Measuring Health Vulnerability: An Interdisciplinary Indicator Applied to Mainland Portugal.

Oliveira Oliveira,Vidal Vidal,Maia Maia,Calheiros Calheiros,Ferraz Ferraz,Pontes Pontes,Barreira Barreira,Cabeda Cabeda

doi:10.3390/ijerph16214121

Abstract

Health promotion and inequality reduction are specific goals of the United Nations 2030 Agenda, which are interconnected with several dimensions of life. This work proposes a composite index SEHVI—socioeconomic health vulnerability index—to address Portuguese population socioeconomic determinants that affect health outcomes. Variables composing SEHVI are aligned with the sustainable development goals considering data and times series availability to enable progress monitoring, and variables adequacy to translate populations’ life conditions affecting health outcomes. Data for 35 variables and three periods were collected from official national databases. All variables are part of one of the groups: Health determinants (social, economic, cultural, and environmental factors) and health outcomes (mortality indicators). Variables were standardized and normalized by “Distance to a reference” method and then aggregated into the SEHVI formula. Several statistical procedures for validation of SEHVI revealed the internal consistency of the index. For all municipalities, SEHVI was calculated and cartographically represented. Results were analyzed by statistical tests and compared for three years and territory typologies. SEHVI differences were found as a function of population density, suggesting inequalities of communities’ life conditions and in vulnerability to health.

Highlights

Equity in health was defined by Margaret Whitehead in 1991, and is an utmost issue related to an unfair and uneven distribution of healthcare [1]
SEHVI was designed in the scope of the United Nations 2030 Agenda for Sustainable Development with the purpose to evaluate how socioeconomic and environmental determinants constrain life conditions, namely health and wellbeing outcomes
The major contribution of this study is the development of an index to evaluate health vulnerability as a function of health determinants and health outcomes at a local scale

Summary

Introduction

Equity in health was defined by Margaret Whitehead in 1991, and is an utmost issue related to an unfair and uneven distribution of healthcare [1]. Individual health condition is no longer considered only as a consequence of biological causes as previous studies [5,8,9,10,11] indicate that it is influenced by social, environmental, cultural, political, and economic factors. These factors include housing quality, access to healthcare and education, work conditions, environmental quality, sanitation availability, and safety [12,13]. Public Health 2019, 16, 4121; doi:10.3390/ijerph16214121 www.mdpi.com/journal/ijerph

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