the 2007 recessions and following austerity policies.

The full economic effects of the pandemic are yet unknown, but in Scotland inequalities have widened and young people in particular may struggle to make up for lost educational, social and employment opportunities. To reduce deaths of despair, building back from the pandemic needs to focus on more equitable distribution of resources to develop 'wellbeing economies' prioritising human and ecological wellbeing above economic growth.