Determinants Of Health Inequalities Research Articles

Evolving trends, regional differences, determinants, and disease sources of provincial-level health inequalities in china 1990–2019: a temporal convergence and novel triple decomposition analysis

BackgroundPromoting health equity has been a worldwide goal, but serious challenges remain globally and within China. Multiple decomposition of the sources and determinants of health inequalities has significant implications for narrowing health inequalities and improve health equity.MethodsLife expectancy (LE), healthy life expectancy (HALE), age-standardized mortality rate (ASMR), and age-standardized disability-adjusted life-year (DALY) rates in 31 provinces of mainland China were selected as health status indicators, obtained from the Global Burden of Disease (GBD) database. Temporal convergence analysis was used to test the evolving trends of health status. Dagum’s Gini coefficient decomposition was used to decompose the overall Gini coefficient based on intraregional and interregional differences. Oaxaca-Blinder decomposition was used to calculate contributions of determinants to interregional differences. The factor-decomposed Gini coefficient was used to analyze the absolute and marginal contribution of each component to overall Gini coefficients.ResultsFrom 1990-2019, China witnessed notable improvements in health status measured by LE, HALE, ASMR and age-standardized DALY rates.Nevertheless, the three regions (East, Central and West) exhibited significant inter-regional differences in health status, with the differences between the East and West being the largest. The adjusted short-term conditional β-convergence model indicated that the inter-provincial differences in LE, HALE, ASMR, and age-standardized DALY rates significantly converged at annual rates of 0.31%, 0.35%, 0.19%, and 0.28% over 30 years. The overall Gini coefficients of LE, HALE, and age-standardized DALY rates decreased, while the ASMR exhibited an opposite trend. Inter-regional and intra-regional differences accounted for >70% and<30% of overall Gini coefficients, respectively. Attribution analysis showed that socioeconomic determinants explained 85.77% to 91.93% of the eastern-western differences between 2010-2019, followed by health system determinants explaining 7.79% to 11.61%. The source-analysis of Gini coefficients of ASMR and age-standardized DALY rates revealed that noncommunicable diseases (NCDs) made the largest and increasing absolute contribution, while communicable, maternal, neonatal, and nutritional diseases (CMNNDs) had a diminishing and lower impact. However, NCDs exerted a negative marginal effect on the Gini coefficient, whereas CMNNDs exhibited a positive marginal effect, indicating that controlling CMNNDs may be more effective in reducing health inequities.ConclusionsRegional differences are a major source of health inequities in China. Prioritizing prevention and control of CMNNDs, rather than NCDs, may yield more pronounced impacts on reducing health inequalities from the perspective of marginal effect, although NCDs remain the largest absolute contributor to health inequalities.

Reporting of determinants of health inequities and participant characteristics in randomized controlled trials of juvenile idiopathic arthritis in Canada: a scoping review

BackgroundJuvenile Idiopathic Arthritis (JIA) is the most common form of childhood inflammatory arthritis. The disease burden of JIA is substantial as patients require specialized medical practitioners for diagnosis and chronic treatments that are both costly and time intensive. Discrepancies in access to care due to health inequities such as socioeconomic status or geographic location may lead to vastly different health outcomes. As research informs advances in care, is important to consider inclusion and diversity in JIA research.MethodsWe reviewed and synthesized randomized controlled trials for juvenile idiopathic arthritis, the most common type of arthritis among children and adolescents, in Canada with the aim of characterizing participants and identifying how determinants of health inequities are reported. To do so, we searched Medline (1990 to July 2022), Embase (1990 to July 2022), and CENTRAL (inception to July 2022) for articles meeting all of the following criteria: Canadian randomized controlled trials evaluating pharmacological or non-pharmacological interventions on juvenile idiopathic arthritis populations. Data extraction was guided by the Campbell and Cochrane Equity Methods Group’s PROGRESS-Plus framework on determinants that lead to health inequities (e.g., Place of residence; Race; Occupation; Gender/Sex; Religion; Education; Socioeconomic status; and Social capital).ResultsOf 4,074 unique records, 5 were deemed eligible for inclusion. From these determinants of health inequities, Gender/Sex and Age were the only that were reported in all studies with most participants being female and 12.6 years old on average. In addition, Race, Socioeconomic status, Education and Features of relationships were each reported once in three different studies. Lastly, Place of residence, Occupation, Religion, Social Capital and Time-dependent relationships were not reported at all.ConclusionsThis scoping review suggests limited reporting on determinants of health inequities in randomized controlled trials for JIA in Canada and a need for a reporting framework that reflects typical characteristics of juvenile patient populations.

