Trends In Health Inequalities Research Articles

Health inequalities in Germany and in international comparison: trends and developments over time.

Social epidemiological research has consistently demonstrated that people with a low socioeconomic status are particularly at risk of diseases, health complaints and functional limitations, and die at younger ages than those with a higher socioeconomic status. Greater stresses and strains in the workplace, family and living environment are under discussion as possible explanations. Health-related behaviours, psycho-social factors and personal resources, which are important in coping with everyday demands, certainly also play a role. From a public health and health policy perspective, reducing these health inequalities is an important goal. Insights into developments and trends in health inequalities over time can contribute towards highlighting new and emerging problems, and can thus help identify possible target groups and settings for relevant interventions. At the same time, these insights provide a basis upon which the success of policies and programmes that have already been implemented can be analysed and measured. Against this background, this review examines how health inequalities in Germany have developed over the last 20 to 30 years and places its findings within the context of the latest international research in this field.

Comparing trends in health inequalities in Great Britain by different measures

Comparing trends in health inequalities in Great Britain by different measures

Trends in health inequalities in developing countries

This is a review of current professional thinking about health inequalities in developing countries and how to reduce them. It is in four parts. The first provides a brief history of recent trends in concern about health inequalities and related issues. The second is a discussion of the concept of health inequalities, and of the similarities and differences between other distributional measures in current use. The third summarizes what is known about the dimensions and magnitude of health inequalities. The fourth presents a comparable summary of current thought about how best to reduce inequalities. The review closes with a brief conclusion.

Socioeconomic Disparities in Health Outcomes and Access to Health Care across Three Islands in Comoros.

The purpose of this paper is two-fold. First, to give an overview of the size and measure trends in health inequalities in the Comoros islands (Comoros) since 1996. Second, to assess the wide differences in health and health care across rural/urban areas and islands in Comoros, by using available and comparable leading indicators, in order to promote regular monitoring of policy goals. This assessment is aimed at reducing health inequalities and providing adequate or equal access to health care between islands. Data from the Demographic and Health Survey, Multiple Indicators Cluster Surveys from 1996, 2000 and 2012, the World Health Organization, the World Bank, the African Development Bank data sources, were analyzed for a population health-oriented approach characterized by measuring health differences from the population average, taking account of the population size of the social groups on both relative and absolute scales. The results showed that there exist geographic disparities in health in Comoros, mainly in maternal and child health.

Social Determinants of Health in the United States: Addressing Major Health Inequality Trends for the Nation, 1935-2016.

Objectives:This study describes key population health concepts and examines major empirical trends in US health and healthcare inequalities from 1935 to 2016 according to important social determinants such as race/ethnicity, education, income, poverty, area deprivation, unemployment, housing, rural-urban residence, and geographic location.Methods:Long-term trend data from the National Vital Statistics System, National Health Interview Survey, National Survey of Children’s Health, American Community Survey, and Behavioral Risk Factor Surveillance System were used to examine racial/ethnic, socioeconomic, rural-urban, and geographic inequalities in health and health care. Life tables, age-adjusted rates, prevalence, and risk ratios were used to examine health differentials, which were tested for statistical significance at the 0.05 level.Results:Life expectancy of Americans increased from 69.7 years in 1950 to 78.8 years in 2015. However, despite the overall improvement, substantial gender and racial/ethnic disparities remained. In 2015, life expectancy was highest for Asian/Pacific Islanders (87.7 years) and lowest for African-Americans (75.7 years). Life expectancy was lower in rural areas and varied from 74.5 years for men in rural areas to 82.4 years for women in large metro areas, with rural-urban disparities increasing during the 1990-2014 time period. Infant mortality rates declined dramatically during the past eight decades. However, racial disparities widened over time; in 2015, black infants had 2.3 times higher mortality than white infants (11.4 vs. 4.9 per 1,000 live births). Infant and child mortality was markedly higher in rural areas and poor communities. Black infants and children in poor, rural communities had nearly three times higher mortality rate compared to those in affluent, rural areas. Racial/ethnic, socioeconomic, and geographic disparities were particularly marked in mortality and/or morbidity from cardiovascular disease, cancer, diabetes, COPD, HIV/AIDS, homicide, psychological distress, hypertension, smoking, obesity, and access to quality health care.Conclusions and Global Health Implications:Despite the overall health improvement, significant social disparities remain in a number of health indicators, most notably in life expectancy and infant mortality. Marked disparities in various health outcomes indicate the underlying significance of social determinants in disease prevention and health promotion and necessitate systematic and continued monitoring of health inequalities according to social factors. A multi-sectoral approach is needed to tackle persistent and widening health inequalities among Americans.

