Increase In Health Inequalities Research Articles

The COVID-19 crisis and ART activity in France

Research questionWhat was the impact of the COVID-19 pandemic on assisted reproductive technology (ART) activity in public and private hospitals in France in 2020? DesignAll women who underwent oocyte retrieval in 2020 (study group, n = 40,759) or in 2019 (comparison group, n = 52,403) were selected from French national health insurance databases. The weekly ART activity in 2020 was compared with the weekly ART activity in 2019. ResultsIn 2020, annual ART activity dropped by nearly 30% compared with 2019. Whereas weekly ART activity was at its normal level at the beginning of 2020, it sharply decreased and was almost non-existent during the first French lockdown (March–May 2020) in both public and private hospitals. After the first lockdown, private hospitals returned to their normal activity level within 1 month. In contrast, the activity of public hospitals remained well below normal until the summer break, before peaking at 40% of normal activity compared with an expected level of 57%. During the second French lockdown, ART activity was only slightly affected, principally in public hospitals where ART activity was around 48% compared with an expected level of 57%. ConclusionsIn countries where intensive care units are principally in public hospitals, greater disruption in public than in private hospitals may have led to an increase in health inequalities for ART activity, as for other healthcare.

Exploring the Impact of Social Determinants of Health on Post-Covid Behavior

Problem: The COVID 19 pandemic has had a very strong and negative impact in several sectors of society, the economy and health on post-COVID behavior. Although it has caused a very large and generalized socio-economic and health crisis with regard to the labor market, employment and health, this pandemic has above all contributed to the increase in health inequalities, the loss of jobs due to the breakdown of resources in families, anxiety and depression, not to mention the loss of social ties and capital due to prolonged isolation; all of these are confirmed as social determinants of health. Objectives: Describe the social determinants of health that impact post-COVID behavior, determine the impact of social determinants of health on post-COVID behavior, analyze the consequences of the social determinants of health that impact post-COVID behavior and propose effective solutions to combat the social determinants of health on post-COVID behavior. Method: Qualitative and quantitative methods were used and it is the qualitative data coding system that allowed us to achieve reliable results. Using Alain Bouchard’s sampling technique, 78 health professionals were selected. Quantitative data were analyzed using sta tistical software for the social sciences. Results : This article has highlighted the direct or indirect impact of the social determinants of health that impact post-COVID behavior such as barrier measures put in place by the WHO and the particularities of the virus on the behavior of the population. such as the determinants of health that have stimulated the individual to have good sanitary behavior, namely washing their hands often, which is a positive act for the good health of the population, the members of the community are made aware of going to the health facilities for early detection, community engagement in health prevention is the result of determinants of health and social well-being. Outlook: After the onset of COVID-19, we have observed an enhancement in hygiene protocols and the implementation of hygiene procedures, social distancing, and the provision of personal protective gear. Additionally, there has been an introduction of new methods of work organization through constructive discussions between employers and their workers’ representatives.

Participatory and deliberative processes in the UK related to income insecurity: a scoping review