A holistic model of health inequalities for health policy and state administration: a case study in the regions of the Czech Republic

BackgroundHealth inequities exist within and between societies at different hierarchical levels. Despite overall improvements in health status in European Union countries, disparities persist among socially, economically, and societally disadvantaged individuals. This study aims to develop a holistic model of health determinants, examining the complex relationship between various determinants of health inequalities and their association with health condition.MethodsHealth inequalities and conditions were assessed at the territorial level of Local Administrative Units (LAU1) in the Czech Republic. A dataset of 57 indicators was created, categorized into seven determinants of health and one health condition category. The necessary data were obtained from publicly available databases. Comparisons were made between 2001–2003 and 2016–2019. Various methods were employed, including composite indicator creation, correlation analysis, the Wilcoxon test, aggregate index calculation, cluster analysis, and data visualization using the LISA method.ResultsThe correlation matrix revealed strong relationships between health inequality categories in both periods. The most significant associations were observed between Economic status and social protection and Education in the first period. However, dependencies weakened in the later period, approaching values of approximately 0.50. The Wilcoxon test confirmed variations in determinant values over time, except for three specific determinants. Data visualization identified persistently adverse or worsening health inequalities in specific LAU1, focusing on categories such as Economic status and social protection, Education, Demographic situation, Environmental status, Individual living status, and Road safety and crime. The health condition indices showed no significant change over time, while the aggregate index of health inequalities improved with widened differences.ConclusionSpatial inequalities in health persist in the Czech Republic, influenced by economic, social, demographic, and environmental factors, as well as local healthcare accessibility. Both inner and outer peripheries exhibit poor health outcomes, challenging the assumption that urban areas fare better. The combination of poverty and vulnerabilities exacerbates these inequalities. Despite the low rates of social exclusion and poverty, regional health inequalities persist in the long term. Effectively addressing health inequalities requires interdisciplinary collaboration and evidence-based policy interventions. Efforts should focus on creating supportive social and physical environments, strengthening the healthcare system, and fostering cooperation with non-medical disciplines.

Cross-country comparison of income-related inequality in physical functional disability among middle-aged and older adults: Evidence from 33 countries

Physical functional disability is prevalent among middle-aged and older adults, with substantial health inequality. This study compared cross-country variation in the prevalence and inequality of physical functional disability and investigated the potential determinants of household income-related inequality.This cross-sectional study used data from 33 countries between 2017 and 2020, containing 141 016 participants aged 55 years and older. Physical functions were grouped into three domains: activities of daily living (ADLs), instrumental activities of daily living (IADLs), and mobility function. Physical functional disability of each domain was indicated by having some difficulty with the activity. We first estimated the prevalence of physical functional disability in each country. Second, the concentration index was used to quantify household income-related health inequality. Finally, recentred influence function (RIF) decomposition method was used to decompose the inequality into individual and country-level determinants.Physical functional disability prevalence was higher in lower-middle-income countries than in high-income countries and more prevalent in the poor-income groups in all study countries. Besides, health inequality in different domains of disability was higher in high-income countries than in low-income countries. Regarding determinants of health inequality, we found that individual married, tertiary education, and country-level health infrastructure and resources were associated with reduced health inequality. In contrast, age, unhealthy lifestyles, and chronic diseases were associated with increased health inequality.Inequality in physical functional disability among middle-aged and older adults varies substantially across countries, with individual and macro determinants being contributing factors. Policies to achieve healthy ageing and reduce the inequality of physical function disability can focus on improving individual healthy lifestyles and country health care facilities.

Determinants of Health Inequalities in Iran and Saudi Arabia: A Systematic Review of the Sleep Literature.