Time trends in health inequalities due to care in the context of the Spanish Dependency Law

ObjectiveIn Spain, responsibility for care of old people and those in situations of dependency is assumed by families, and has an unequal social distribution according to gender and socioeconomic level. This responsibility has negative health effects on the carer. In 2006, the Dependency Law recognised the obligation of the State to provide support. This study analyses time trends in health inequalities attributable to caregiving under this new law. MethodsStudy of trends using two cross-sectional samples from the 2006 and 2012 editions of the Spanish National Health Survey (27,922 and 19,995 people, respectively). We compared fair/poor self-rated health, poor mental health (GHQ-12 >2), back pain, and the use of psychotropic drugs between non-carers, carers sharing care with other persons, and those providing care alone. We obtain prevalence ratios by fitting robust Poisson regression models. ResultsWe observed no change in the social profile of carers according to gender or social class. Among women, the difference in all health indicators between carers and non-carers tended to decrease among those sharing care but not among lone carers. Inequalities tend to decrease slightly in both groups of men carers. ConclusionsBetween 2006 and 2012, trends in health inequalities attributable to informal care show different trends according to gender and share of responsibility. It is necessary to redesign and implement policies to reduce inequalities that take into account the most affected groups, such as women lone carers. Policies that strengthen the fair social distribution of care should also be adopted.

The impact of increasing income inequalities on educational inequalities in mortality - An analysis of six European countries.

BackgroundOver the past decades, both health inequalities and income inequalities have been increasing in many European countries, but it is unknown whether and how these trends are related. We test the hypothesis that trends in health inequalities and trends in income inequalities are related, i.e. that countries with a stronger increase in income inequalities have also experienced a stronger increase in health inequalities.MethodsWe collected trend data on all-cause and cause-specific mortality, as well as on the household income of people aged 35–79, for Belgium, Denmark, England & Wales, France, Slovenia, and Switzerland. We calculated absolute and relative differences in mortality and income between low- and high-educated people for several time points in the 1990s and 2000s. We used fixed-effects panel regression models to see if changes in income inequality predicted changes in mortality inequality.ResultsThe general trend in income inequality between high- and low-educated people in the six countries is increasing, while the mortality differences between educational groups show diverse trends, with absolute differences mostly decreasing and relative differences increasing in some countries but not in others. We found no association between trends in income inequalities and trends in inequalities in all-cause mortality, and trends in mortality inequalities did not improve when adjusted for rising income inequalities. This result held for absolute as well as for relative inequalities. A cause-specific analysis revealed some association between income inequality and mortality inequality for deaths from external causes, and to some extent also from cardiovascular diseases, but without statistical significance.ConclusionsWe find no support for the hypothesis that increasing income inequality explains increasing health inequalities. Possible explanations are that other factors are more important mediators of the effect of education on health, or more simply that income is not an important determinant of mortality in this European context of high-income countries. This study contributes to the discussion on income inequality as entry point to tackle health inequalities. More research is needed to test the common and plausible assumption that increasing income inequality leads to more health inequality, and that one needs to act against the former to avoid the latter.Electronic supplementary materialThe online version of this article (doi:10.1186/s12939-016-0390-0) contains supplementary material, which is available to authorized users.

How robust is the calculation of health inequality trends by educational attainment in England and Wales using the Longitudinal Study?

Background and objectivesInequalities in mortality by educational attainment are wider in Eastern Europe than in West and Central Europe, but have thus far been largely limited to cross-sectional analyses. This study explored the potential to use the Longitudinal Study to describe trends in mortality inequality by educational attainment in England and Wales from 1971 to 2009 and the limitations in the available data. Study designComparison of cohort studies. MethodsData from the Office for National Statistics Longitudinal Study were used which takes a sample of respondees from each Census (1971–2001) and links them to death certification. Age-standardized mortality was calculated by educational attainment for those aged 25–69 years as was the Relative Index of Inequality and Slope Index of Inequality for men and women for each time period. ResultsOverall mortality declined in all categories of educational attainment for men and women from 1971. Limited data were collected on educational attainment in the Censuses prior to 2001, combined with the high proportion of respondents with missing data or reporting ‘no education’, meant that estimates of inequalities for the period 1971 to 2000 were very imprecise and likely to be misleading. For 2001–2009, the slope index of inequality was 268 (95% CI 57–478) and relative index of inequality was 0.61 (95% CI 0.13–1.10) for the total population; 354 (95% CI 72–636) and 0.67 (95% CI 0.14–1.21) respectively for men; and 231 (95% CI 72–389) and 0.66 (95% CI 0.21–1.11) respectively for women. ConclusionsLimited educational data in the Censuses prior to 2001 makes calculation of mortality inequalities by educational attainment in England and Wales imprecise and potentially misleading. International comparisons and time trend analyses using these data prior to 2001 should be done with great caution.

