Health-related Inequalities Research Articles

Diabetes in the cost‐of‐living crisis

Diabetes in the cost‐of‐living crisis

Environmental pollution and socioeconomic health inequality: Evidence from China

Recent work on socioeconomic health inequality has explored the possible determinants, but there is a lack of empirical evidence examining the associations between environmental pollution and socioeconomic health inequality. Most of studies employed the one-dimensional decomposition method, focusing on health but ignoring rank, to analyze the factors of health inequality. Hence, we fill this gap by using nationally representative individual-level data, employing the recentered influence function regressions method (a two-dimensional decomposition method), and estimating the marginal effect of environmental pollution on socioeconomic inequality in three health outcomes in China straightforward: physical discomfort, chronic disease, and self-rated health. Findings show that environmental pollution increases the income related health inequality of people, and the effect is larger for the middle-aged. The evidence of the possible channel through which environmental pollution is correlated with socioeconomic health inequality is also provided. In the face of environmental pollution, the rich pay more attention to their health condition and increase beneficial health behaviors, such as increasing sleeping hours, decreasing smoking, or having a more balanced diet, compared with the poor. It partly explains why environmental pollution widens the income related health inequality. These findings imply that reducing environmental pollution is an effective strategy for improving environmental quality and narrowing the income related health inequality.

Inequalities in access to new medication delivery services among non-communicable disease patients during the COVID-19 pandemic: findings from nationally representative surveys in Thailand

BackgroundThis study describes the inequalities in access to a medication delivery service (MDS) during the COVID-19 pandemic and identifies the social determinants of health-related inequalities among non-communicable disease (NCD) patients.MethodsData were obtained from a study on the impact of health behaviours and modifications in health behaviours during the COVID-19 pandemic in the Thai population in 2021. The participants were recruited from Bangkok and all four regions of Thailand. The concentration index was used to examine the inequality among income quintiles, which were standardised by age, sex, living area, job type, health insurance scheme, and education level. Logistic regression was used to examine the associations between socio-demographics and access to regular services and new NCD MDSs, adjusted for age, sex, and other covariates.ResultsAmong 1,739 NCD patients, greater income inequalities in accessing regular NCD services and collecting medicines at registered pharmacies during the COVID-19 pandemic were observed, for which the concentration index indicated utilisation inequalities in favour of richer households. In contrast, receiving medicine at primary care centres, by postal delivery, and delivered by village health volunteers were the new NCD MDSs, which favoured less wealthy households. NCD patients living in rural areas were more likely to access new NCD MDSs, compared to those in urban areas (adjusted odds ratio = 2.30; 95% confidence interval [CI]: 1.22–4.34). Significant associations with receiving medicine at hospitals were also observed for the income quintiles. Individuals in the lowest and 2nd lowest income quintiles were more likely to access new MDSs than those in the richest quintiles.ConclusionsThis study highlighted a disproportionate concentration of access to new NCD MDSs during the COVID-19 pandemic in Thailand, which was more concentrated in lower-income groups. The government should further study and integrate MDSs with the highest cost benefits into nationwide regular systems, while addressing systematic barriers to access to these services, such as the lack of shared health data across health facilities and tele pharmacy equipment. This will promote access to public services among patients in the less advantaged groups and reduce the health inequality gap.

Culture, religion and gender: considerations in facing migration related health inequalities in Italy.

The presence in Italy of a significant foreign population (5-6 million including both formally residents and not officially registered ones) introduces significant transformations in the Italian demography with important challenges on ensuring fundamental rights including work, education and above all, health. Access to healthcare. Issues common to the entire migrant population concern the difficulty of accessing the health system of the host country due to the lack of knowledge of its rules and its functioning, the linguistic and cultural barriers and the distrust towards a system that is not recognized as his own, as well as the difficulties and misunderstandings encountered in the relationship with health professionals. Religion, culture and gender may even increase these difficulties. Conlusion and future perspective. Culture and religion should be taken into account when designing and implementing healthcare services and healthcare workers need to be trained in acknowledging these challenges. The National Health Service should become more sensitive to the increasing cultural and religious pluralism of patients starting with investing more in the training of health professionals.

COVID-19-Related Health Inequalities Induced by the Use of Social Media: Systematic Review.