Sleep health inequalities represent an increasing public health concern. Among multiple determinants affecting sleep health, there is people's socioeconomic status (SES), and no systematic review on the relationship between SES and sleep health has been previously conducted in Iran and Saudi Arabia. Following the Prisma protocol, ten articles were selected. Findings revealed that the combined number of participants was N = 37,455 participants, including 73.23% of children and adolescents (n = 27,670) and 26.77% of adults (n = 10,026). The smallest sample was N = 715 and the larger was N = 13,486. In all these studies, sleep variables were assessed using self-reported questionnaires. The studies conducted in Iran assessed the risk of obstructive sleep apnea (OSA), while those in Saudi Arabia were interested in sleep duration, nap time, bedtime, rise time and insomnia. The studies performed on adult populations in Iran and Saudi Arabia concluded that there is no significant association between SES determinants and sleep components in adult populations. One study in Iran found a significant association between parent's low SES and children and adolescent insomnia; and one study in Saudi Arabia found a significant association between the father's education and the longer sleep duration of their children. More longitudinal studies are necessary to establish a causal relationship between public health policies and sleep health inequalities. An extension of the investigation to more sleep disturbances is required to cover the entirety of sleep health inequalities in Iran and Saudi Arabia.

The usage of DiGA, stratified by sociodemographic/socioeconomic characteristics

Abstract Background The German government undertakes efforts to implement DiGA into the statutory health insurance to improve its quality. DiGA are physician-prescribed applications for patients with certain diagnosed diseases, whose costs are covered by the statutory health insurers. DiGA have the potential to improve healthcare, but it is also possible, that the usage of these applications perpetuates existing health inequalities, summarized by the term Digital Divide; meaning that socially deprived populations are less able to benefit from digital technologies. The aim of this analysis is to determine whether differences exist in DiGA use by sociodemographic/socioeconomic characteristics. Methods The results based upon the analysis of an online survey involving 1,200 people (18-74 years) living in Germany between March 10 and March 18, 2022. The sample composition reflects the current distribution of age, gender, and place of residence in the federal states (uncrossed). The questionnaire focused, among other aspects, on the use of DiGA. A binary logistic regression was used for the analysis. Results Compared to the lowest subjective social status (SSS), probands with a medium (OR 2.865) or a high SSS (OR 4.085) are more likely to use DiGA. Compared to the reference group (60 years and older), the 18-29-year- (OR 2.044) and the 30-39-year-olds (OR 1.952) tend to have a higher likelihood of using DiGA. The likelihood of the use decreases among probands with medium (OR 0.632) and high educational degree (OR 0.580) compared to the reference group (low education). Conclusions In accordance with the results of existing studies, social differences could be identified regarding known determinants of health inequalities, like age and SSS. In this analysis, the highest degree of education does not appear as a predictor for an increased likelihood of use. Thus, further analyses are needed to address the influence of education, especially to develop a broader understanding of the DiGA use. Key messages • It appears that DiGA are not equally accessible or used across different population groups, and thus indicating an already existing or emerging Digital Divide regarding the use of DiGA. • Contrary to the broad assumption that higher expressions of health determinants are related to a higher likelihood of using DiGA, a higher degree of education decreases the likelihood of using DiGA.

Understanding Health Inequalities Through the Lens of Social Epigenetics.

Longstanding racial/ethnic inequalities in morbidity and mortality persist in the United States. Although the determinants of health inequalities are complex, social and structural factors produced by inequitable and racialized systems are recognized as contributing sources. Social epigenetics is an emerging area of research that aims to uncover biological pathways through which social experiences affect health outcomes. A growing body of literature links adverse social exposures to epigenetic mechanisms, namely DNA methylation, offering a plausible pathway through which health inequalities may arise. This review provides an overview of social epigenetics and highlights existing literature linking social exposures—i.e., psychosocial stressors, racism, discrimination, socioeconomic position, and neighborhood social environment—to DNA methylation in humans.We conclude with a discussion of social epigenetics as a mechanistic link to health inequalities and provide suggestions for future social epigenetics research on health inequalities.

Advancing the Social Epidemiology Mission of the American Journal of Epidemiology.

Social epidemiology is concerned with how social forces influence population health. Rather than focusing on a single disease (as in cancer or cardiovascular epidemiology) or a single type of exposure (e.g., nutritional epidemiology), social epidemiology encompasses all the social and economic determinants of health, both historical and contemporary. These include features of social and physical environments, the network of relationships in a society, and the institutions, politics, policies, norms and cultures that shape all of these forces. This commentary presents the perspective of several editors at the Journal with expertise in social epidemiology. We articulate our thinking to encourage submissions to the Journal that: 1) expand knowledge of emerging and underresearched social determinants of population health; 2) advance new empirical evidence on the determinants of health inequities and solutions to advance health equity; 3) generate evidence to inform the translation of research on social determinants of health into public health impact; 4) contribute to innovation in methods to improve the rigor and relevance of social epidemiology; and 5) encourage critical self-reflection on the direction, challenges, successes, and failures of the field.

