The impact of neoliberal "political attack" on health: the case of the "Scottish effect"

Int J Health Serv. 2011;41(3):501-23. doi: 10.2190/HS.41.3.f.


The health impact of neoliberal "shock treatment" has been explored in relation to the former USSR, but much remains to be done to ascertain its impact elsewhere. The authors consider the "Scottish Effect" in health-the unexplained excess mortality in Scotland, compared with the rest of Britain, after accounting for deprivation. A prevalent but as yet untested view is that this effect is linked to the neoliberal "political attack" against the organized working class, implemented by the post-1979 U.K. Conservative governments. The article begins to develop and test this view in the form of a "political attack hypothesis". It shows how the west of Scotland became a particular target for the political attack planned by the U.K. Conservative Party prior to its election in 1979; outlines how such an attack might affect health; and shows that after 1979 the United Kingdom as a whole was exposed to neoliberalism in a way other European nations were not and, crucially, that the west of Scotland was more vulnerable to its damaging effects than other U.K. regions. The authors conclude that it is now appropriate to explore more fully the role of neoliberal political attack in creating the "Scottish Effect" in health.

MeSH terms

  • Europe
  • Health Status*
  • Humans
  • Mortality
  • Politics*
  • Scotland / epidemiology
  • Social Change*
  • Social Class
  • Social Environment
  • Social Welfare
  • Socioeconomic Factors
  • Sociology, Medical
  • United Kingdom