Health Inequalities In Europe Research Articles

Time to reap the fruits of EU-SILC's new way of measuring unmet needs.

A change in the methodology of the EU-SILC questionnaire on health needs, implemented from 2015 onwards, made it possible to distinguish the probability of a person saying they needed care from the probability that they received it. However, datasets taking advantage of this change were not published by Eurostat until the end of 2023 and offered only limited possibilities for disaggregation. In this article, we show how useful these results can be, despite their limitations. In order to facilitate more and better research into health inequalities in Europe, Eurostat should give priority to publishing more datasets as soon as possible.

Cardiovascular diseases and health inequalities in Europe—a pressing public health challenge

Cardiovascular diseases and health inequalities in Europe—a pressing public health challenge

Life-course Factors and Later Life Health in Eastern and Western Europe

Human development and ageing are lifelong processes, where earlier life conditions and events are interlinked with later life outcomes. Patterns of inequality within and among cohorts emerge over time as products of the interplay between institutional arrangements and individual life, often dependent on childhood or earlier life circumstances. The life conditions and experiences of older adults in Eastern and Western Europe differ significantly, but whether their cumulative effects on later life outcomes vary across these two regions has not been compared. We explore the effects of socioeconomic position, the experience of a period of hunger, the dispossession of assets, and discrimination suffered by parents in respondents’ life courses on later life health inequalities in Europe. Self-reported health, everyday activity limitations, and cognitive functioning are the main outcomes that provide an adequate overview of different health domains. We mainly use data from the seventh wave of the Survey of Health, Ageing, and Retirement in Europe (SHARE 2017) and restrict our sample to respondents aged 65 and older from 26 European countries (N=41,566). We find that older people in Eastern Europe fare worse in self-rated health and everyday activity limitations than Western Europeans, while Eastern Europeans indicate somewhat better outcomes in cognitive functioning. A disadvantaged socioeconomic position in childhood and adulthood has the strongest association with all health outcomes, followed by the experience of hunger over the life course for the whole of Europe. However, we do not find diverging associations between life-course factors and health outcomes in Eastern and Western Europe. We argue that self-reported health, everyday activity limitations and cognitive functioning have to be analysed within their own frameworks and cannot yield conclusions that are uniform for all health outcomes. Moreover, major generalisations either about Eastern or Western Europe must be treated with caution as the regions have very different historical as well as demographic developments and thus cannot be treated as uniform. * This article belongs to a special issue on “Demographic Developments in Eastern and Western Europe Before and After the Transformation of Socialist Countries”.

The socioeconomic profile of alcohol use in Europe: findings from 33 European countries

Background: Alcohol’s detrimental health effects do not affect everyone equally but accumulate in people with low socioeconomic status (SES). Using data from the 2021 Standard European Alcohol Survey, we explore gender- and SES-specific consumption patterns, and COVID-19 related changes in consumption across Europe.
 Methods: Cross-sectional population-based survey data from 54,354 adults from 33 European countries plus Spain-Catalonia were analysed. Five alcohol indicators were of interest: prevalence of past-year alcohol use; and, among past-year alcohol users, prevalence of monthly/more frequent risky-single-occasion-drinking (monthly+ RSOD); prevalence of high-risk alcohol use (40+/60+ grams pure alcohol daily for women/men); mean daily grams of pure alcohol consumed; and self-reported consumption changes during COVID-19. Alcohol indicators were age-standardised and decomposed by gender and SES (education attainment), and analysed using regression models with location-specific random intercepts.
 Results: Across jurisdictions, past-year alcohol use, monthly+ RSOD, and high-risk drinking were all commonly reported, with distinct gender-specific socioeconomic profiles. While high-SES men and women were generally more likely to report past-year alcohol use, monthly+ RSOD and high-risk drinking were more prevalent among currently drinking low/mid-SES compared to high-SES men. No such SES differences in risky drinking were observed among women, however, female alcohol users with high SES reported higher mean daily drinking levels. High-SES women but not men were more likely to both increase and decrease their drinking during COVID-19 compared to their low/mid-SES counterparts.
 Conclusion: High consumption levels and distinct socioeconomic profiles among men and women highlight the need for effective alcohol policies to reduce health inequalities in Europe.