Perceived health and interaction with healthcare workers of a hard-to-reach group in a Roman suburb

Abstract Previous studies have showed that people living in Bastogi - a segregated and deprived peripheral area of Rome- have difficulties in accessing and relating to health services. Our aim was to analyze the health perception, health-related behaviors, and the interaction between healthcare professionals and the census population living in Bastogi, compared to the population living in the area of the same local health unit, ASL Roma 1 (hereafter ASL). The PASSI survey (from the Italian Surveillance System) was administered by phone and through door-to-door interviews to a sample of 210 residents of Bastogi. Data were analyzed and compared to the ones of the ASL collected in 2017-2018. Descriptive and univariate analysis were performed with STATA 13. P-values ≤ 0.05 were considered statistically significant. The socio-economic indicators, acknowledged determinants of health inequalities, showed a worse condition for the inhabitants of Bastogi. There was a significantly higher proportion of foreign and unemployed residents in Bastogi, with a lower educational level compared to the ASL. 58.1 % of the Bastogi group claimed their health to be good/very good (ASL: 71.6%; p = 0.000). 56.2% of the respondents from Bastogi were current smokers (ASL: 25.8%; p = 0.000). Risk factors for and prevalence of chronic diseases were significantly higher in Bastogi. The proportion of respondents who stated they had not had any recent contact with health professionals was significantly higher, and mammogram screening uptake was lower (75.3%; ASL: 90.4%; p = 0.001). Despite their lower help-seeking behavior, our study pointed out that the respondents from Bastogi who had had a contact with a health professional reported a higher perceived interest about their health than in the ASL. Further studies are needed to investigate whether this attention is attributable to the higher prevalence of chronic diseases or to the health professional's awareness of vulnerability of a hard-to-reach group. Key messages The population from Bastogi is marginalized and hard-to-reach: we found a worse overall self- reported health condition, a worse help-seeking behavior and a lack of reliance on health professionals. The PASSI survey administration has led to a greater involvement of the competent health institution, which resulted in the introduction of a community nurse and a Single Access Point.

Explaining subjective social status in two countries: The relative importance of education, occupation, income and childhood circumstances

In the literature on social inequalities in health, subjective socioeconomic position (SEP) is increasingly applied as a determinant of health, motivated by the hypothesis that having a high subjective SEP is health-enhancing. However, the relative importance of determinants of subjective SEP is not well understood. Objective SEP indicators, such as education, occupation and income, are assumed to determine individuals' position in the status hierarchy. Furthermore, an extensive literature has shown that past childhood SEP affects adult health. Does it also affect subjective SEP? In this paper, we estimate the relative importance of i) the common objective SEP indicators (education, occupation and income) in explaining subjective SEP, and ii) childhood SEP (childhood financial circumstances and parents' education) in determining subjective SEP, after controlling for objective SEP. Given that the relative importance of these factors is expected to differ across institutional settings, we compare data from two countries: Australia and Norway. We use data from an online survey based on adult samples, with N ≈ 1400 from each country. Ordinary least squares regression is conducted to assess how objective and childhood SEP indicators predict subjective SEP. We use Shapley value decomposition to estimate the relative importance of these factors in explaining subjective SEP. Income was the strongest predictor of subjective SEP in Australia; in Norway, it was occupation. Of the childhood SEP variables, childhood financial circumstances were significantly associated with subjective SEP, even after controlling for objective SEP. This association was the strongest in the Norwegian sample. Only the mother's education had a significant impact on subjective SEP. Our findings highlight the need to understand the specific mechanisms between objective and subjective SEP as determinants of inequalities in health, and to assess the role of institutional factors in influencing these complex relationships.

The Social Roots of Health Inequity in Tunisia: A Preliminary Study on the Social Determinants of Health Inequity

Addressing the Social Determinants of Health is critical if we truly want to achieve health equity. The World Health Organization’s Commission on the Social Determinants of Health (2008) recognized the need to broaden the understanding of these determinants among the general public to facilitate change in communities and improve the overall health status. Using the data from the Tunisian Health Examination Survey (2016), this quantitative preliminary study explored the state of social inequity in health among the Tunisian population using a quantitative statistical analysis that shed light on the relations between the SDHs (Age – gender – SES – Geographical location – Area of residence – and Educational attainment) and the self-rated health status. This preliminary study explored the current state of health equity in Tunisia through exploring the hidden patterns of social identity formation and power relation inside society. This preliminary study also pointed out certain aspects of health inequity in Tunisia as well as the social factors and determinants contributing to the status-quo. The findings of this preliminary study could be the basis of an ambitious academic work that will explore the intersection between SDHs and their impact on health outcomes in Tunisia that will be an asset in the process of implementing health equity policies in the future.