COVID-19-related health inequalities were reported in some studies, showing the failure in public health and communication. Studies investigating the contexts and causes of these inequalities pointed to the contribution of communication inequality or poor health literacy and information access to engagement with health care services. However, no study exclusively dealt with health inequalities induced by the use of social media during COVID-19. This review aimed to identify and summarize COVID-19-related health inequalities induced by the use of social media and the associated contributing factors and to characterize the relationship between the use of social media and health disparities during the COVID-19 pandemic. A systematic review was conducted on this topic in light of the protocol of the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 statement. Keyword searches were performed to collect papers relevant to this topic in multiple databases: PubMed (which includes MEDLINE [Ovid] and other subdatabases), ProQuest (which includes APA PsycINFO, Biological Science Collection, and others), ACM Digital Library, and Web of Science, without any year restriction. Of the 670 retrieved publications, 10 were initially selected based on the predefined selection criteria. These 10 articles were then subjected to quality analysis before being analyzed in the final synthesis and discussion. Of the 10 articles, 1 was further removed for not meeting the quality assessment criteria. Finally, 9 articles were found to be eligible and selected for this review. We derived the characteristics of these studies in terms of publication years, journals, study locations, locations of study participants, study design, sample size, participant characteristics, and potential risk of bias, and the main results of these studies in terms of the types of social media, social media use-induced health inequalities, associated factors, and proposed resolutions. On the basis of the thematic synthesis of these extracted data, we derived 4 analytic themes, namely health information inaccessibility-induced health inequalities and proposed resolutions, misinformation-induced health inequalities and proposed resolutions, disproportionate attention to COVID-19 information and proposed resolutions, and higher odds of social media-induced psychological distress and proposed resolutions. This paper was the first systematic review on this topic. Our findings highlighted the great value of studying the COVID-19-related health knowledge gap, the digital technology-induced unequal distribution of health information, and the resulting health inequalities, thereby providing empirical evidence for understanding the relationship between social media use and health inequalities in the context of COVID-19 and suggesting practical solutions to such disparities. Researchers, social media, health practitioners, and policy makers can draw on these findings to promote health equality while minimizing social media use-induced health inequalities.

Ventanillas de Salud (VDS) and Mobile Health Units (MHU): A binational collaborative models.

Over the years, the Mexican population in the United States has faced high prevalence of health-related inequalities and disadvantages and represents one of the most vulnerable migrant groups in the country. To help reduce the gaps in health care for the Mexican population, the Mexican government, in collaboration with strategic allies from various sectors, launched the Ventanillas de Salud (VDS) strategy, which was subsequently reinforced through the Mobile Health Units (MHU) care model. Both the VDS strategy and the MHU care model are intended to contribute to the development of initiatives, projects, and actions in health that will benefit the Mexican community living in the United States, which lacks or has difficulty accessing health services. This article provides a descriptive, analytical analysis of the VDS strategy and the MHU care model, as unique collaborative models, which can be replicated, and have achieved a positive impact on the health of Mexican and other Hispanic communities in the United States, at both the individual and community level.

Educational inequalities in self-rated health and emotional exhaustion among workers during the COVID-19 pandemic: a longitudinal study

ObjectiveThis study aimed to investigate trends in educational inequalities in poor health and emotional exhaustion during the pandemic among workers, and differences in trends between men and women.MethodsFive waves (2019–2021) from the longitudinal study ‘the Netherlands Working Conditions Survey COVID-19 study’ were used (response rates: 32–38%). Generalized logistic mixed models were used to estimate the changes in absolute and relative educational inequalities in poor health and emotional exhaustion for all workers (n = 12,479) and for men and women, separately.ResultsLow and intermediate educated workers reported more often poor health (OR 2.54; 95% CI 1.71–3.77 and OR 2.09; 95% CI 1.68–2.61, respectively) than high educated workers. Intermediate educated women (OR 0.49; 95% CI 0.37–0.64) reported less emotional exhaustion than high educated women, but no differences were observed among men. The prevalence of poor health first decreased across all educational levels until March 2021, and bounced back in November 2021. A similar pattern was found for emotional exhaustion, but for low and intermediate educated workers only. Relative educational inequalities in poor health reduced among men during the pandemic, and absolute differences decreased among men and women by 2.4–2.6%. Relative educational inequalities in emotional exhaustion widened among men only. Absolute differences in emotional exhaustion first increased among both men and women, but narrowed between the last two waves.DiscussionSocioeconomic inequalities for poor self-rated health remained but narrowed in relative and absolute terms during the pandemic. With regard to emotional exhaustion, socioeconomic inequalities returned to pre-COVID-19 levels at the end of 2021.