Addressing health inequalities in Europe: key messages from the Joint Action Health Equity Europe (JAHEE)

Health inequalities within and between Member States of the European Union are widely recognized as a public health problem as they determine a significant share of potentially avoidable mortality and morbidity. After years of growing awareness and increasing action taken, a large gap still exists across Europe in terms of policy responses and governance. With the aim to contribute to achieve greater equity in health outcomes, in 2018 a new Joint Action, JAHEE, (Joint Action Health Equity Europe) was funded by the third EU Health Programme, with the main goal of strengthening cooperation between participating countries and of implementing concrete actions to reduce health inequalities. The partnership led by Italy counted 24 countries, conducting actions in five policy domains: monitoring, governance, healthy living environments, health systems and migration, following a three-step implementation approach. Firstly, specific Policy Frameworks for Action (PFA) collecting the available evidence on what practice should be done in each domain were developed. Second, different Country Assessments (CAs) were completed to check the country’s adherence to the recommended practice in each domain. The gap between the expected policy response (PFA) and the present policy response (CA) guided the choice of concrete actions to be implemented in JAHEE, many of which are continuing even after the end of JA. Final recommendations based on the best results achieved during JAHEE were elaborated and agreed jointly with the representatives of the involved Ministries of Health. The JAHEE initiative represented an important opportunity for the participating countries to work jointly, and the results show that almost all have increased their level of action and strengthened their capacities to address health inequalities.

Impact of the COVID-19 pandemic on perinatal health and perinatal health inequalities in Europe

Abstract Background The COVID-19 pandemic and lockdowns may adversely affect pregnancy outcomes due to disrupted healthcare provision and increased stress, anxiety and economic hardship. We assessed changes in perinatal outcomes in 2020 using population birth data in Europe. Methods 25 Countries in the Euro-Peristat Network implemented a federated analysis using routine national data. Countries generated anonymised aggregate data files using R scripts from individual-level data formatted to a common data model with 22 variables. We compared preterm birth, stillbirth, neonatal death and caesarean delivery rates in 2020 to 2015-2019 for 2 periods: full-year (FY) and pandemic (March-September [MS]). Data from October onward were not included in the MS period because potentially declining pandemic-related fertility may affect perinatal indicators. Country-specific relative risks (RR) for the periods, adjusted for linear trends, overall and by socio-economic (SES) group, were calculated and pooled using random effects meta-analysis. Results Preterm birth rates decreased slightly (pooled RR: 0.97FY [95% confidence interval (CI) 0.95-0.99]; 0.98MS [0.96-1.00]) in 2020. Heterogeneity was high (I2FY=85%; I2MS=70%), with 5 countries experiencing significant declines. Neonatal mortality rates were unchanged (0.97FY [0.92-1.01]) while stillbirth rates were higher (1.05FY [1.01; 1.09]; 1.10MS [1.02; 1.19]). Caesarean rates were slightly raised (1.02FY [1.00-1.03]; 1.02MS [0.99-1.04], 5 countries had significant increases). Increases for stillbirth were more pronounced in the lowest (1.08FY [0.99-1.16]) versus highest SES group (1.05 FY [0.93-1.17]). Conclusions In 2020, there was an unexpected decline in preterm birth in some countries, while increases in stillbirths and caesarean occurred in others. High country-level heterogeneity suggests that some government policies to mitigate the pandemic might have been more protective of pregnant women and newborns than others.

Are 2020’s medical students still suffering from gender stereotypes? An Italian study

