Abstract
Repeated Norwegian cross-sectional data for the period 2005 to 2011 are used to compare sources of inequality in health, as represented by self-assessed health and obesity, with sources of inequality in lifestyles that are central to the production of health, as represented by physical activity, cigarette smoking and dietary behavior. Sources of overall inequality and socioeconomic inequality in these lifestyle and health indicators are compared by estimating probit models, and by decomposing the explained part of the associated Gini and concentration indices with respect to education and income. As potential sources of inequality, we consider education, income, occupation, age, gender, marital status, psychological traits and childhood circumstances. Our results suggest that sources of inequality in health are not necessarily representative of sources of inequality in underlying lifestyles. While education is generally an important source of overall inequality in both lifestyles and health, income is unimportant in all lifestyle indicators except physical activity. In several cases, education and income are clearly outranked by other factors in terms of explaining overall inequality, such as gender in eating fruits and vegetables and age in fish consumption. These results suggest that it is important to decompose both overall inequality and socioeconomic inequality in different lifestyle and health indicators. In indicators where other factors than education and income are clearly most important, policy makers should consider to target these factors to efficiently improve overall population health.Published: Online October 2015. In print December 2015.
Highlights
In Norway as in many other countries, reducing health inequalities represent a key goal for health policy (Commission on Social Determinants of Health, 2008; Norwegian Ministry of Health and Care Services, 2006)
A number of studies have employed decomposition of inequality techniques to consider the contribution of lifestyle indicators to inequality in health (e.g., Balia and Jones, 2008; Rosa Dias, 2009; Vallejo-Torres and Morris, 2010; Tubeuf et al, 2012)
The objective of this study has been to directly compare sources of inequality across important lifestyle and health indicators using the same sample of individuals with a common set of explanatory factors
Summary
In Norway as in many other countries, reducing health inequalities represent a key goal for health policy (Commission on Social Determinants of Health, 2008; Norwegian Ministry of Health and Care Services, 2006). Using British longitudinal data, Balia and Jones (2008) found that six observable lifestyle indicators in 1984/85 accounted for approximately 25% of the explained part of the Gini index for predicted mortality in 2003 Recognizing their importance to health, some studies have employed decomposition of inequality techniques directly on lifestyle indicators themselves, rather than health outcomes. Examples of such studies are CostaFont and Gil (2008) and Ljungvall and Gerdtham (2010), who both found significant income-related inequalities in obesity and Combes et al (2011), who found that alcohol consumption in Sweden is pro-rich
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