Trends and Changes in Socio-Economic Inequality in Self-Rated Health among Migrants and Non-Migrants: Repeated Cross-Sectional Analysis of National Survey Data in Germany, 1995-2017.

Socio-economic inequalities in health may change over time, and monitoring such change is relevant to inform adequate policy responses. We aimed to quantify socio-economic inequalities in health among people with direct, indirect and without migration background in Germany and to assess temporal trends and changes between 1995 and 2017. Using nationally representative survey data from the Socio-Economic Panel (SOEP), we quantified absolute and relative socio-economic inequalities in self-reported general health by calculating the slope (SII) and relative index of inequality (RII) with 95% confidence intervals (CI) among each group and year (1995–2017) in a repeated cross-sectional design. Temporal trends were assessed using a GLM regression over the SII and RII, respectively. The total sample size comprised 492,489 observations, including 108,842 (22.23%) among people with migration background. About 31% of the population with and 15% of the population without migration background had a low socio-economic status. Socio-economic inequalities in health persisted in the group with migration background (1995 to 2017), while inequalities in the non-migrant population increased (SII: = 0.04, p < 0.01) and were on a higher level. The highest socio-economic inequalities in health were found among those with direct migration background ( = −0.23, p< 0.01; = −0.33, p < 0.01). The results show that the magnitude and temporal dynamics of inequalities differ among populations with direct, indirect and without migration background. Monitoring systems can capture and investigate these inequalities if migrant populations are adequately integrated into the respective systems.

Health Inequality in the Global Burden of Chronic Obstructive Pulmonary Disease: Findings from the Global Burden of Disease Study 2019.

BackgroundThis study assessed health inequality in the global burden of chronic obstructive pulmonary disease (COPD) between 1990 and 2019 using data extracted from the Global Burden of Diseases (GBD 2019) study.MethodsData were extracted from the GBD 2019 study. A series of comparative and descriptive analyses of the disease burden between women and men in countries with different socioeconomic development (SDI) status were performed. The slope index of inequality (SII), relative index of inequality (RII), and concentration index (CI) were calculated to measure the socioeconomic-related cross-national health inequity between 1990 and 2019.ResultsThe global health burden caused by COPD increased by 25.7% in terms of disability-adjusted life years (DALY) from 59.2 million years in 1990 to 74.4 million years in 2019. Global age-standardized DALY rate (ASDR) associated with COPD decreased by 40.0%, from 1537.7 per 100,000 population in 1990 to 926.1 per 100,000 population in 2019. The highest sex-specific DALY number was at age 70–74 in male and female, and female is lower than male. However, after controlling for population size, the burden of COPD is more concentrated in the population living in low SDI countries, relative health inequality indicators (RII and CI) supported this conclusion.ConclusionThe health inequalities caused by the disparity of socioeconomic status are increasing, and the increasing concentration of wealth worldwide is likely to aggravate health inequalities associated with COPD.

Nordic research on health inequalities: A scoping review of empirical studies published in Scandinavian Journal of Public Health 2000-2021.

Aims:An important task for the Scandinavian Journal of Public Health is to address health inequality topics. This scoping review characterises Nordic empirical studies within this research field, published 2000–2021 by the Scandinavian Journal of Public Health.Methods:Original empirical research studies using data from Denmark, Finland, Iceland, Norway and/or Sweden, which linked differences in health or health-related aspects to socioeconomic positions, immigrant status, family structures and/or residential areas, were included in the review. The initial search in the Web of Science article database resulted in 294 possibly relevant articles, and 171 were judged to comply with our criteria.Results:Only one study was based on qualitative data, while all others used either surveys or register data, or both in combination. A wide variety of outcomes was addressed. Most studies had a social causation design, but 16 studies analysed health-related mobility processes and four reported intervention results. The most common statistical method was logistic regression. Poisson, Cox and ordinary least squares regression were less used. Few studies engaged explicitly with health inequality theories or with rigorous causality designs.Conclusions: The empirical health inequality studies published by the Scandinavian Journal of Public Health are rich sources for knowledge on a large array of health and health-related inequalities in Nordic countries. Drawbacks are underuse of qualitative data, few theoretical discussions and lack of studies assessing effects of interventions and policies.