BackgroundDemocratising decision making related to socioeconomic policy is an area of growing interest in health inequalities research; however, there is a recognised gap between the democratic theory and practical application at a macro socioeconomic level. This gap is notable in the current UK policy context defined by over a decade of austerity, rising income insecurity, and an increase in health inequalities. Underpinned by theories related to participatory, deliberative, and economic democracy, particularly those concerned with democratic innovations, this scoping Review investigates how, when, and where participatory and deliberative processes have been used to influence socioeconomic policy over the past 15 years in the UK and how this influence might inform any so-called democratic rejuvenation moving forward. MethodsThis Review, presenting the interim findings, is structured in accordance with the Joanna Briggs Institute's guidance for conducting systematic scoping reviews and applies the PRIMSA-Scoping Review checklist. Key search terms included “public policy”, “economic policy”, “income insecurity”, “poverty”, “public participation” “decision-making”, and “democratic innovation”. Searches were conducted in EconLit, SOC Index, Sociological Abstracts, and MedLine, as well as grey literature sources, including BASE database, government, third sector, and thinktank websites for articles related to participatory and deliberative processes (informed by theories of associative and direct democracy as well as Fung's Democracy Cube of public participation) in socioeconomic policy making in the UK, in English, from January, 2007, until June, 2022. A combined framework of democratic goods and typology of interventions to tackle health inequalities were applied for analysis. Findings14 articles were included in the final review (three peer-reviewed and 11 grey literature) with a concentration of results in Scotland (six articles) and in local government (five articles). Interim findings suggest a multiplicity of activities exist under the banner of participatory and deliberative processes; however, there are few, if any, examples that influence typically closed macro socioeconomic policy making and instead disperse participatory decision-making across less empowered spaces. InterpretationAmbitions for a democratic rejuvenation to tackle the upstream socioeconomic drivers of health inequalities require critical reflection on the locus of decision-making power, as well as the fractured and challenging nature of participatory policy making. FundingThis study is part of a PhD studentship with the Medical Research Council and Chief Scientist Office, Social and Public Health Sciences Research Unit at the University of Glasgow. The studentship is funded by the Medical Research Council (MC_UU_00022/3) and Chief Scientist Office of the Scottish Government Health Directorates (SPHSU18). KS is funded by the Medical Research Council (MC_UU_12017/11 and MC_UU_00022/3) and Strategic Award (MC_PC_13027) and Chief Scientist Office of the Scottish Government Health Directorates (SPHSU18). GF is funded through the UK Medical Research Council (MC_ UU_00022/2) and the Chief Scientist Office of the Scottish Government Health Directorates (SPHSU17).

Health inequalities in very old age: Continuity, accumulation or convergence?

Abstract Background Health inequalities are well documented empirically. However, it is unclear whether health inequalities persist in very old age (continuity), whether they accumulate steadily (accumulation), or whether they even attenuate in old age (convergence) - not least because of social inequalities in life expectancy, which make it less likely for individuals with lower social status to reach old age at all. The aim of this study is to empirically test these three hypotheses. Methods The analyses are based on representative cross-sectional data from 1,863 very old people and panel data from 912 participants in the 1st and 2nd wave (W1, W2) living in North Rhine-Westphalia the largest federal state in Germany (NRW80+ study). Health outcomes of the analyses are subjective health, multimorbidity and need for long-term care. Indicators of socioeconomic status (SES) are education, occupational status, and net equivalent income. Regression models (linear, logistic, ordinal) are used to analyze cross-sectional and longitudinal data. Panel selectivity is also considered by means of a failure model. Results Cross-sectional findings show health inequalities for all SES variables: persons with low education and low income have poorer subjective health and higher need for care. Low status is associated with higher need for care. Preliminary results from longitudinal analyses show a slight increase in health inequality: low income and low status are associated with higher multimorbidity and low education with higher dependency on long-term care at W2. Conclusions Despite the socially conditioned unequal chances of reaching old age, health inequality is still present in very old age and even increases slightly over time. The results argue against the convergence hypothesis and in favor of the continuity or even the accumulation hypothesis. A better understanding of the mechanisms leading to the persistent inequality is needed to development targeted interventions also in old age. Key messages • Health inequalities persist and even increase in very old age (80+). • It is imperative that the oldest old – an increasingly large population group – be considered when designing strategies to reduce health inequalities.

Challenges in school-to-work transition for marginalized groups - the need to strengthen structures for vulnerable youth (post pandemics) Findings from the German project “Co*Gesund”

Abstract Objective The transition from school to work is a challenge for young people which is closely correlated with health and well- being. Promoting resilience factors contributes to adolescents’ mental health and social and educational success. The aim of this study is to examine how especially vulnerable youth cope with the transition during the pandemic to identify which structural measures are helpful and which are a hindrance and to develop recommendations for action. Methods First, a rapid review on the subject of young people's mental health during the pandemic was conducted. Based on this 30 interviews with professionals from schools and vocational education and two focus groups with young people from participating institutions follow in spring and summer 2022. Finally, recommendations for action will be developed together with both groups. Results The results of the literature research illustrate the strong influence of the pandemic on the mental health of adolescents and, in particular, the increase in health inequalities along the social gradient. In relation to school and education, it is clear that young people lacked contact persons during this time. It is expected that the interviews and focus groups give insight, which resources of the young people can be strengthened in a low- threshold way and will provide further concrete indications on what structural development is needed to strengthen the resilience of young people. Conclusions For the promotion of mental health it is necessary to rely not only on the resources of young people themselves, but especially on the resources available in their environment. Only in this way transition processes can be managed successfully by the young people and they can be strengthened for the future. To this end, solutions should be developed jointly and support systems should be improved

