Inequalities In Self-perceived Health Research Articles

Intersectionality as a theoretical-analytical tool to study health inequalities in the AmericasA interseccionalidade como ferramenta teórico-analítica para estudo das desigualdades em saúde nas Américas

Analyze inequalities in self-perceived health among population groups located at the intersections of gender identity, ethnicity, and education level in countries of the Americas, classified by income level. Panel data from the World Values Survey were used for the period 1990-2022. The study sample included 58 790 people between 16 and 65 years of age from 14 countries in the Americas. The dependent variable was poor self-perceived health, and the independent variables were gender, education level, and ethnicity. A multi-categorical variable with 12 strata was created for the intercategorical intersectionality analysis. An analysis of individual heterogeneity and diagnostic accuracy was performed using five logistic regression models, adjusted by age and by survey wave. A clear and persistent intersectional gradient for poor self-perceived health was observed in all country disaggregations by income. Compared to the category with the most advantage (men of majority ethnicity and higher education), the other groups had increased risk of poor health, with the highest risk among women of minority ethnicity and in Indigenous peoples with less than secondary education (three to four times higher). In addition, women had a higher risk of poor health than men in each pair of intersectional strata. The intersectional analysis demonstrated a persistent social gradient of self-perceived ill health in the Americas.

Local Welfare Systems and Health Inequalities: The Effects of Institutional Overlapping and Local Variations.

A growing research agenda shows the importance of local welfare systems in understanding socio-spatial inequalities in health. Welfare services provided by local governments overlap with those provided by other levels of government. Thus, differences in the provision of welfare services between municipalities could explain differences in residents' health, moderating the magnitude of health inequalities if local governments deploy actions capable of positively influencing the social determinants of health. This article attempts to analyse this idea in the Spanish case, exploring the influence of local policies according to the orientation of municipal spending on three indicators of the population's health status: self-perceived health, healthy practices and activity limitations due to health problems. A multilevel cross-sectional study was designed using information from two waves of the 2006-2007 and 2011-2012 National Health Survey for the population aged 15 years and older (N = 31,378) residing in Spanish municipalities of 20,000 inhabitants or over (N = 373). The results show that the magnitude of inequalities in self-perceived health, in the adoption of healthy practices and in daily activity limitations by social class are smaller as municipalities" spending was oriented towards policy areas considered as redistributive. Therefore, the proposed institutional overlap thesis could help understand the role of subnational governments on the magnitude of health inequalities, as well as in comparative analysis between countries with institutional systems in which local governments have a greater or lesser capacity to provide welfare services.

Inequalities in health in a municipality of Serbia

Background/Aim. A consistent association between socioeconomic determinants and health related variables has been found in many European countries. The aims of this study were: to analyze the association of socioeconomic factors with self-perceived health and utilization of health services as well as to suggest some interventions to overcome the existing problems. Methods. Hybrid study was pefrormed. The two cross-sectional studies were conducted on quota samples (1999 and 2015) in Krusevac Municipality. The questionnaire was used as the investigation instrument for 196 interviewees in 1999 and 226 interviewees in 2015. Results. In the reporting period, there were the following results: a significant increase in people who did not have a steady income (?2 = 22.800; df = 4; ? < 0.01), a decrease in the number of people who perceived their own health as ?well? and ?very well?, a significant increase (6.1%) in people who did not visit anyone when disease occurred, a decrease of 13.2% in number of people who, at least once, visited the general practitioner and an increase in the number of people who visited private health care sector. The findings revealed inequalities in self-perceived health depending on socioeconomic position, in particular educational and employment status (?2 = 11.293; df = 4; p < 0.05). There are two major ways in which unemployment affects health: lack of income and ability to meet daily needs and emotional stress related to the meaning of the work, uncertain future, loss of self-esteem, and identity. Conclusion. Equality is a key value in the assessment of the effects on health. It is necessary to conduct effective interventions for overcoming the consequences in society that would be focused on a specific target group in one territory.

Desigualdades en la salud autopercibida de la población española mayor de 65 años

ObjectiveRecent publications have concluded that there are social health inequalities in people older than 65 years in Spain, especially among women and people with low socioeconomic status. Self-perceived health is an indicator that is related to the possibility of chronic disease, the use of health services, and mortality. The aim of this study was to assess inequalities in self-perceived health in relation to age, gender, socioeconomic factors, and functional dependence. MethodsA systematic review was conducted following the PRISMA criteria. An exhaustive search was performed in PubMed, WOK, Science Direct, EMBASE, IME, Cochrane, JSTOR, Ovid, Proquest, the BMJ Group and in Spanish doctoral theses up to April 2013. The quality of the studies was assessed by two independent editors through the Berra Tool. ResultsA total of 20 documents were selected. These studies were in agreement in the deterioration of self-perceived health among older people (except the oldest), in those with functional dependence, lower socioeconomic status, and in women. ConclusionsThis review shows that, among older people, inequalities in self-perceived health due to socioeconomic status and gender have persisted in time. Future research is needed to cast light on the factors determining the persistence of these inequalities among older people, so that specific health policies can be designed for this sector of the population.

