Objective There is a prevalent, but as yet untested, view in Scottish society that the “Scottish Effect” (the excess mortality in Scotland after taking account of deprivation) is linked to the neo-liberal “political attack” against the organised working class implemented by the post-1979 UK Conservative governments. The objective is to develop and begin to test such a “political attack hypothesis”.

Design Development of a “political attack hypothesis” underpinned by social science literature on UK and Scotland, and by a theory of change connecting neo-liberal “political attack” and mortality. Identification of key respects in which the West of Scotland in particular would seem to have been more susceptible to negative impacts of “political attack” on key upstream determinants of mortality. Testing with relevant data.

Setting West of Scotland and comparison areas consisting of other UK and European de-industrialised areas.

Results The links between such neo-liberal “political attack” and adverse health outcomes are plausible and have been examined in other contexts, including the former USSR. Evidence from the Fraser Institute and Luxembourg Income Study indicates that a neo-liberal policy agenda was implemented in the UK to an extent not seen elsewhere in Europe. Authoritative historical accounts indicate that the West of Scotland became a particular target for the UK political attack planned by the Conservative Party prior to its election in 1979. They also suggest that Scotland was disproportionately vulnerable to its adverse effects. This is confirmed by data on industrial employment, on housing tenure and on voting trends (taken as an indication of an intensifying sense of disempowerment and loss of control within Scotland during the period in which the “Scottish Effect” is known to have emerged).

Conclusion There is some evidence to support a “political attack” hypothesis in relation to the Scottish Effect. The hypothesis offers an important avenue for further investigation. Similarly elaborated hypotheses may also have broader relevance to other contexts where a radical neo-liberal agenda has been implemented.