Trends in adolescent mental health problems: Differences by SES and gender

Abstract Background Studies in Sweden and elsewhere have shown that mental health problems have increased among adolescents in recent decades. Unlike the previous studies, we extend the investigation to the trends of various mental health problems, namely: psychosomatic symptoms, suicide attempts, depressive symptoms, and suicide ideations in the last two decades, from 2004 to 2020. We also investigate the moderating role of gender and SES on these trends. Methods Data were collected through repeated bi-annual cross-sectional surveys between 2004 and 2020 among 32061 adolescents (49% girls) in middle and upper secondary schools in a county of Sweden. We fitted two linear and two logistic regressions with gender and socioeconomic status (SES) as predictors, and by interacting them with year of survey, we examined if they are associated with trends in mental health problems. Results Psychosomatic and depressive symptoms remained stable overtime (β = -0.04, p = 0.12; and β = 0.007, p = 0.69, respectively). Trend in depressive symptoms has declined overtime only for girls (β = -0.07, p < 0.005) while gender did not have effect on the trend in psychosomatic symptoms. Both psychosomatic (β = -0.09, p < 0.001) and depressive (β = -0.08, p < 0.001) symptoms have declined overtime only among those with high SES. Trends in both suicidal ideations and attempts were stable. Suicidal ideations declined overtime only for the girls (OR = 0.86, CI = 0.82 - 0.91, p < 0.001). However, gender did not have significant effect on trends in suicidal attempts. Both suicidal ideations (OR = 0.97, CI = 0.95 - 0.99, p = 0.02) and suicidal attempts (OR = 0.98, CI = 0.96 - 0.99, p = 0.007) declined overtime among those with higher SES. Conclusions Mental health problems seem to decrease from 2004 to 2020, however only for girls and adolescents with high SES. This indicates an increase in health inequalities especially for youth with low SES. Key messages Mental health problems declined in the last two decades, especially among girls. Adolescents with low SES did not show the same mental health improvement, which indicated that health inequalities in adolescent mental health seem to have increased in the last two decades.

Equity impacts of interventions to increase physical activity: A health impact assessment

Abstract Background Behavioural interventions may increase social inequalities in health. This study aimed to project the equity impact of physical activity interventions that have differential effectiveness across education groups on the long-term health inequalities among older adults in Germany. Methods We created six hypothetical intervention scenarios targeting adults aged 55 years and above: Scenarios #1 to #4 applied realistic intervention effects that varied by education. Under scenario #5, the lower and medium educated group adapted the physical activity pattern of the higher educated. Under scenario #6, all persons increased their physical activity level to the recommended 300 minutes weekly. The number of incident ischemic heart disease, stroke and diabetes cases as well as deaths from all causes was simulated under each of these six intervention scenarios for males and females over a 10-year projection period using the DYNAMO-HIA tool, and compared against a reference scenario with unchanged physical activity pattern. Results For males, the highest reduction of disease cases and deaths would be achieved under scenario #4 (most effective in higher educated persons), while increasing inequalities between education groups. For females, the highest reduction would be achieved under scenario #3 (most effective in lower educated persons), while decreasing inequalities between education groups. Scenarios #1 to #4 would prevent only a fraction of the disease cases and deaths that would be avoided under scenario #5 or scenario #6. Conclusions This modelling study shows how the overall population health impact varies, depending on how intervention-induced physical activity changes differ across education groups. For decision-makers, both the assessment of health impacts overall as well as within a population is relevant, as interventions with the greatest population health gain might be accompanied by an unintended increase in health inequalities. Key messages Health impact assessments with a focus on equity are essential for decision-makers. In order to correctly project population health effects, and choose between options of intervention types from a public health perspective, data on subgroup-specific intervention effects are needed.