The influence of gender equality policies on gender inequalities in health in Europe

Few studies have addressed the effect of gender policies on women's health and gender inequalities in health. This study aims to analyse the relationship between the orientation of public gender equality policies and gender inequalities in health in European countries, and whether this relationship is mediated by gender equality at country level or by other individual social determinants of health.A multilevel cross-sectional study was performed using individual-level data extracted from the European Social Survey 2010. The study sample consisted of 23,782 men and 28,655 women from 26 European countries. The dependent variable was self-perceived health. Individual independent variables were gender, age, immigrant status, educational level, partner status and employment status. The main contextual independent variable was a modification of Korpi's typology of family policy models (Dual-earner, Traditional-Central, Traditional-Southern, Market-oriented and Contradictory). Other contextual variables were the Gender Empowerment Measure (GEM), to measure country-level gender equality, and the Gross Domestic Product (GDP). For each country and country typology the prevalence of fair/poor health by gender was calculated and prevalence ratios (PR, women compared to men) and 95% confidence intervals (CI) were computed. Multilevel robust Poisson regression models were fitted.Women had poorer self-perceived health than men in countries with traditional family policies (PR = 1.13, 95%CI: 1.07–1.21 in Traditional-Central and PR = 1.27, 95%CI: 1.19–1.35 in Traditional-Southern) and in Contradictory countries (PR = 1.08, 95%CI: 1.05–1.11). In multilevel models, only gender inequalities in Traditional-Southern countries were significantly higher than those in Dual-earner countries.Gender inequalities in self-perceived health were higher, women reporting worse self-perceived health than men, in countries with family policies that were less oriented to gender equality (especially in the Traditional-Southern country-group). This was partially explained by gender inequalities in the individual social determinants of health but not by GEM or GDP.

Social Inequalities in Self-Perceived Health: Comparing Hungarian and Ethnic Minority Adolescents from Transylvania, Rumania

Social Inequalities in Self-Perceived Health: Comparing Hungarian and Ethnic Minority Adolescents from Transylvania, Rumania

Socioeconomic inequalities, health damaging behavior, and self-perceived health in Serbia: a cross-sectional study

AimTo analyze the association of socioeconomic factors with self-perceived health in Serbia and examine whether this association can be partly explained by health behavior variables.MethodsWe used data from the 2007 Living Standards Measurement Study for Serbia. A representative sample of 13 831 persons aged ≥20 years was interviewed. The associations between demographic factors (age, sex, marital status, and type of settlement), socioeconomic factors (education, employment status, and household consumption tertiles), and health behavior variables (smoking, alcohol consumption) and self-perceived health were examined using logistic regression analyses.ResultsA stepwise gradient was found between education and self-perceived health for the total sample, men, and women. Compared to people with high education, people with low education had a 4.5 times higher chance of assessing their health as poor. Unemployed (odds ratio [OR], 1.64; 95% confidence interval [CI], 1.29-2.10), inactive (OR, 2.82; 95% CI, 2.49-3.19), and the most deprived respondents (OR, 1.17; 95% CI, 1.02-1.34) were more likely to report poor self-perceived health than employed persons and the most affluent group. After adjustment for demographic and health behavior variables, the magnitudes of all associations decreased but remained clearly and significantly graded.ConclusionsThis study revealed inequalities in self-perceived health by socioeconomic position, in particular educational and employment status. The reduction of such inequalities through wisely tailored interventions that benefit people’s health should be a target of a national health policy in Serbia.

The association of demographic and socioeconomic determinants and self-perceived health

Inequalities in health are evident in the whole world and present an important and consistent public health issue. The highest contribution to the inequality in heath is attributable to the demographic and socioeconomic determinants of health. The aim of this study was to analyse the association between the demographic (gender, age, marital status and type of settlement) and socioeconomic determinants of health (education and Wealth Index), and self-perceived health. In the study the data from 2006 National Health Survey of the population of Serbia were used. The interview involved 14,522 adults aged >20 years. The association between the demographic and socioeconomic determinants of health as independent variables, and self-perceived health as dependent variable were examined using bivariate and multivariate logistic regression analyses. The minimum level of significance was p < 0.05. According to our study, the elderly and females significantly more often perceived their health as poor. Respondents living in rural settings were less likely to perceive their health as poor compared to those living in urban settings (odds ratio was 0.82 in males and 0.75 in females). Males with low education were three times more likely to perceive their health as poor (odds ratio was 3.46) in relation to males with high education. This association was more pronounced in females (odds ratio was 5.37). The same pattern was observed for Wealth Index. This study showed that demographic and socioeconomic inequalities in self-perceived health are present in Serbia. Comprehensive public health policies and interventions for reducing these inequalities are urgently needed with the primarily focus on the most disadvantaged socioeconomic groups.