Abstract Background Gender medicine is crucial to reduce health inequalities in Europe. Knowledge about medical students' attitudes and beliefs regarding sex and gender is important to improve gender medicine courses. The aim of this study is to evaluate gender awareness and its predictors in Italian medical students. Methods During 2020, we performed a cross-sectional study among medical students from the University of Turin, Italy. We used the validated Nijmegen Gender Awareness Scale in Medicine (N-GAMS) to investigate gender sensitivity (GS) and gender role ideology towards patients (GRIP) or doctors (GRID). Multivariable logistic regression model was performed to explore potential predictors of gender awareness. Results Globally, 430 participants completed the survey (68.4% were females). The 62.5% of male students had a poor knowledge of gender medicine. GRID score significantly differs between males and females (1.64±0.68 vs 1.51±0.49; p = 0.028). Males had lower GS scores (coefB -0.96, p < 0.05), while students who had a better knowledge on gender medicine (coefB 0.14, p < 0.05) and those who have received good example from tutors (coefB 0.14, p < 0.05) were more gender-sensitive. Older age (coefB 0.04, p < 0.05), a better knowledge on gender medicine (coefB 0.12, p < 0.05) and having had a tutor sensitive to gender issues (coefB 0.13, p < 0.05) were predictors of more stereotyped opinions towards patients. Having had a tutor aware of gender medicine (coefB 0.03, p < 0.05), male sex (coefB 0.12, p < 0.05) and older age (coefB 0.03, p < 0.05) were associated with more stereotypes towards doctors. Conclusions Gender stereotypes are still common. During university courses and practical training more attention must be paid to explain that stereotyped gender differences are not scientifically proven and they do not contribute to provide better care. Therefore, the implementation of gender specific teaching throughout elective courses should be seriously considered. Key messages Receiving more knowledge and more attention about gender medicine during university education was associated with higher gender stereotypes in our sample of medical students. Interventions in European university education are needed to make gender medicine education more effective in order to reduce gender stereotypes and contribute to better care.

EUROlinkCAT protocol for a European population-based data linkage study investigating the survival, morbidity and education of children with congenital anomalies

IntroductionCongenital anomalies (CAs) are a major cause of infant mortality, childhood morbidity and long-term disability. Over 130 000 children born in Europe every year will have a CA. This paper...

Strengthening CAMHS and reducing child and adolescent mental health inequalities in Europe.

Strengthening CAMHS and reducing child and adolescent mental health inequalities in Europe.

Intersectional migration-related health inequalities in Europe: Exploring the role of migrant generation, occupational status & gender.

Integrating intersectionality theory and employing a quantitative design, the current study explores how migration-related health inequalities in Europe interact with migrant generation, occupational status and gender. Multilevel logistic regression analyses are conducted using pooled data from six waves of the European Social Survey (2004-2014), from 27 countries for two subjective health measures (general self-reported health and hampering conditions). The results reveal multiple relationships of health inequality that operate simultaneously and the complexity through which the combination of social privilege and disadvantage can have a particularly negative impact on individual health. The 'healthy migrant effect' seems to apply particularly for first-generation immigrants working as manual employees, and within occupational categories, in certain cases non-migrant women are more susceptible to poor health than migrant men. This evidence highlights how the health impact of migration is subject to additional dimensions of social positioning as well as the importance of an intersectional perspective for the monitoring of health inequalities in Europe.

Educational Inequalities in Self-Rated Health in Europe and South Korea.

While numerous comparative works on the magnitude of health inequalities in Europe have been conducted, there is a paucity of research that encompasses non-European nations such as Asian countries. This study was conducted to compare Europe and Korea in terms of educational health inequalities, with poor self-rated health (SRH) as the outcome variable. The European Union Statistics on Income and Living Conditions and the Korea National Health and Nutrition Examination Survey in 2017 were used (31 countries). Adult men and women aged 20+ years were included (207,245 men and 238,007 women). The age-standardized, sex-specific prevalence of poor SRH by educational level was computed. The slope index of inequality (SII) and relative index of inequality (RII) were calculated. The prevalence of poor SRH was higher in Korea than in other countries for both low/middle- and highly educated individuals. Among highly educated Koreans, the proportion of less healthy women was higher than that of less healthy men. Korea’s SII was the highest for men (15.7%) and the ninth-highest for women (10.4%). In contrast, Korea’s RII was the third-lowest for men (3.27), and the lowest among women (1.98). This high-SII–low-RII mix seems to have been generated by the high level of baseline poor SRH.

Mediators of health inequalities in Europe: social capital of personal network and generalized trust

Mediators of health inequalities in Europe: social capital of personal network and generalized trust

Health inequalities in Europe: Does minimum income protection make a difference?

Poverty, a risk factor for ill health, could be alleviated by generous welfare states. However, do generous social policies also reduce the health implications of socio-economic inequalities? This study investigates how minimum income protection is associated with socio-economic health inequalities. The author hypothesises that higher benefit levels are associated with lower health inequalities between income groups. Minimum income benefits support the people most in need, and therefore should improve the health of the lowest income groups, which in turn would reduce overall health inequalities. This hypothesis is tested with the European Social Survey (2002–2012) and the SaMip dataset using three-level multilevel models, covering 26 countries. The results show a robust relationship between benefit levels and individual self-rated health. However, the hypothesis of reduced health inequalities is not completely supported, since the findings for the cross-level interactions between income quintiles and benefit levels differ for each quintile.

