In July 2027, the world’s most powerful financial decision-makers will gather at the Edinburgh International Conference Centre for the G20 Finance Ministers and Central Bank Governors meeting.
It is a significant moment for Scotland – recognition of Edinburgh’s standing as a global financial capital, a city whose financial sector employs over 157,000 people and generates £17.7 billion a year for the Scottish economy.
But as Scotland sees the world’s leaders land on its doorstep – will it step up to the demographic and ageing challenges that will shape its future.
Population decline: The National Records of Scotland projects that Scotland’s overall population will begin to decline from around 2034. But some areas are already there. Of the 18 UK local authorities where the population is currently falling rather than growing, five are in Scotland: Argyll and Bute, Angus, Dundee, Na h-Eileanan Siar (the Western Isles) and Dumfries and Galloway – all places where deaths now outnumber births, and where inward migration is not filling the gap.
ILC’s Better Lives Index ranks 359 UK local authorities on nine measures, from life expectancy and child poverty to housing costs and economic activity across the life course. It paints a picture of a country where parts are thriving while other areas struggle.
Inequalities in life expectancy: Inequalities in Scotland is not a new story. But they persist. East Renfrewshire ranks 30th out of 359 on the index – a top-decile performer, with life expectancy at birth of 82.8 years. Its neighbour, Glasgow City, ranks 272nd, with life expectancy of 76.2 years. The gap between them is nearly seven years of life, but they are only ten miles apart.
Healthy life expectancy is below State Pension age: According to the National Records of Scotland, healthy life expectancy – the years Scots can expect to live in good health – now stands at just 59.1 years for men and 59.4 years for women. That is below the State Pension age of 66.
In Dumfries and Galloway, one of the five councils already losing people, healthy life expectancy is 58.9 years. In Glasgow, the figure for men is 54.75 years.
Ill health is related to economic inactivity: As we age and move through our fifties and sixties, the economic consequences compound. Scotland’s economic inactivity rate among 50–64-year-olds runs at 28.1%, above the UK average of 26.9%. More than 860,000 people are on NHS waiting lists in Scotland.
Research by the Scottish Parliament’s own information service found that NHS wait times are a leading indicator for economic inactivity. People waiting for treatment may not be able to work; when they cannot work they may become welfare-dependent; the longer they wait, the harder the return.
Some waiting times in Scotland are extraordinary – gynaecology in Lothian currently runs at over 90 weeks. Conditions such as endometriosis, which can cause pain, fatigue and heavy bleeding, can drive significant absence from work. It is not difficult to see why Scotland’s economic inactivity rate has been persistently above the UK average since 2016.
Drug deaths are high: Scotland’s drug death rate is the highest in Europe: 1,133 deaths in 2025, up 11% on the previous year, and 15 times higher in Scotland’s most deprived communities than in its least deprived. The councils with the worst drug death rates are, almost without exception, the same councils that rank lowest in the Better Lives Index and those that are already losing people.
How is the Scottish Government responding?
First Minister John Swinney has described his proposal to replace Scotland’s 14 territorial health boards with just two – one east, one west – as “the most significant structural reform of our NHS in the devolution era.”
There is logic in reducing duplication. But the data raises a pointed question. Waiting times vary dramatically within Scotland, with some health boards carrying some of the longest lists in the UK. A geographic east-west split does not obviously address that within-Scotland disparity.
The five councils losing people are scattered across both halves of the map, all in the bottom fifth of the Better Lives Index. What they share is not geography but deprivation, poor health outcomes, and low workforce participation.
What happens now
In Scotland, healthy life expectancy is below State Pension age. Drug deaths are the highest in Europe. The population of five councils are already shrinking. And Scotland spends more than almost anywhere else in the UK while struggling to produce good health outcomes.
The debate about why – and what to do about it – is the one Scotland needs to have. Engaging honestly with the evidence is not “talking down Scotland.” It is what is required for things to get better.
The G20 meeting hosted in Edinburgh is not just a platform for Edinburgh to showcase its financial credentials. It is an opportunity to lead a harder conversation about how long-term trends can be addressed, how a longevity dividend can be driven and how to drive an investment in prevention.
ILC will be coming to Edinburgh to urge finance ministers to create a “finance ministers for ageing coalition”. Addressing the inequalities in our experience of ageing should be at the top of their list for action.
David Sinclair is Chief Executive of the International Longevity Centre