Midlothian Health and Social Care Partnership

Income, and the lack of it can affect people’s health in a number of different ways

• Material: Money buys goods and services that improve health. The more money families have, the better the goods and opportunities they can buy.
• Psychosocial: Managing on a low income is stressful. Comparing oneself to others and feeling at the bottom of the social ladder can be distressing, which can lead to biochemical changes in the body causing ill health.
• Behavioural: For various reasons, people on low incomes are more likely to adopt unhealthy behaviours – smoking and drinking, for example – while those on higher incomes are more able to afford healthier lifestyles.
• Reverse causation (poor health leads to low income): Health may affect income by preventing people from taking paid employment. Childhood health may also affect educational outcomes, limiting job opportunities and potential earnings.

Half of all people in Scotland living in poverty live in a working household.

The availability and the nature of employment affects people’s health.  In the past being involved in mining has had a considerable legacy, while more recently sedentary office work is also having an effect. 

 

Employment by Occupation for Midlothian residents

 

In-work income

Working Population: The economically active population was 48,100 which is 82.3% of total working age population in 2019. This is an increase from 2018 (81.8%) and 2017 (81.1%). The Scottish rate is 77.5% (2019). The public sector is the biggest local employer and over 50% of the working age population work in the City of Edinburgh.  20.2% of school leavers entered employment in 2019-20. This is the lowest percentage in the last five years but above the National average of 16.2%.

Earnings: Workers in Midlothian (by place of residence) consistently earn less than the Scottish median earnings per week. Midlothian full-time employed residents in 2020 earned on average £556.80 per week. This compares to the Scottish equivalent of £595, (a gap of £38.20) and UK of £587.10. This gap has increased from £25.80 in 2019, and £28.70 in 2018. 

Women’s earnings: Female full-time workers in Midlothian (by place of residence) earned on averages £49.90 less than the overall Midlothian full time employee average figure in 2020, £31.10 less in 2019 and £21.10 less in 2018.  

Employment: Between 2015 and 2019, there was an increase in the number of Midlothian residents in employee jobs from 29,000 to 31,000, 10,000 of which are part time. (Employee jobs exclude self-employed, government-supported trainees, HM Forces and farm-based agriculture.)  In 2019, Job Density (rate of jobs in location to population aged 16-64) remains below the Scottish average figures -  0.62 Midlothian to 0.82 Scotland and 0.87 The UK. 

 

Covid-19 and benefits

Covid-19 and lockdown have changed people’s employment and income. In February 2021, there were 3,085 people claiming out-of-work benefits in Midlothian, this represents 5.4% of the resident population aged 16-64. The proportion of people claiming out-of-work benefit is higher in Scotland and UK at 6.1% and 6.5% respectively. This is the highest proportion of claims since the 1990s. 

Furlough was a temporary scheme introduced by the UK government in the Spring of 2020 to stop people being paid off by their employers during lockdown. In February 2021, 6,700 people remained on furlough. There is a concern that furlough may be a precursor to redundancy with retail, hospitality and accommodation services vulnerable to job loses.

Midlothian Council set up the Food and Key Essentials Fund, paying grocery vouchers and fuel payments, in December 2020 using Scottish Government funding. In 11 weeks 5,140 applications were processed and 2099 applicants were referred to the 2 Citizens Advice Bureaus (Dalkeith and Penicuik) for further support. Many people were not previously known to Citizens Advice who were already dealing with an approximate 30% increased workload due to the impacts of Covid.

As of November 2020, 7,155 households in Midlothian were on universal credit of which 6,103 are in payment. Universal Credit replaces the following benefits into one monthly payment (or twice a month in Scotland if selected) Child Tax Credit, Housing Benefit, Income Support, Income-based Jobseeker’s Allowance (JSA), Income-based Employment and Support Allowance (ESA) & Working Tax Credits. Most claimants are now on Universal Credit. Transfers are triggered by a change of circumstances. 

As of April 2021, 5,069 people were receipt of Personal Independence Payment including where the payment has been suspended (e.g. due to hospital admission). This benefit is gradually replacing Disability Living Allowance. There are 2,372 people still in receipt of active Disability Living Allowance payments.

It will take some time to fully understand the impact of Covid-19 on employability due to time lags in the data and initiatives such as the Coronavirus Job Retention Scheme. The medium term effects on the economy and labour market from the exit of the UK from the European Union are also still to be fully understood.

 

Inequalities

People in our most deprived communities are more likely to die younger from every common cause of death. This makes inequalities a crosscutting theme and the reduction of inequalities a crosscutting goal for all service areas.

Inequalities are the unfair and avoidable differences in people’s health and wellbeing across social groups and between different population groups. Social determinants of health are the conditions in which we are born and in which we live and work. They can impact on our health and wellbeing and include childhood experiences, housing, education, social support, family income, employment, community and access to health services. 

Deprivation is a key determinant of differences in people’s health. Health and life expectancy both generally decline as deprivation increases. People affected by poverty and social disadvantage have poorer health outcomes, are more likely to die younger and are more likely to suffer ill-health than their neighbours with more resources.

People also experience disadvantage through, gender, social position, ethnic origin, geography, age and disability.

The Scottish Index of Multiple Deprivation (SIMD) 2020 is the Scottish Government’s tool for identifying places experiencing deprivation.  Rankings are relative not absolute. By identifying small areas where there are concentrations of multiple deprivation, policies and resources can be targeted at the places with greatest need. 

The SIMD identifies areas NOT individuals. Not everybody living in a deprived area is deprived and not all deprived people live in deprived areas. The SIMD uses data relating to seven aspects of life. It measures deprivation and not affluence. Financial poverty is treated as just one aspect of deprivation. 10 datazones in Midlothian were within the most deprived 20% datazones in Scotland:

• 2 datazone in the most deprived 5% - both in Dalkeith. 
• 1 datazone in the most deprived 5-10% - in Dalkeith
• 2 datazones in the most deprived 10-15% - in Easthouses and Mayfield
• 5 datazones in the most deprived 15-20% - in Straiton, Mayfield, Easthouses, North Gorebridge and Gorebridge & Middleton

Whilst all areas in the most deprived 20% were around Dalkeith, Mayfield, Easthouses and Gorebridge, areas in the most deprived 20 -30% were spread more widely including Thornybank, Penicuik and Newtongrange.

Population by 2020 SIMD Quintiles (1 = Most deprived, 5 = Least deprived)

	1	2	3	4	5	Total
East Lothian	5,322	30,878	24,371	26,602	20,727	107,900
Edinburgh	61,963	74,735	75,243	91,700	223,979	527,620
Midlothian	7,171	31,121	22,091	19,066	13,161	93,150
West Lothian	26,486	51,523	34,972	36,837	34,002	183,820
Lothian	100,942	188,257	156,677	174,745	291,869	912,490

Data source: Scottish Index of Multiple Deprivation  [Accessed Sept. 2021]

 

Some health inequalities in Midlothian in areas affected by social disadvantage:

Early death due to coronary heart disease	Hospital stay for a preventable reason	Difference in life expectancy	Prescription for anxiety/ depression	Children living in poverty:
55% higher	38% more likely	9 years shorter	30% higher	24%

Scottish data:

Women with a learning disability	Average age of death for a Homeless male	Average age of death for a Homeless female	Poverty rate after housing costs for person with a disability
Around 30% attend cervical screening	43 compared to 77 in general population	39 compared to 81 in general population	23% compared to 17% of people in a family without a disability

 

SIMD Data zone Quintiles by geography