Workshop: Bridging the Gap in Digital Public Health in Europe

Abstract Europe is facing several health challenges and public health plays an important role in it. However, to address the increasing demand for public health services, public health institutions need to tackle digitalization in a proper and evidence-based way. Digital health comprises both an organizational and a technological component. While the technological one has been widely addressed, the organizational one got little attention so far. This is due to a lack of knowledge regarding the understanding of the new role of organizations that provide digital health services. Public health is a field deeply dependent on data and with an important opportunity to leverage information technology. Digital health could, within 10 years establish a new paradigm in public health. The public health professionals need urgently to tackle digital health to bridge the gap with others areas of healthcare. Moreover, since public health is a multi-disciplinary activity we want to take the opportunity to debate digital public health with European experts from different fields of knowledge. Three presentations from the point of view of People, Technology and Services. Digital health should be addressed as an evidenced-based approach towards both improving health professionals performance and quality of life of patients. This workshop aims at: To create the momentum towards the proper use of digital technologies in public health by discussing the main challenges and opportunities for European Public Health.To establish a forum to discuss digital public health solutions based on evidence to better improve the adoption of these tools in the public health profession;To have a serious discussion after 3 presentations that will clarify the main challenges and opportunities;After de presentations, a debate will be guide to help identify the main challenges for digital public health in Europe; Key messages Public Health Digitalization is essential to address health inequalities in Europe. The workshop identifies what are the main priorities for a sustainable EU public Health digitalization. Mutual learning, knowledge and good practice exchange in using digital technology can be organised in various ways – we show practical current examples on how it has been done.

Educational inequalities in self-rated health and social relationships - analyses based on the European Social Survey 2002-2016.

While there is evidence for educational health inequalities in Europe, studies on time trends and on the explanatory contribution of social relations are less consistent. It has been shown that the use of welfare state typologies can be helpful to examine health inequalities in a comparative perspective. Against this background, analyses are focused on three research questions: (1) How did educational inequalities in self-rated health (SRH) develop between 2002 and 2016 in different European countries? (2) In how far can structural and functional aspects of social relations help to explain these inequalities? (3) Do these explanatory contributions vary between different types of welfare states? Data stem from the European Social Survey. Data from 20 countries across 8 waves (2002-2016) was included in the sample (allocated to 5 types of welfare states). Structural aspects of social relations were measured by living with a partner, frequency of social contacts and social participation. Availability of emotional support was used as functional dimension. Educational level was assessed based on the International Standard Classification of Education. SRH was measured in all waves on a five-point scale by one question: "How is your health in general? Would you say it is very good, good, fair, bad or very bad?" Across all countries, educational inequalities were increasing between 2002 and 2016. Explanatory contribution of emotional support, living with a partner, and social contacts was small (5% or less across the eight waves). Social participation explained 11% of the educational inequalities in SRH in the European countries. There were small variations in the explanatory contribution of social participation between welfare states. Promoting social participation, especially of people with low education is a possible intervention to reduce inequalities in SRH in Europe.

Examining gender health inequalities in Europe using a Synthetic Health Indicator: the role of family policies.

Family policies have been shown to affect men's and women's health throughout the European Union, though particularly in the case of women. This paper seeks to analyze this effect by creating two Synthetic Health Indicators (SHIs) differentiated by gender applying the P2 distance method. We also aim to compare the results obtained by means of our SHI and the Self-rated health (SRH) indicator, as it is the most common indicator used to approach individuals' health. The 2012 European Quality of Life Survey was used to construct the SHI. Dimensions such as physical health, mental health, psychosocial resources, the capacity of health services and community health status were included in our SHI. All proved to be relevant when measuring individuals' health. Gender health inequalities differed depending on the indicator used in each European country. When considering family policy, we found significant gender health gaps that favoured men in traditional countries, regardless of the indicator used (SHI or SRH). Moreover, with our SHI we found significant gender health inequalities in market-oriented and dual-earner countries that were not revealed by the SRH indicator, highlighting the fact that current equality policies are necessary but insufficient to overcome the gender health gap. The SHI was more sensitive to gender differences and evidenced certain advantages compared to the SRH. The SHI includes a wide range of variables that incorporated large amounts of fresh information, allowing men and women to have a personalized design of their own health.

