2025 Inequality Landscape
This is the second annual report from the Health Foundation funded Scottish Health Equity Research Unit (SHERU). This year we have split the report into two sections:
Part 1 provides a stock-take of key data that capture health inequality trends and the underpinning socio-economic conditions that shape population health in Scotland.
Part 2 offers a deep dive into deaths from drugs, alcohol and suicide and highlights young adult men experiencing socio-economic deprivation as a population group at high risk of these preventable deaths.
Overall, this report suggests there have been modest gains in some living-standards, including some hopeful signs of reductions in child poverty, but this is set against persistent, and in places deepening, structural inequalities that continue to drive poor health. Focusing on average outcomes paints a picture of men in Scotland doing relatively well but this obscures a subset of young adult men facing multiple socio-economic challenges who are at high risk of early, preventable deaths.
1. Progress on key trends: what changed this year?
Life expectancy & mortality: Both life expectancy and median income ticked up slightly from pandemic lows, but pre-pandemic stagnation looms large; inequality in key health indicators remains pronounced and shows, at best, only marginal narrowing.
Incomes & poverty: Median household income was higher in 2021–2024 than in 2020–2023 for most groups; pensioners were the exception. Methodological improvements now better capture the Scottish Child Payment, with early signs of child-poverty reduction. However, families with three or more children, households with disabled members, and households in rural areas are not seeing the same gains, and interim child poverty targets were not met.
Housing & homelessness: Homelessness applications dipped slightly in 2024–25, despite an overall upward trend in recent years, with temporary accommodation rising to unprecedented levels amid evidence of overcrowding, disrepair, and safety concerns. Targets for affordable homes remain a long way from being met in the context of what the Scottish Government has declared is a housing emergency. Damp/condensation and mould have increased in rented sectors and, while new laws should strengthen social-landlord duties, similar obligations are not yet planned for private renting.
Education & early years: The gap in developmental concerns at 27–30 months narrowed slightly over the last year but remains wide. School attainment gaps show limited improvement, while other indicators of childhood inequality remain stubbornly high. Attendance gaps persist, with higher levels of disengagement among disadvantaged pupils further reinforcing inequalities. In 2025, higher education participation rates for the 20% least and most deprived remained largely unchanged from the previous year, despite a slight widening of the gap.
Labour market & earnings: Survey quality issues mean there is some uncertainty as to whether economic inactivity is increasing to the degree that the statistics imply, which leaves policymakers struggling to make evidence-based decisions. Earnings data indicate small real-terms gains at the bottom and middle and declines at the top decile, narrowing, but not closing, the gap. Qualitative accounts highlight the need for tailored approaches to support people with health issues to stay in work.
Headline message: modest improvements in incomes and some child-poverty measures are not yet translating into material reductions in health inequality. Structural drivers – housing insecurity and quality, working conditions, and the long shadow of austerity – continue to shape outcomes.
2. Young adult men and preventable deaths
Scotland’s rates of drug-related deaths, alcohol-specific deaths and deaths from suicide remain the highest in the UK, with drug misuse mortality among the highest in Western Europe; around 70% of deaths across these causes were among men in 2023. The burden is concentrated in the most deprived communities and contributes to Scotland’s stark male life-expectancy gap (13+ years between the most and least deprived).
The report argues that young adult men at heightened risk are a policy ‘blind spot’: while they often ‘average’ well on income and employment, a subset experience compounding exclusion across work, housing, justice and mental health. Contact points – homelessness presentations, police/justice interactions, or A&E – typically occur after crises emerge, missing the preventative ambition of Scottish policy.
Two international examples of prevention: Ireland’s cross-government suicide-prevention governance strategy and Iceland’s community-led prevention model both demonstrate what is possible when national coordination, data, and local delivery align. The immediate challenges for Scotland are to: (1) strengthen the evidence base to track at-risk trajectories across systems; and (2) create robust, cross-sector governance so prevention is embedded in national policy and budgets, with a strong focus on delivery and implementation. Taken together, these examples suggest that Scotland will only deliver its long-standing ambition of prioritising prevention by improving cross-sector collaboration and tackling fragmentation between local and national bodies.
Overall conclusion: Scotland has begun to stabilise some indicators of living-standards but average trends obscure the fact that progress is not evenly distributed. As we show in Part 2, some young adult men facing disadvantage are at high risk of preventable deaths and yet seem to constitute a policy ‘blind spot’. A more joined-up, preventative approach to housing, income security, work quality and early intervention is urgently needed to tackle health inequalities. The path forward requires both targeted upstream investment and governance mechanisms to ensure that joined-up policy approaches are effectively implemented. Without these changes, the Scottish Government cannot credibly drive the action needed for long-term progress.