Social Inequalities in Health Determinants in Spanish Children during the COVID-19 Lockdown.

The COVID-19 lockdown was imposed in a context of notable inequalities in the distribution of the social determinants of health. It is possible that the housing conditions in which children and their families experienced the confinement, and the adoption of healthy behaviors, may have followed unequal patterns. The aim was to describe social inequalities in housing conditions and in health-related behaviors among children during the lockdown in Spain. This cross-sectional study was based on data from an online survey collecting information on the child population (3–12 years) living in Spain (n = 10,765). The outcome variables used were several housing conditions and health-related behaviors. The socioeconomic variables used were financial difficulties and parents’ educational level. Crude prevalence and prevalence ratios estimated using Poisson models were calculated. During lockdown, children from families with low educational levels and financial difficulties not only tended to live in poor housing conditions, but were also exposed to negative health determinants such as noise and tobacco smoke; they took less physical exercise, had a poorer diet, spent more time in front of screens and had less social contact. A notable social gradient was found in most of the variables analyzed. The results point to the need to incorporate the perspective of equity in the adoption of policies in order to avoid the increase of pre-existing social inequalities in the context of a pandemic.

Prescribing patterns for medical treatment of suspected prostatic obstruction: a longitudinal register-based study of the Scottish Health and Social Care Open Data

BackgroundThe diagnosis of lower urinary tract symptoms related to suspected bladder outflow obstruction from benign prostate hyperplasia/enlargement in men is increasing. This is leading to high demand on healthcare services;...

Neighborhood Social Deprivation and Caregiving Intensity for Community-Dwelling Older Adults With Disabilities

There is growing interest in the role of “place” in the provision of long-term services and supports (LTSS) for older adults with disabilities, who receive ~16 billion hours of care per year from family and unpaid caregivers, but information is lacking. Using data from the 2015 National Health and Aging Trends Study (NHATS) linked to census-tract-level information from the American Community Survey, we described the association between caregiving intensity (hours of care received per week) and neighborhood social deprivation among N=2125 community-dwelling older adults with disabilities. Individuals receiving 40 hours or more of help per week had greater levels of functional impairment and dementia, and more often lived in neighborhoods at the highest quartile of social deprivation compared to those receiving fewer than 20 hours of care (26.8% vs. 21.7%, respectively). Findings have policy implications for targeting LTSS strategies toward addressing inequities in social determinants of health for vulnerable populations.

Building the Transdisciplinary Resistance Collective for Research and Policy: Implications for Dismantling Structural Racism as a Determinant of Health Inequity.

Structural racism is a multilevel system of ideologies, institutions, and processes that have created and reified racial/ethnic inequities. As a system, it works in concert across institutions to propagate racial injustice. Thus, efforts to address structural racism and its implications for health inequity require transdisciplinary collaboration. In this article, we begin by describing the process through which we have leveraged our discipline-specific training -- spanning education, epidemiology, social work, sociology, and urban planning -- to co-construct a transdisciplinary analysis of the determinants of racial health inequity. Specifically, we introduce the underlying theories that guide our framework development and demonstrate the application of our integrated framework through a case example. We conclude with potential research and policy implications.

Constructing social identity through multiple \u201cus and them\u201d: a grounded theory study of how contextual factors are manifested in the lives of residents of a vulnerable district in Brazil

The association between contextual factors and health inequalities is well documented, also in Brazil. However, questions about how contextual factors actually affect health and well-being persist. The aim of this qualitative study was to explore how contextual factors—i.e., social stratification and neighborhood opportunity structures—are manifested in the lives of the residents of a vulnerable district in Brazil. We used a Constructivist Grounded Theory approach based on 12 in-depth interviews. The core category constructing social identity through multiple “us and them” is supported by eight main categories that characterize different pairs of “us and them”, based on internal and external aspects of the social processes involved. Our findings strengthen and support the links between contextual factors and health inequalities, highlighting the relevance of downward social comparison, territorial segregation and stigmatization and erosion of social capital in the construction of social identities and the manifestation of social hierarchies and neighborhood structures in the Brazilian context. Ultimately, these create shame and stress but also pride and empowerment, which are recognized determinants of health inequities.

