“We are asking for social security to be increased. We want a reduction in the poverty rate…we know that poverty is incredibly damaging for people’s health”, says Gerry McCartney from the Public Health Observatory.

Life expectancy across Scotland had been increasing since 1945. But in 2012, those improvements started to slow and then, in the last three years, go backwards.

The reason, according to one of Scotland’s leading public health analysts, is the UK Government’s policy of austerity pursued since 2010 and the ensuing cuts to the social security system.

Gerry McCartney is head of the Scottish Public Health Observatory, part of public health promotion organisation NHS Health Scotland, and an expert in life expectancy.

He tells healthandcare.scot that spending policies come at a price:

“We know there have been a number of restrictions to the social security system for the last nine years or so, and that has had a lot of implications for people’s incomes, their security of income and ultimately their health.”

Funding squeezes for public services are also partly to blame, he says, explaining countries taking a ‘more austere’ approach to economic policy after the 2008 recession saw “worse health trends and wider health inequalities”.

Investigating each change that has taken place since 2010 is difficult because researchers do not have access to DWP data that would allow each individual’s experience to be tracked.

But the surveys that do exist show universal credit and restrictions to single parents’ benefits have been “particularly bad”.

The life expectancy advisor adds: “We know that the areas which have seen the biggest cutbacks in social security spending – for example pension credit – have seen the worst trends for mortality outcomes.”

“We’ve also got quite a number of high-quality qualitative studies when we’ve interviewed people and understood their experiences.

“They described in great detail how the changes to social security system – in terms of the value of the benefits the delays in getting the benefits, a lack of certainty around it, the conditions introduced – have all been damaging for the health.”

Asked if it’s possible to put a figure on the number of excess deaths, he says:

“The studies on austerity and health outcomes only really look up to 2015 and so we think that they are probably underestimating the impact because trends have continued to diverge beyond that

“So, we are currently designing a study to look at that in more detail, which will give us a closer estimate of the total impact of [austerity], that should be ready sometime next year.”

Researchers believe the fraying of the social security safety net lies behind life expectancy stalling because it could explain why trends have changed negatively for “almost all causes of death”.

This includes deaths caused by drugs, which have risen to the highest level on record.

“Drug-related deaths are particularly tragic,” the population health specialist continues, “because they impact so much on younger adults who we do not expect to be dying at the rate they are.

“Lots and lots of factors impact on how likely people with substance misuse issues are to die. It’s a group that is particularly affected by poverty, by insecurity of housing and rough sleeping, and struggles to be well-served by our services.

“By meeting those needs we can we think we can reduce the rate of drug-related deaths in Scotland.”

When it’s suggested that many of the factors that affect health – housing and social security – are outside the health service’s control, Mr McCartney insists the NHS still has “lots of influence”.

It can use its position as the largest employer in Scotland and major purchaser of goods and services, he argues, to shape the broader social determinants of health.

This chimes with previous suggestions that the NHS could make a ‘far greater contribution’ to reducing poverty and health inequalities by helping groups at risk of unemployment get into work and by spending locally.

“There’s also lots that we can do to improve the accessibility of our service,” says Mr McCartney, “addressing those unmet needs affect our poorest communities most.

“So, we need to work hard as an NHS to ensure that our services are provided according to need and are accessible to those who have the greatest needs.”

Ultimately, Mr McCartney is clear about the changes his organisation wants to see:

“We are asking for social security to be increased. We want a reduction in the poverty rate. Many people who are reliant on social security benefits as their income are in poverty and we know that poverty is incredibly damaging for people’s health”.

Modelling by NHS Health Scotland has previously suggested transferring income to the poorest is one of the best ways to reduce ill-health and health inequalities across society.

Options researchers assessed included increasing the value of all means-tested benefits by half and bringing in a citizens’ basic income – where everyone would be paid a cash sum with no strings attached.

And while the organisation does not have an “advocacy view” when it comes to specific reforms, Mr McCartney says the modelling shows “any of the interventions that increased the income of those in the poorest groups…had quite substantial positive impacts on overall mortality and hospital admissions”.

So, is the Scottish Public Health Observatory straying into politics?

“We don’t take political positions, we’re NHS employees,” he responds.

“What we do is try and speak to the evidence and make sure that we tell the truth.

“It’s quite clear what the evidence says: it’s that poverty and income really, really matter to health.”