Analyzing Differences in the Magnitude of Socioeconomic Inequalities in Self-Perceived Health by Countries of Different Political Tradition in Europe

The objectives of this study are to describe, for European countries, variations among political traditions in the magnitude of inequalities in self-perceived health by educational level and to determine whether these variations change when contextual welfare state, labor market, wealth, and income inequality variables are taken into account. In this cross-sectional study, the authors look at the population aged 25 to 64 in 13 European countries. Individual data were obtained from the Health Interview Surveys of each country. Educational-level inequalities in self-perceived health exist in all countries and in all political traditions, among both women and men. When countries are grouped by political tradition, social democratic countries are found to have the lowest educational-level inequalities.

Inequalities in health by social class dimensions in European countries of different political traditions

To compare inequalities in self-perceived health in the population older than 50 years, in 2004, using Wright's social class dimensions, in nine European countries grouped in three political traditions (Social democracy, Christian democracy and Late democracies). Cross-sectional design, including data of the Survey of Health, Ageing and Retirement in Europe (Sweden, Denmark, Austria, France, Germany, The Netherlands, Spain, Italy and Greece). The population aged from 50 to 74 years was included. Absolute and relative social class dimension inequalities in poor self-reported health and long-term illness were determined for each sex and political tradition. Relative inequalities were assessed by fitting Poisson regression models with robust variance estimators. Absolute and relative health inequalities by social class dimensions are found in the three political traditions, but these differences are more marked in Late democracies and mainly among women. For example the prevalence ratio of poor self-perceived health comparing poorly educated women with highly educated women, was 1.75 (95% CI: 1.39-2.21) in Late democracies and 1.36 (95% CI: 1.21-1.52) in Social democracies. The prevalence differences were 24.2 and 13.7%, respectively. This study is one of the first to show the impact of different political traditions on social class inequalities in health. These results emphasize the need to evaluate the impact of the implementation of public policies.

Trends of socioeconomic inequalities and socioeconomic inequalities in self-perceived health in Spain

Objective To study the trends of socioeconomic inequalities and socioeconomic inequalities in self-perceived health in Spain between 1987 and 2001. Methods We estimated the distribution of educational level and per capita provincial income, and the differences in lessthan-good self-perceived health by educational level and per capita provincial income in each period. Results The percentage of the population that had completed secondary or higher education was larger and inequality in per capita provincial income was smaller in 2001 than in 1987. In general, the differences in less-than-good self-perceived health by educational level and provincial income were larger in 2001 than in 1987, in both absolute and relative terms. However, when the effect of residual correlation within provinces was taken into account, the differences by per capita provincial income were smaller in 2001 than in 1987. Conclusions The redistribution of socioeconomic resources achieves greater social justice, but probably does not lead to reduced health inequalities in all cases.

Determinants of and inequalities in self-perceived health in Ukraine

Ukraine is the second most populous of the former Soviet Republics and since transition its economy has fared even more poorly than Russia. Although the impact of the collapse of the former Soviet Union on health in Russia has been investigated, little is known of its impact in other post-Soviet republics. We report a cross-sectional study undertaken in Ukraine in March 2000. A multi-stage random sampling technique was used and 1600 interviews completed (72% response rate) with a representative national sample of Ukrainian adults. We investigated socioeconomic and psychosocial determinants of self-perceived health, which has been shown to be a valid and reliable measure of overall health and predictive of mortality. Odds ratios for less than good physical health were calculated using logistic regression. The self-rated health of Ukrainians was poor, 25% of men and 43% of women rated their health as poor or very poor. This is worse than levels recorded in Russia and considerably worse than levels seen in western Europe. Marked gender, geographical and socioeconomic inequalities in health were recorded. Women are at increased risk of poor self-rated health compared with men (OR 3.58, 2.50–5.14) as are women living in villages compared with those in cities (OR 3.24, 1.30–8.07). Socioeconomic factors including poor material situation (OR 1.64, 1.01–2.67), and psychosocial factors including low control over life (OR 1.89, 1.15–3.11) were identified as independent health determinants. Control over life was found to account for the negative impact of low social position on health. Good family relations protected against poor health. The findings suggest that a decrease in control, arising from an increasingly uncertain political and economic environment, a reduction in material wealth and the stress of change may all have contributed to the decline in life expectancy seen with transition.