Economic inactivity and poor health in Scotland

This blog forms part of an academic fellowship that our Fellow, Hannah Randolph, completed at the Scottish Parliament Information Centre (SPICe). You can read more information in this SPICe briefing.

This blog summarises the key points of a briefing that explores the relationship between poor health and economic inactivity in Scotland. It uses data on the labour force, health trends, and NHS service wait times to understand how economic inactivity is related to poor health and how this relationship differs both in comparison to the rest of the UK and within Scotland.

What is economic inactivity?

The economic inactivity rate represents the proportion of the population that is not in work and is not ready to start work in the near future. While some types of inactivity are not causes for concern, like being in further education, others like poor health may reflect barriers to participation in paid work.

How do trends in economic inactivity and health differ between Scotland and rUK?

Rates of inactivity in Scotland and the rest of the UK (rUK) both trended downwards from 2001 to about 2015, when Scotland’s began to rise and the rest of the UK’s continued to fall (Chart 1). In contrast to rUK, Scotland’s inactivity rate actually fell during the pandemic, starting to rise again in 2023.

Chart 1: Trends in economic inactivity, Scotland and rUK

Source: Quarterly Labour Force Survey, 2001-2023
Notes: Economic inactivity is calculated among the working age population (16-64). Quarterly rates are smoothed using a rolling average across four quarters and may therefore differ from official statistics.

One potential reason for this divergence in inactivity trends for Scotland compared to rUK is differences in population health and health inequalities.

Poor health explains a larger proportion of economic inactivity in Scotland than in the rest of the UK (Chart 2). This reflects both a higher proportion of the population with long-term conditions or disabilities and a higher correlation between long-term conditions or disabilities and inactivity.

Chart 2: Percent of inactivity attributed to permanent ill health or disability, Scotland and rUK

Source: Quarterly Labour Force Survey, 2001-2023
Notes: Rates are calculated among the working age population (16-64). Quarterly rates are smoothed using a rolling average across four quarters.

How do trends in Scotland differ by personal characteristics?

Trends differ by gender, age, and level of education (Chart 3).

Chart 3: Percent of inactivity attributed to permanent ill health or disability by gender and age

Source: Quarterly Labour Force Survey, 2001-2023
Notes: Rates are calculated among the working age population (16-64). Quarterly rates are smoothed using a rolling average across four quarters.

Permanent illness or disability are typically cited as the reason for less than 10% of inactivity among young people (aged 15-24) although this figure has risen over the last few years.

In contrast, nearly 60% of inactivity among men 25-49 was attributed to permanent illness or disability at the end of 2023. This figure hovered around 60% in the early 2000s, then fell in the 2010s; it subsequently rose during the Covid-19 pandemic. Similar trends hold for men aged 50-64.

Inactivity due to ill health or disability has typically been lower for women than for men (explaining 20-40% of inactivity), and highest for women 50-64 compared to younger women.

While the proportion of inactivity attributed to ill health or disability spiked for women aged 25-49 during the pandemic and then fell back to pre-pandemic levels, the proportion for women aged 50-64 has risen since 2018 and is now very similar to the rate for men in the same age group (47-48%).

While education is not necessarily the primary driver of differences in the relationship between poor health or disability and inactivity, it may be seen as a proxy for other related factors like type of work and approximate level of income.

Those with degree-level or higher education qualifications make up a small but growing proportion of those inactive due to permanent poor health or disability. Conversely, those without qualifications made up over 50% of those inactive for this reason at the start of 2001, but only around 25% by the end of 2023.

What role is played by healthcare access?

One leading indicator of healthcare access is wait times for NHS A&E services. Rates of A&E attendances not meeting the four-hour statutory targets have increased sharply since the start of the pandemic in many health boards (Figure 1), indicating reduced healthcare access in these areas.

Figure 1: Percent of A&E wait times not meeting 4-hour statutory targets, January 2024

Source: Public Health Scotland
Notes: Site-level wait times have been aggregated to the health board level.

FAI analysis of A&E wait times combined with labour market data from the Annual Population Survey from 2014-2023 shows a positive correlation between reduced healthcare access in the past year and:

• Rates of long-term health conditions and disabilities; and
• Attribution of economic inactivity due to poor health or disability.

These relationships hold even when controlling for the health board and individual characteristics such as age, gender, level of education, and number of children in the household.

This relationship likely goes in both directions – reduced healthcare access is likely related to poorer health, while areas with lower average health quality face greater pressures on their healthcare services.

What’s next?

These findings emphasise that health policy is likely to impact employment outcomes, while employment policies should consider health drivers.

Areas where more evidence is needed include how different health interventions affect inactivity and how employability services can better support people with long-term health conditions and disabilities into work.

You can read the full briefing here.