Equity impacts of interventions to increase physical activity among older adults: a quantitative health impact assessment

BackgroundBehavioural interventions may increase social inequalities in health. This study aimed to project the equity impact of physical activity interventions that have differential effectiveness across education groups on the long-term health inequalities by education and gender among older adults in Germany.MethodsWe created six intervention scenarios targeting the elderly population: Scenarios #1–#4 applied realistic intervention effects that varied by education (low, medium high). Under scenario #5, all older adults adapted the physical activity pattern of those with a high education. Under scenario #6, all increased their physical activity level to the recommended 300 min weekly. The number of incident ischemic heart disease, stroke and diabetes cases as well as deaths from all causes under each of these six intervention scenarios was simulated for males and females over a 10-year projection period using the DYNAMO-HIA tool. Results were compared against a reference-scenario with unchanged physical activity.ResultsUnder scenarios #1–#4, approximately 3589–5829 incident disease cases and 6248–10,320 deaths could be avoided among males over a 10-year projection period, as well as 4381–7163 disease cases and 6914–12,605 deaths among females. The highest reduction for males would be achieved under scenario #4, under which the intervention is most effective for those with a high education level. Scenario #4 realizes 2.7 and 2.4% of the prevented disease cases and deaths observed under scenario #6, while increasing inequalities between education groups. In females, the highest reduction would be achieved under scenario #3, under which the intervention is most effective amongst those with low levels of education. This scenario realizes 2.7 and 2.9% of the prevented disease cases and deaths under scenario #6, while decreasing inequalities between education groups. Under scenario #5, approximately 31,687 incident disease cases and 59,068 deaths could be prevented among males over a 10-year projection period, as well as 59,173 incident disease cases and 121,689 deaths among females. This translates to 14.4 and 22.2% of the prevented diseases cases among males and females under scenario #6, and 13.7 and 27.7% of the prevented deaths under scenario #6.ConclusionsThis study shows how the overall population health impact varies depending on how the intervention-induced physical activity change differs across education groups. For decision-makers, both the assessment of health impacts overall as well as within a population is relevant as interventions with the greatest population health gain might be accompanied by an unintended increase in health inequalities.

Policies for Prevention and Control of Oral Cancer in the light of Giddens' Structuration Theory.

Challenges remain to ensure access to diagnosis and treatment ten years into continuous cancer prevention, control, and oral health policies. This study aims to analyze the oncology and oral health policies in force regarding the process of implanting oral cancer-related care components. Ten policies were analyzed under the lenses of the Structuration Theory, besides data on the supply of services between 2002 and 2017. Low coverage and inadequate regional distribution were highlighted in primary and secondary health care levels, despite increased funding and number of services. Unequal distribution of performed surgeries was identified in tertiary care. The limitation of home care services has hindered users' access to palliative care. A convergence was identified between the analyzed policies and concern with the regulation of authoritative resources and the increase of allocative resources, which stirred the expansion of services. Investments should be made in the expansion, regionalization, and universalization of services. A possible setback in these policies could aggravate the situation and contribute to the increase in health inequalities.

The French pill scare and the reshaping of social inequalities in access to medical contraceptives.

While the consequences of various "pill scares" have been relatively well-documented in the public health literature revealing a drop in pill use and a rise in unplanned pregnancies and abortion rates, researchers rarely considered that these controversies would affect women contraceptive practices differently according to their social background. Indeed, social differentiations in reaction to "pill scares" could contribute to reinforce the social gradient in the use of contraceptive methods and choice of visiting the health professionals who prescribe them. These could contribute to an increase in health inequalities on access to contraceptive methods. Using data from three state nationally representative cross-sectional surveys conducted in France in 2010, 2013 and 2016, we studied the changes in women's contraceptive uses around the French "pill scare" that occurred in 2012–2013. We focused on the changes in the use of all contraceptives available under medical prescription (called medical contraceptives) on one hand, and on each specific method (pill, IUD, implant, patch or vaginal ring, and female sterilization) on the other hand according to the women's social background. We saw a social gradient in contraceptives changes. The decline in the use of contraceptive methods available under medical prescription was particularly marked for women from lower and higher classes in which we observe a decrease in pill use between 2010 and 2013, whereas it was observed only between 2013 and 2016 among middle class women. Moreover, while some women from upper class shifted from pill to IUD between 2010 and 2013, this was not the case for their less privileged counterparts. As a consequence, it seems that the French "pill scare" led to the reshaping of social inequalities in access to medical contraceptives.