Analyzing socioeconomic related health inequality in mothers and children using the concentration index

&#x0D; Background: The effect of socioeconomic inequity on major public health indices such as maternal and child mortality rates in low- and middle-income countries are less understood and needs to be evaluated through the concentration index.&#x0D; Method: This cross-sectional study was conducted in 2012 in Hamadan City, the west of Iran, and 1400 households were enrolled through a stratified cluster random sampling method. The effect of inequity on health outcomes was investigated via a three-stage procedure including: (a) definition of health outcomes; (b) measuring socioeconomic status using an asset index; and (c) measuring inequality of health outcome using concentration index (CI).&#x0D; Results: There was inequality for all outcomes of interest. The CI was negative for low birth weight, underweight, stunting, wasting, minor injuries, moderate injuries, consanguineous marriage, child with disability, short birth spacing, and adolescent pregnancy indicating the disproportionate concentration of the health outcomes among the poor. On the other hand, CI was positive for preterm birth, Nonexclusive breastfeeding, severe injuries, incomplete health care, cesarean section, and advanced maternal age indicating opposite conclusion.&#x0D; Conclusion: According to our results, there is a health inequality between the poor and the rich subgroups which may increase the risk of mothers and infant mortality and morbidity rates among the poor while the majority of the conditions related to the health outcomes are preventable.&#x0D;

Socioeconomic and health-related inequalities in major depressive symptoms among older adults: a Wagstaff’s decomposition analysis of data from the LASI baseline survey, 2017–2018

ObjectivesTo find out the association between socioeconomic and health status and depression among older adults and explore the contributing factors in the socioeconomic and health-related inequalities in late-life depression.DesignA cross-sectional...

Oral health inequality in Canada, the United States and United Kingdom

The objective of this study was to quantify the magnitude of absolute and relative oral health inequality in countries with similar socio-political environments, but differing oral health care systems such as Canada, the United States (US), and the United Kingdom (UK), in the first decade of the new millennium. Clinical oral health data were obtained from the Canadian Health Measures Survey 2007-2009, the National Health and Nutrition Examination Survey 2007-2008, and the Adult Dental Health Survey 2009, for Canada, the US and UK, respectively. The slope index of inequality (SII) and relative index of inequality (RII) were used to quantify absolute and relative inequality, respectively. There was significant oral health inequality in all three countries. Among dentate individuals, inequality in untreated decay was highest among Americans (SII:28.2; RII:4.7), followed by Canada (SII:21.0; RII:3.09) and lowest in the UK (SII:15.8; RII:1.75). Inequality for filled teeth was negligible in all three countries. For edentulism, inequality was highest in Canada (SII: 30.3; RII: 13.2), followed by the UK (SII: 10.2; RII: 11.5) and lowest in the US (SII: 10.3; and RII: 9.26). Lower oral health inequality in the UK speaks to the more equitable nature of its oral health care system, while a highly privatized dental care environment in Canada and the US may explain the higher inequality in these countries. However, despite an almost equal utilization of restorative dental care, there remained a higher concentration of unmet needs among the poor in all three countries.

Inequalities and inequities in the types of chronic pain services available in areas of differing deprivation across England.

In England, the prevalence of chronic pain is higher in more deprived compared to less deprived areas. Patients in such areas also experience more severe and disabling pain than those in less deprived areas. However, little is known about whether the distribution of services for chronic pain reflect these ranging levels of need. This study examines how the types of services available for chronic pain patients vary between healthcare providers in England, serving areas of differing deprivation. National guidelines regarding primary as well the 8 commonest causes of secondary chronic pain (in the United Kingdom) were used to compile a list of services that have been recommended for supporting chronic pain patients. After searching the websites of 63 randomly selected National Health Service (NHS) Trusts and contacting their pain receptionists and/or secretaries, it was recorded whether the Trusts were providing each of these recommended chronic pain services. Mean Index of Multiple Deprivation 2019 scores were used to compare deprivation levels of areas covered by each NHS Trust. There was no significant difference in the overall number of types of chronic pain services provided by NHS Trusts serving areas of differing deprivation, but deprived areas were being disadvantaged with regards to specific services. These areas were significantly (p<0.05) less likely to have occupational therapy, return-to-work programmes, and hand therapy services. Areas with fewer types of professionals (≤3) in their pain multidisciplinary team were also significantly (p<0.05) more deprived than those with more types (>3). There are significant differences in the provision of certain types of chronic pain services between areas of differing deprivation. Similar research across Europe is recommended to inform policy to combat the widespread chronic pain related health inequalities.

