Abstract
To explore variations in educational gradients or gaps between high- and low-preventable health conditions. This is one of the first European studies to test whether the association between socioeconomic status and morbidity is stronger for 10 high- than three low-preventable health conditions, by gender across 20 countries. The 2014 European Social Survey included questions on 11 health conditions experienced over the last 12 months, cancer at any age, and symptoms of depression during the last week. We include respondents from 20 countries (Nmen=12,073; Nwomen=13,488) aged 25 to 69. We estimated age-adjusted educational gradients on 13 conditions using logistic or OLS-regression stratified by country and gender, and high- and low-preventable pooled conditions variables on pooled country samples. Both among men and women the proportion of educational gaps were larger for the high-preventable than the low-preventable conditions in most countries, supporting the Fundamental Cause Theory (FCT) hypothesis. However, there was large variations in the number of significant associations across countries and between genders. In the pooled conditions and countries analysis, no associations were significant among the low-preventable conditions. For the high-preventable conditions there was a weak significant educational gap among men, and a weak but nevertheless more distinctive and complete sigificant educational gradient among women. In a first explorative comparative European analysis we found support for the FCT hypothesis. Thus, the FCT can be used on morbidity data classified as low- versus high-preventable. We recommend extending this framework with institutional theories to explain within- and between-country health inequalities.
Highlights
Since the 1980s social inequalities in health have been well documented both within and between countries in Europe and NorthAmerica
Link and Phelan (1995) considered contemporary research on health inequalities as moving from merely describing social patterns of disease towards attempting to understand the mechanisms that link social conditions to health. They argued for a move away from disease-proximate risk factors and towards contextualizing health risk: “investigators must (1) use an interpretive framework to understand why people come to be exposed to risk or protective factors and (2) determine the social conditions under which individual risk factors are related to disease” (Link and Phelan, 1995, pp. 83–84)
As the boxes depicting confidence intervals show, few conditions had a significant tripartite monotonous social gradient, i.e. significant differences between primary, secondary, and tertiary education for each condition that goes in one direction
Summary
Since the 1980s social inequalities in health have been well documented both within and between countries in Europe and NorthAmerica. Attempts to explain social inequalities in health have included a materialist theory, with an emphasis on inequalities generated by structure; a psychosocial theory, that emphasizes relative deprivation, and a behavioral-cultural theory, focusing on individual health agency and inequalities generated by consumption patterns (Elstad, 2000) These explanations all relate to the theoretical perspective of health determinants, defined by Elstad Knowledge, power, prestige and social connections were proposed as key, flexible resources – associated with variables such as SES, social networks, stigmatization, ethnicity, and gender – that could help individuals avoid multiple health risks and promote good health Inequalities in possessing these resources were considered to be a fundamental cause of inequalities in multiple disease outcomes across time and space – putting people at risk of risks, irrespective of the aforementioned societal changes (Link and Phelan, 1995). They implied that these measures of social position – SES, gender, ethnicity, and social capital – had an independent, causal link to inequalities in health outcomes rather than merely being a “confounding variable” or “placeholder” for yet undiscovered proximate factors (Lutfey and Freese, 2005; Phelan et al, 2004)
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