Crise e austeridade no Sul da Europa: impacto nas economias e sociedades

This article discusses the economic and social impact of the 2008 crisis and its related austerity policy on South European countries (SEC). Damages caused by these policies includes the decrease in GDP, the increase in unemployment and precariousness, especially amongst the younger population, and the worsening of social services. SEC health systems have also been seriously affected by the crisis, with a particular impact on the most vulnerable social groups, as a result of the decrease in public health expenditure. The increase in health inequalities is another side effect of the structural adjustment programs.

Impact of socio-economic inequities on tuberculosis in a Southern European city: what is the effect of the recession?

Economic crises affect a population's health, particularly among the most deprived. The increase in health inequalities in the latest recession may have influenced the incidence of tuberculosis (TB). We analysed the effect of socio-economic inequities and recession on TB incidence in Barcelona, Spain. We conducted a population-based incidence study of TB cases in Barcelona of patients who started treatment between 2003 and 2015. A multilevel interrupted time-series analysis was performed to analyse differences in incidence trends between the pre-recession (until 2008) and recession periods. We found differences in TB incidence according to deprivation and immigration status. TB incidence among the most deprived neighbourhoods was 2.72 times higher than the least deprived neighbourhoods. Compared with native-born persons, incidence was nine times higher among those born in Africa, and six times higher among those born in Asia and Oceania. The previous decreasing trend in incidence (4%) was accentuated during the recession (7%). TB incidence decreased during the recession, probably due to a reduction in the number of new immigrants and the TB programme. However, incidence was highly unequal between districts with different levels of deprivation, and between foreign-born persons from different geographic regions. Social measures are important to reduce inequalities and TB incidence in Barcelona.

Subjective Health and Unemployment in Germany: Analysis of 2005-2014 EU-SILC Data

This study aims to analyze self-perceived health and chronic illness in the working population and to explore disparities between social groups. The annual EU-SILC Survey has been conducted in Germany since 2005. The reference population is defined as all private households. In the EU-SILC 2014, a random sample of 22,695 persons aged 16 years and older was interviewed in Germany (860 unemployed and 11,390 employed). In accordance to the EU-SILC-Surveys 2005 until 2014, the self-perceived general health of the population has improved in Germany. 65.2% of the population (aged 16 years and older) in Germany assessed their health as very good or good in 2014 vs. 60.7% in 2005, despite an ageing population. However, there was an increase in health inequalities between employment status groups. In 2014, only 37.2% among unemployed persons vs. 77.1% of the employed perceived their general health as very good or good (53.8 vs. 73.2% in 2005). Multivariate logistic regression models revealed strong associations of subjective general health and chronic illness with age groups and social determinants on the EU-SILC-Survey 2014. Cross-sectional analysis showed unemployed persons to be much less likely to have very good or good self-perceived health (OR=0.26) and more likely to have chronic illness (OR=3.99) compared to employed people after adjustment for sociodemographic characteristics. The probabilities of better health and lower chronic illness rose with the increasing disposable (net) income as well as educational levels. 78.8% of the household members in the highest income quintile vs. 51.7% of the household members in the lowest income quintile said they had very good or good health (OR=2.53). In all investigated age groups, members of the households at risk of poverty were more likely to have poor health on average. High educational level (ISCED 5-8) was associated with higher positive self-rated health (OR=1.78). The EU-SILC-Survey shows distinct health developments and inequalities in Germany. EU-SILC is useful as an annual general population survey to monitor public health targets and reduce health inequalities.

European health inequality through the 'Great Recession': social policy matters.

This paper investigates the association between the Great Recession and educational inequalities in self-rated general health in 25 European countries. We investigate four different indicators related to economic recession: GDP; unemployment; austerity and a 'crisis' indicator signifying severe simultaneous drops in GDP and welfare generosity. We also assess the extent to which health inequality changes can be attributed to changes in the economic conditions and social capital in the European populations. The paper uses data from the European Social Survey (2002-2014). The analyses include both cross-sectional and lagged associations using multilevel linear regression models with country fixed effects. This approach allows us to identify health inequality changes net of all time-invariant differences between countries. GDP drops and increasing unemployment were associated with decreasing health inequalities. Austerity, however, was related to increasing health inequalities, an association that grew stronger with time. The strongest increase in health inequality was found for the more robust 'crisis' indicator. Changes in trust, social relationships and in the experience of economic hardship of the populations accounted for much of the increase in health inequality. The paper concludes that social policy has an important role in the development of health inequalities, particularly during times of economic crisis.