Institutions, Incorporation, and Inequality: The Case of Minority Health Inequalities in Europe.

Scholars interested in the relationship between social context and health have recently turned attention further "upstream" to understand how political, social, and economic institutions shape the distribution of life chances across contexts. We compare minority health inequalities across 22 European countries ( N = 199,981) to investigate how two such arrangements-welfare state effort and immigrant incorporation policies-influence the distribution of health and health inequalities. We examine two measures of health from seven waves of the European Social Survey. Results from a series of multilevel mixed-effects models show that minority health inequalities vary across contexts and persist after accounting for socioeconomic differences. Cross-level interaction results show that welfare state effort is associated with better health for all groups but is unrelated to levels of inequality between groups. In contrast, policies aimed at protecting minorities from discrimination correlate with smaller relative health inequalities.

The impact of social expenditure on health inequalities in Europe

Welfare states are assumed to play a fundamental role in the protection and promotion of the health and socioeconomic well-being of citizens. However, empirical evidence on the effect of the welfare state is still contradictory. The inconsistency of the results has led researchers to a lack of consensus in defining the mechanisms that might explain the relationship between the welfare state and health. To shed some light on the current debate, we rely on individual and country data from the European Social Survey (ESS) and Eurostat to explore the direct and indirect effects of the welfare state on health inequalities in a sample of European countries. We use multilevel models to test the hypothesized impact of social expenditure on reducing health inequalities. Firstly, results show that health inequalities are lower in countries where social expenditure is higher. Secondly, the relationship between socio-economic status (SES) and health is moderated by social expenditure. The positive effect of SES on health decreases in countries where social expenditure is higher, while this effect is higher in countries with lower social expenditure. Our findings suggest that social spending has a positive impact on equalizing health conditions in Europe.

Some microeconometric evidence on the relationship between health and income

This paper examines the association between income, income inequalities and health inequalities in Europe. The contribution of this paper is to study different hypotheses linking self-perceived health status and income, allowing for the identification of different mechanisms in income-related health inequalities. Using data from the Survey of Health, Ageing and Retirement in Europe (15 countries), we take the advantage of the cross-sectional and longitudinal nature of this rich database to make robust results. The analyses (coefficient estimates as well as average marginal effects) strongly support two hypotheses by showing that (i) income has a positive and concave effect on health (Absolute Income Hypothesis); (ii) income inequalities in a country affect all members in a society (strong version of the Income Inequality Hypothesis). However, our study suggests that, when considering the position of the individual in the income distribution, as well as the interaction between income inequalities and these rankings, one cannot identify individuals the most affected by income inequalities (which should be the least well-off in a society according to the weak version of the Income Inequality Hypothesis). Finally, the robustness of this study is emphasized when implementing a generalized ordered probit to consider the subjective nature of the self-perceived health status to avoid the traps encountered in previous studies.

Depressed during the depression: has the economic crisis affected mental health inequalities in Europe? Findings from the European Social Survey (2014) special module on the determinants of health.

Economic crises constitute a shock to societies with potentially harmful effects to the mental health status of the population, including depressive symptoms, and existing health inequalities. With recent data from the European Social Survey (2006–14), this study investigates how the economic recession in Europe starting in 2007 has affected health inequalities in 21 European nations. Depressive feelings were measured with the CES-D eight-item depression scale. We tested for measurement invariance across different socio-economic groups. Overall, depressive feelings have decreased between 2006 and 2014 except for Cyprus and Spain. Inequalities between persons whose household income depends mainly on public benefits and those who do not have decreased, while the development of depressive feelings was less favorable among the precariously employed and the inactive than among the persons employed with an unlimited work contract. There are no robust effects of the crisis measure on health inequalities. Negative implications for mental health (in terms of depressive feelings) have been limited to some of the most strongly affected countries, while in the majority of Europe persons have felt less depressed over the course of the recession. Health inequalities have persisted in most countries during this time with little influence of the recession. Particular attention should be paid to the mental health of the inactive and the precariously employed.