Patterns Of Health Inequalities Research Articles

Socio-economic health differences among the elderly population in Krakow, Poland

To assess whether socio-economic health differences persist into old age in Poland and if there are SES-related differences in health by age group and gender. 528 randomly chosen, not institutionalized elderly people aged 65-85 living in Krakow were interviewed about their socio-economic status (occupation, education, income, house ownership), health status (self-rated health) and quality of life (Cantril's ladder). People with higher level of education and higher occupational status reported significantly better health and better quality of life compared to people who were not as well off. Income level and house ownership had a significant influence on the quality of life of elderly people. In addition, some findings indicate differences in the patterning of health inequalities across particular age and gender groups. There are socio-economic differences in health and quality of life among the urban elderly population in Poland which are unfavourable for lower social strata.

Monitoring health inequalities through general practice: the Second Dutch National Survey of General Practice

For the second time a plan to monitor public health and health inequalities in the Netherlands through general practice was put into action: the Second National Survey of General Practice (DNSGP-2, 2001). The first aim of this paper is to describe the general design of DNSGP-2. Secondly, to describe self assessed health inequalities in the Netherlands. Thirdly, to present differences in prevalence of chronic conditions by educational attainment using both self-assessed health and medical records of GPs. Finally, inequalities in 1987 (DNSGP-1) and 2001 will be compared. Data were collected from 96 (1987) and 104 (2001) general practices. The data include background information on patients collected via a census, approximately 12,000 health interview surveys per time point and more than one million recorded contacts of patients with their GPs in both years. The method of statistical analysis is logistic regression. The analyses shows that the lower educated have significantly higher odds of feeling unhealthy and having chronic conditions in 2001. Diabetes and myocardial infarction (GP data) showed the largest difference in prevalence between educational groups (OR 2.5 and 2.4, self-reported data). The way the data is collected (self-assessment versus GP registration) hardly affects the magnitude of the educational differences in the prevalence of chronic conditions. The pattern of health inequalities across chronic conditions in 1987 and 2001 hardly differs. Diabetes doubled in prevalence and health inequalities were not significant in 1987, but compared to the other conditions were largest in 2001 (OR 1.1 versus 2.5). Health inequalities were shown to be substantial in 2001 and persistent over time. Socio-economic differences were shown to be similar using self-assessed health data and GP data. Hence, a person's educational attainment did not appear to play a part in presenting health problems to the GP.

Social causation, health-selective mobility, and the reproduction of socioeconomic health inequalities over time: panel study of adult men

This study examines how socioeconomic inequalities in perceived health were reproduced as a cohort of adult men became 10 years older, and focuses especially on the role of social causation and health-selective mobility. A two-wave panel data set collected by the Nord-Trøndelag Health Study (HUNT), Norway, is used, and the study is based on a sample of 9189 men aged 25–49 at baseline. Systematic socioeconomic inequalities in perceived health were observed both at baseline and 10 years later when the sample was aged 35–59. Measured as age-adjusted percentage differences, inequalities in perceived health widened during the study period, both among those who were continuously employed and between the employed and non-employed. The pattern of health inequalities was transformed as a result of numerous changes in perceived health and considerable social mobility during the study period. Compared to higher white collar, changes in perceived health during the study period were more negative among medium-level and manual occupations, and even more negative among the non-employed. Mobility between occupational classes among those employed at both observation points was not selective for health, but transitions into and out of employment were strongly health-selective. It is argued that the transformation of the health inequality pattern among those continuously employed was solely due to social causation, i.e., to more negative changes in perceived health among medium/manual occupations than among the white collar. The wider difference in perceived health between the employed and non-employed was, however, primarily a result of health-selective mobility into and out of the non-employed category.

Health inequality: an introduction

There is unequivocal evidence from across Australia of entrenched patterns of socioeconomic related health inequality. These patterns are seen in mortality, morbidity, health risk factors and access to preventive health services. Discussing the potential role of health promotion in addressing these health inequalities needs to be based on an agreed definition of health inequality and an understanding of the differences between health inequity and health inequality. This involves making value judgements on whether opportunities for health are fairly distributed. Health promotion practitioners need to be able to argue why they think health inequalities are important, have a clear understanding of what they think are the causes of health inequality and be informed on action that can be taken to reduce health inequality. The ever increasing level of information on patterns of health inequality within Australian society are likely to place increased pressure on health promotion policymakers and practitioners to ensure that their actions reduce health inequality - or at least not contribute to widening health inequality. The way in which these issues are approached will be strongly influenced by our values, the values of the organisations in which we work and the wider community. This requires each of us to be proactive in articulating our values and beliefs and being open to them being challenged. (author abstract)