Devolution and the regional health divide: a longitudinal ecological study of 14 countries in Europe.

Greater regional devolution can reduce economic inequalities between regions; however, the impact on health inequalities is not clear. We investigated the association between changes over time in the level of devolution in European countries and regional economic and health inequalities. We used the proportion of government expenditure controlled by subnational levels of government as our measure of devolution in 14 European countries between 1995 and 2011. Fixed effects linear regression models were used to analyse trends in the level of devolution, trends in regional economic inequalities (Gini-coefficient) and trends in regional health inequalities (slope index) in life expectancy. Each additional percentage of government expenditure managed at subnational level reduced the Gini-coefficient of regional GDP by -0.17 points (95% CI: -0.33 to -0.01; P = 0.04). However, it increased the slope index of regional life expectancy by 23 days (95% CI: -2 to 48; P = 0.07). When trends in regional economic inequalities were controlled for, as a potential mediator-increased devolution-was significantly associated with an increase in health inequalities between regions (P = 0.01). Increased devolution does not appear to reduce regional health inequalities-even when it reduces regional economic inequalities-and it could be associated with increased health inequalities.

Comparative observational study of mortality amenable by health policy and care between rural and urban Finland: no excess segregation of mortality in the capital despite its increasing residential differentiation.

BackgroundLarge cities are often claimed to display more distinct geographical and socioeconomic health inequalities than other areas due to increasing residential differentiation. Our aim was to assess whether geographical inequalities in mortality within the capital (City of Helsinki) both exceeded that in other types of geographical areas in Finland, and whether those differences were dependent on socioeconomic inequalities.MethodsWe analysed the inequality of distribution separately for overall, ischemic heart disease and alcohol-related mortality, and mortality amenable (AM) to health care interventions in 1992–2008 in three types of geographical areas in Finland: City of Helsinki, other large cities, and small towns and rural areas. Mortality data were acquired as secondary data from the Causes of Death statistics from Statistics Finland. The assessment of changing geographical differences over time, that is geographical inequalities, was performed using Gini coefficients. As some of these differences might arise from socioeconomic factors, we assessed socioeconomic differences with concentration indices in parallel to an analysis of geographical differences. To conclude the analysis, we compared the changes over time of these inequalities between the three geographical areas.ResultsWhile mortality rates mainly decreased, alcohol-related mortality in the lowest income quintile increased. Statistically significant differences over time were found in all mortality groups, varying between geographical areas. Socioeconomic differences existed in all mortality groups and geographical areas. In the study period, geographical differences in mortality remained relatively stable but income differences increased substantially. For instance, the values of concentration indices for AM changed by 54 % in men (p < 0.027) and by 62 % in women (p < 0.016). Only slight differences existed in the time trends of Gini or in the concentration indices between the geographical areas.ConclusionsNo geographical or income-related differences in the distribution of mortality existed between Helsinki and other urban or rural areas of Finland. This suggests that the effect of increasing residential differentiation in the capital may have been mitigated by the policies of positive discrimination and social mixing. One of the main reasons for the increase in health inequalities was growth of alcohol-related mortality, especially among those with the lowest incomes.

Salud percibida y nivel educativo en España: tendencias por comunidades autónomas y sexo (2001-2012)