Social Inequalities and Health among Older Immigrant Women in the Nordic Countries: An Integrative Review.

IntroductionThe Nordic countries have a surprisingly strong relative socioeconomic health inequality. Immigrants seem to be disproportionately affected due to their social economic position in the host countries. Healthcare professionals, including nurses, have a professional obligation to adhere to fairness and social equity in healthcare. The aim of this review was to identify and synthesize research on health status and the impact of social inequalities in older immigrant women in the Nordic countries.MethodsWe conducted an integrative review guided by the Whittemore and Knafl integrative review method. We searched multiple research databases using the keywords immigrant, older, women, socioeconomic inequality, health inequality, and Nordic countries. The results were limited to research published between 1990 and 2021. The retrieved articles were screened and assessed by two independent reviewers.ResultsBased on the few studies on older immigrant women in the Nordic countries, the review findings indicate that they fare worse in many health indicators compared to immigrant men and the majority population. These differences are related to various health issues, such as anxiety, depression, diabetes, multimorbidity, sedentary lifestyle, and quality of life. Lower participation in cancer screening programs is also a distinctive feature among immigrant women, which could be related to the immigrant women's help-seeking behavior. Transnational family obligations and responsibilities locally leave little room for prioritizing self-care, but differing views of health conditions might also contribute to avoidance of healthcare services.ConclusionThis integrative review shows that there is a paucity of studies on the impact of social inequalities on the health status of older immigrant women in the Nordic countries. There is a need for not only research focused on the experiences of health status and inequality but also larger studies mapping the connection between older immigrant women's economic and health status and access to healthcare services.

Comparing the magnitude of oral health inequality over time in Canada and the United States.

To assess the magnitude of, and changes in, absolute and relative oral health inequality in Canada and the United States, from the 1970s till the first decade of the new millennium. Data were obtained from four national surveys; two Canadian (NCNS 1970-1972 and CHMS 2007-2009) and two American (HANES 1971-1974 and NHANES 2007-2008). The slope and relative index of inequality were used to measure absolute and relative inequality, respectively. Percentage change in inequality was also calculated. Relative inequality for untreated decay increased by 91% in Canada and 189% in the United States, while for filled teeth it declined by 63% in Canada and 16% in the United States. Relative inequality in edentulism rose by 200% and 78% in Canada and United States, respectively. Absolute inequality declined in both countries. There was persistent absolute and relative inequality in Canada and the United States. An increase in relative inequality for adverse outcomes suggests that improvements in oral health were occurring primarily among the rich, while reductions in relative inequality for filled teeth indicate higher utilization of restorative services among the poor. These results point to the necessity of tackling the sociopolitical determinants of health to mitigate oral health inequality in Canada and the United States.

Trends in absolute and relative educational inequalities in health during times of labour market restructuring in coastal areas: The HUNT Study, Norway

BackgroundRestructuring labour markets offers natural population-level experiments of great social epidemiological interest. Many coastal areas have endured substantial restructuring of their local labour markets following declines in small-scale fishing and transitions to new employment opportunities. It is unknown how educational inequalities in health have developed in formerly fishery-dependent communities during such restructuring. In this study, we compare trends in social inequalities in health in Norwegian coastal areas with adjacent geographical areas between 1984 and 2019. MethodsWe used cross-sectional population-based data from the Trøndelag Health Study (HUNT), collected four times: HUNT1 (1984–86), HUNT2 (1995–97), HUNT3 (2006–08) and HUNT4 (2017–19). Adults above 30 years of age were included. Using Poisson regression, we calculated absolute and relative educational inequalities in self-rated health, using slope (SII) and relative (RII) indices of inequality. ResultsTrends in absolute and relative inequalities in rural coastal health were generally more favourable than in adjacent geographical areas. We found a statistically significant trend of declining relative educational inequalities in self-rated health in the rural coastal population from HUNT1 to HUNT4. Absolute inequalities overall increased from HUNT1 to HUNT4, although a declining trend followed HUNT2. Nonetheless, the rural coastal population exhibited the highest prevalence of poor self-rated health across the four decades. ConclusionsAlthough absolute educational inequalities in self-rated health widened in all geographical areas, the smallest increase was in rural coastal areas. Relative educational inequalities narrowed in this rural coastal population. Considering the concurrent processes of large-scale investments in the Norwegian public sector and welfare schemes, increased fishing fleet safety, and employment opportunities in aquaculture, our findings do not suggest that potential positive effects on public health of this restructuring have benefitted inhabitants with higher educational attainment more than inhabitants with lower educational attainment in this rural coastal population.