Socioeconomic inequalities in morbidity and mortality in western Europe

Previous studies of variation in the magnitude of socioeconomic inequalities in health between countries have methodological drawbacks. We tried to overcome these difficulties in a large study that compared inequalities in morbidity and mortality between different countries in western Europe. Data on four indicators of self-reported morbidity by level of education, occupational class, and/or level of income were obtained for 11 countries, and years ranging from 1985 to 1992. Data on total mortality by level of education and/or occupational class were obtained for nine countries for about 1980 to about 1990. We calculated odds ratios or rate ratios to compare a broad lower with a broad upper socioeconomic group. We also calculated an absolute measure for inequalities in mortality, a risk difference, which takes into account differences between countries in average rates of illhealth. Inequalities in health were found in all countries. Odds ratios for morbidity ranged between about 1.5 and 2.5, and rate ratios for mortality between about 1.3 and 1.7. For men's perceived general health, for instance, inequalities by level of education in Norway were larger than in Switzerland or Spain (odds ratios [95% CI]: 2.57 [2.07-3.18], 1.60 [1.30-1.96], 1.65 [1.44-1.88], respectively). For mortality by occupational class, in men aged 30-44, the rate ratio was highest in Finland (1.76 [1.69-1.83]), although there was no large difference in the size of the inequality in those countries with data. For men aged 45-59, for whom France did have data, this country had the largest inequality (1.71 [1.66-1.77]). In the age-group 45-64, the absolute risk difference ranked Finland second after France (9.8% [9.1-10.4], 11.5% [10.7-12.4]), with Sweden and Norway coming out more favourably than on the basis of rate ratios. In a scatter-plot of average rank scores for morbidity versus mortality. Sweden and Norway had larger relative inequalities in health than most other countries for both measures; France fared badly for mortality but was average for morbidity. Our results challenge conventional views on the between-country pattern of inequalities in health in western European countries.

Health inequalities in the early years: Is there equalisation in youth?

In the light of a still prevalent view that health inequalities are an invariant feature of the life-course, this paper re-examines the thesis that youth, in contrast to childhood, is characterised by relative equality in health, and proposes a process of equalisation to account for changes in the social class patterning of certain dimensions of health between these life stages. The evidence relating to the relationship between class of background and health over the early years is first reviewed, focusing on seven dimensions of health: mortality, chronic illness, specific conditions, self-rated health, symptoms of acute illness, accidents and injuries, and mental health. The overall picture is consistent with a conclusion of relative equality of health in youth with one major exception, severe chronic illness, which particularly on the evidence of the 1991 British Census is class differentiated from infancy. In respect of other dimensions of health, notably symptoms, non-fatal accidents and (probably) mental health, there is evidence of a change in class patterning between childhood and youth consistent with a hypothesis of equalisation. Within a theoretical perspective that juxtaposes class and age (youth) based influences, it is suggested that this could occur when effects associated with the secondary (high) school, the peer group and youth culture cut across those of the family, home background and neighbourhood in such a way as to reduce or remove class differences in health. In later youth, in the post-school period, the relative balance of class and age based influences shifts once more to produce a “re-emergence” of class gradients in adulthood. Youth may be a barometer of the relative power of post-modern consumer culture and traditional class based structures to shape the pattern of health inequalities over the early years into adulthood.

Health inequalities among men and women in contrasting welfare states

This paper compares the degree and patterning of health inequalities among men and women in 4 different welfare states: in Britain and in 3 Nordic countries (Finland, Norway and Sweden). It is argued that the structural position including social class/employment status and material living standards are determinants of men's health, but additional determinants of women's health include family roles. Employment patterns are similar for men in all 4 countries and for Finnish women, but differ for women in the other 3 countries where women take part-time jobs or, particularly in Britain, where more women are full-time housewives. Prevalence data from comparable surveys in the 4 countries are presented and further analysed by means of logistic regression analysis. Associations with limiting long-standing illness are examined by age, social class, material living standards and family roles. Contrary to expectations inequalities in health are more pronounced for both employed men and employed women in the Nordic countries than in Britain. For men in all 4 countries and for Finnish and Swedish women, age and social class are strongly associated with ill-health. For Norwegian women the evidence remains unclear. Employment participation among British women is lower than in the other 3 countries and in the examination of their ill-health a role framework complements the structural one: in addition to age and social class, marital status and parental status are associated with their ill-health.