ObjectiveTo identify the trend in self-rated health in Spain by autonomous communities (AC) in the period 2001-2012, as well as differences by gender and age, and the influence of educational level. MethodsA cross sectional study was carried out using data from the National Health Surveys from 2001 to 2011-12 and the 2009 European Survey. A descriptive analysis was conducted that included gender, age, educational level, and the AC of residence. Logistic regression analyses were developed to explore the temporal trend and the association between educational level and self-rated health. The predictive capacity of the model was calculated using the C statistic. ResultsThe prevalence of low self-rated health was higher in women with low educational level. Self-rated health improved in women with high educational level (2001:18.6% vs. 2012:14.6%). The highest prevalence of low self-rated health was observed in Andalusia, the Canary Islands, Galicia and Murcia, with differences by gender. Low educational level was associated with low self-rated health in most AC, with good predictive capacity. In all AC except Asturias, low self-rated health was more frequent in women than in men. In Spain, the prevalence of self-rated health showed no variations in the period analyzed and improved in the Balearic Islands, Catalonia, and Madrid. ConclusionsThe prevalence of self-rated health in Spain differed by AC. Although health was unchanged during the period considered, inequalities were found in its temporal trend by educational level and gender, which could lead to an increase in health inequalities in women according educational level.

Are Stressful Developmental Processes of Youths Leading to Health Problems Amplified by Genetic Polymorphisms? The Case of Body Mass Index

Although previous research has documented the adverse influence of early socioeconomic disadvantage on youths' physical health outcomes and the increase in health inequalities over the early life course, little is known about genetically informed sequential life course developmental processes leading to health outcomes. Consistent with the life course-stress process perspective, we hypothesized that early socioeconomic adversity initiates a stress process over the early life course. This process involves the disrupted transition from adolescence to young adulthood, which increases the risk of health problems during young adulthood. Behavioral, psychosocial, and genetic data were collected from 12,424 adolescents (53% female) over a period of 13years participating in the nationally representative National Longitudinal Study of Adolescent Health (Add Health). Early cumulative socioeconomic adversity and the polygenic influence were measured using composite indices. The study provided evidence for stressful developmental processes of adolescents, involving parental rejection, depressive symptoms, and adolescents' precocious transition. This longitudinal process was initiated by early cumulative socioeconomic adversity and eventuated with young adults' increased body mass index (BMI). Furthermore, the study provided evidence for the influence of life context-gene interactions (G×E) on adolescents' precocious development and young adult BMI (after controlling for the lagged measure) amplifying the stress process over the early life course. These findings emphasize the need for incorporating individual genetic characteristics in a longitudinal context into life course stress research. Furthermore, policies focused on eradicating childhood/adolescent adversities are necessary as well as youth programs and policies that promote youth competencies that aid in their successful transition to young adulthood.

Why a positive link between increasing age and income-related health inequality?

This study analyze why the SES-health gradient increases with ageing. We use Statistics Sweden’s Survey of Living Conditions (the ULF). By comparing various SES and health outcome relationships we explore the age increase in health inequality and distinguish between three types of explanations, namely: i) age increase in the causal SES effect; ii) reversed health effect on SES, and iii) lifecycle variation in the measurement errors in SES. Thus, the study indicates that the age increase in health inequality is primarily caused by a reversed causality going from health to annual income, and the probable mechanism is health affecting the labour supply of the individual. The evidence in our study is not conclusive in that we can prove anything, but all the documented evidence supports this conclusion.

HEALTH PROMOTION - THE RATIONALE AND THE OBSTACLES IN WORKPLACES WITH DIFFERENT EMPLOYMENT AND FINANCIAL SOUNDNESS

This paper presents the prevalence of health promotion in workplaces in Poland. It characterises the undertaken ac tions, their rationale and perceived obstacles. It analyses the diversity of these phenomena in the companies of different financial soundness and level of employment. The study was conducted with the use of Computer Assisted Telephone Interview in 2010 on the representative national sample of 1002 workplaces hiring more than 50 employees. The data was compared with the results of the survey conducted in 2006, with the use of a Paper and Pencil interview on 611 similar companies. Both studies have shown that 40% of the companies are concerned about their employees' health to a greater extent than they are obliged to by the law. At the same time, more than 80% of the companies have been introducing various modifications and health-oriented actions without definite health intentions. Most companies improve their physical working environment, organise/sponsor medical services, sports activities and try to reduce stress and smoking. Managers have increased their awareness of business benefits re ceived from health promotion. They have displayed more personal involvement in health promotion implementation. The most often mentioned obstacles have included limited financial resources and little interest of employees regarding health issues. The larger and wealthier the company is, the more often health promotion in the company is performed. Such a company is more convinced about an increase in its activities and has more reasons to care about health. Unequal access to health promotion of wor kers in different companies may contribute to an increase in health inequalities in the working population.