Percepção de saúde no Brasil: uma análise das diferenças por sexo dos trabalhadores

Resumo A saúde afeta diretamente a produtividade e renda dos trabalhadores e, por sua vez, as desigualdades de gênero afetam de forma desproporcional a saúde de ambos os sexos. Nesse sentido, o objetivo central desse trabalho é analisar os fatores que influenciam a percepção de saúde dos trabalhadores do sexo feminino e masculino. A base de dados utilizada foi o suplemento da Pesquisa Nacional de Amostra Domiciliar de 2008. Foram estimados modelos probit em dois estágios para captar as contribuições das características socioeconômicas para a percepção de saúde das pessoas ocupadas por sexo. Os principais resultados mostraram que, em média, as mulheres apresentam menor percepção de boa saúde do que os homens. Portanto, é necessário que as políticas públicas foquem nos determinantes das desigualdades de saúde entre homens e mulheres, tais como a diferença salarial, trabalho precário e a dupla jornada de trabalho. Além disso, são necessárias políticas de saúde que atendam às necessidades especificas de homens e mulheres.

Open Comparisons in Public Health Not Only a Report But Also a Practical Tool Package

Abstract Sweden is a high-income country with about 10 million people 2018. The public health policy has a clear focus on equitable health throughout the population, and a goal to reduce avoidable health inequalities within a generation. The 21 regions and 290 municipalities in Sweden are political self-government and important as most of the welfare services that impact citizens’ lifelong health fall under their remit, for example; healthcare, childcare, education, social service, elderly care and support to people with disabilities, some emergency services, environmental issues urban planning. Therefore, the municipalities and regions need reliable data that can be compared. Such data is available in the report Open Comparisons in Public Health (OCPH). The OPCH 2019 demonstrate large inequities in determinants of health and in health outcomes between municipalities in Sweden. Further work is needed to reduce these unjust and avoidable differences. The OPCH 2019 is not only a report, but rather a concept with additional practical tools to be used by local and regional public health officers, leaders and politicians. Following tools, developed in collaboration with stakeholders, are available in the concept OPCH. OPCH 2019: various managementresearch review, result comparisons, suggested improvement areas Factsheet: for leaders and politicians at policy level Municipality reports: tailored for public health officers to save time Socioeconomic compass: a tool to analyze differences in socioeconomics across municipalities Kolada: the Swedish database for municipal benchmarking Toolbox: tools to facilitate systematic interpretation and analysis The National Public Health Agency: various statistics are available for additional analyses Key messages The OPCH and the tools contributes to initiate local/regional development, improvement, monitoring and analysis concerning the quality and efficiency of the services delivered by these organisations. Governmental policies are important structural links16, but according to the OCPH 2019 the reduction of health disparities also requires measures in each local community.

Status of Health, Education and Income Inequality in Iran

Introduction: Education and income inequality are two important social determinants of health inequality. Every society for improving health status should focus on income equality and education for all. A review of the current situation helps to identify and improve the weaknesses in Iran. Methods: This study was descriptive and data collection was done by documentary study method. This researchtried to study various global databases, papers and global reports to search the status of Iran in comparison to other countries in different regions. Result: Studies have shown that inequality in income and wealth. Although the situation in Iran is better than the Persian Gulf countries, more inequality is observed in Iran in comparison to other parts of the world, including the United States and Western Europe. In terms of health, among the fifty major causes of death, Iran is ranked first and fourth in global terms due to road accidents and illicit drug use. At the same time, mortality from liver cancer, skin cancer, epilepsy, cervical cancer, kidney cancer, and cancer are in good condition compared to other countries in the world. In the field of education, the state of Iran in primary education, the exclusion of children from primary education, the guarantee of equal access for women and men to higher education and the eradication of gender inequality in participating in education is in a better situation than other parts of the world, but has been weaker than many other countries in the number of preschool years and pre-school education. Conclusion: The status of Iran in income inequality and education showed challenges that should be improve. These two as social determinants of health inequalities have an enormous role in health status. Sustainable development goals can be a guideline for developing the current situation.

Społeczne uwarunkowania nierówności w zdrowiu

Społeczne uwarunkowania nierówności w zdrowiu