Adolescent Mental Health Disorders and Upper Secondary School Completion – The Role of Family Resources

ABSTRACT This article investigates the role of socioeconomic family resources in modifying the relationships with upper secondary school completion (SSC) for three mental health dimensions, i.e., externalizing, internalizing and substance use disorders. Using data from administrative registers, we follow a cohort in Norway born in 1996 into early adulthood. We find that having a mental health disorder in adolescence was associated with 12–17 percentage points lower SSC rate after adjustment for demographic and household factors, comorbidity and educational performance. In girls, high family income attenuated the negative relationships between all three mental health dimensions and SSC, while in boys, this was true only for substance use disorders. The paper concludes that access to family socioeconomic resources “buffers” the negative impact of mental health disorders on SSC, but less so in boys, contributing to aggravate social and health-related inequalities in SSC.

COVID-19 and the Nordic Paradox: a call to measure the inequality reducing benefits of welfare systems in the wake of the pandemic

The Nordic Paradox of inequality describes how the Nordic countries have puzzlingly high levels of relative health inequalities compared to other nations, despite extensive universal welfare systems and progressive tax regimes that redistribute income. However, the veracity and origins of this paradox have been contested across decades of literature, as many scholars argue it relates to measurement issues or historical coincidences. Disentangling between potential explanations is crucial to determine if widespread adoption of the Nordic model could represent a sufficient panacea for lowering health inequalities, or if new approaches must be pioneered. As newfound challenges to welfare systems continue to emerge, evidence describing the benefits of welfare systems is becoming ever more important. Preliminary evidence indicates that the COVID-19 pandemic is drastically exacerbating social inequalities in health across the world, via direct and indirect effects. We argue that the COVID-19 pandemic therefore represents a unique opportunity to measure the value of welfare systems in insulating their populations from rising social inequalities in health. However, COVID-19 has also created new measurement challenges and interrupted data collection mechanisms. Robust academic studies will therefore be needed—drawing on novel data collection methods—to measure increasing social inequalities in health in a timely fashion. In order to assure that policies implemented to reduce inequalities can be guided by accurate and updated information, policymakers, academics, and the international community must work together to ensure streamlined data collection, reporting, analysis, and evidence-based decision-making. In this way, the pandemic may offer the opportunity to finally clarify some of the mechanisms underpinning the Nordic Paradox, and potentially more firmly establish the merits of the Nordic model as a global example for reducing social inequalities in health.

The Field of “Public Health” as a Component of Sustainable Development—Poland Compared to the European Union

The objective of the article is to analyse selected indicators of sustainable development in the field of “public health”, especially those related to health and health-related inequalities. The article focuses on the analysis of indicators in the field of “public health” presented by Eurostat. These indicators were presented in terms of averages and medians. Moreover, the paper indicates the amount of funds allocated for prevention in health care. In addition, the cluster method was used to identify EU countries similar to each other in terms of the leading indicator of sustainable development (SD). The study was conducted using annual data for 2010–2019 for Poland as compared to other EU countries. The study used data from the Eurostat and OECD databases. In almost all of the analysed countries, in relation to the demographic and health situation, there is a close link between the financial situation, health and inequalities in health-related fields. Patients’ sense of safety has decreased in Poland, which is the result of the growing consumption of health services and emerging problems with the availability of health care services as well as environmental pollution. Among others, the percentage of people with health problems and low income has increased. Although the percentage of unmet needs resulting from income inequalities has decreased over the past year in the analysed groups of countries, it is still high in Poland. The low level of expenditure on prevention makes these difficulties even more severe. In summary, capturing changes in indicators describing public health in the context of its impact on sustainable development plays a key role in balancing out inequalities in the EU countries and in managing a common policy.