Trends in social inequalities in adolescent health complaints from 1994 to 2010 in Europe, North America and Israel: The HBSC study.

Studies have shown constant or increasing health inequalities in adulthood in the last decades, but less is known about trends in health inequalities among adolescents. The aim is to analyse changes in socioeconomic differences in subjective health complaints from 1994 to 2010 among 11- to 15-year-olds in Europe, North America and Israel. Data were obtained from the international 'Health Behaviour in School-aged Children' (HBSC) survey. Analyses were based on the HBSC surveys conducted in 1994 (19 countries), 1998 (25 countries), 2002 (32 countries), 2006 (37 countries) and 2010 (36 countries) covering a time period of up to 16 years. Log binomial regression models were used to assess inequalities in multiple health complaints. Socioeconomic position was measured using perceived family wealth. Inequalities in multiple health complaints emerged in almost all countries, in particular since 2002 (RR 1.1-1.7). Trend analyses showed stable (29 countries), increased (5 countries), decreased (one country) and no social inequalities (2 countries) in adolescent health complaints. In almost all countries, social inequalities in health complaints remained constant over a period of up to 16 years. Our findings suggest a need to intensify efforts in social and health policy to tackle existing inequalities.

Trends in income-related health inequalities in self-assessed health in Korea, 1998–2011

This study assesses income-related health inequalities in self-assessed health (SAH) and its trend from 1998 to 2011 in Korea that covers important time periods of financial crisis and post-crisis. Data came from the Korean National Health and Nutrition Examination Survey from 1998 to 2011. A population-representative sample aged 46 years and older was analysed. SAH was used as an indicator of health status, with household equivalence income as a proxy for socio-economic position. Age-adjusted prevalence rates of SAH were analysed to estimate both absolute and relative measures of health inequalities and the trend over time by the relative index of inequality (RII) and the slope index of inequality (SII). Results indicated that the highest level of health inequalities was found among men aged 46–59 years, especially in 2001 and 2005. For men, there was no clear, consistent pattern of increase or decrease in the trend over time. On the other hand, increasing trends in the RII and SII were found for women, except for women aged 46–59 years who reported a decreasing trend in the SII. Trends in health inequalities over time were influenced by economic crisis, demonstrating the need for macro-level economic policies as well as health policies addressing health gaps.

Trends in Socioeconomic and Racial/Ethnic Inequalities in Self-Assessed Health, Disability, and Mental Health in California: Findings from CHIS 2001–2011

Despite growing interest in health inequalities across socioeconomic and racial/ethnic groups, research remains scarce on the subject for California. The purpose of this study is to assess magnitude and trends in socioeconomic and race/ethnicity inequalities in self-assessed health, disability, and psychological distress. This study used the population-representative sample aged 45 and older (n = 181,964) in 2001–2011 California Health Interview Survey (CHIS). Based on poverty as socioeconomic position and race/ethnicity as nominal social group, health inequalities and the trend over time were examined by estimating population-weighted measures on both absolute and relative terms. The most economically disadvantaged Californians showed the highest rates of poor self-assessed health, disability, and serious psychological distress for the entire study period. Socioeconomic health inequalities have widened in poor self-assessed health over time for women, while the inequalities appeared to narrow for disability and psychological distress for both men and women. Race/ethnicity inequalities in disability widened considerably for men and women, while those of psychological distress declined from 2005 to 2011. Socioeconomic and race/ethnicity health inequalities are present and persistent in California. Trends in health inequalities appear to reflect potential impact of recent financial crisis and legislative changes in California. Consistent measurement and monitoring of health inequalities are needed to develop socioeconomic and health policies that address health inequalities in California.

Are health inequalities increasing with time? Results of a literature review and recommendations for further research

It has been shown that socio-economic status (SES) and health are closely linked to one another. Now we focus on further questions, and one of the most important ones is whether these "health inequalities" increase with time. In Germany, there is little discussion about this question and no review summarising the empirical evidence is available.This review focuses on 4 dimensions: time trends of health inequalities concerning mortality (or, respectively, life expectancy), self-rated health, smoking and obesity. First we included all empirical analyses from Germany, and all analyses from other European countries published between 2008 and 2012. Then, step-wise, 44 studies (including 5 from Germany) were selected by predefined criteria for a detailed -description of empirical results and methods.The number of publications has strong-ly increased in recent years, illustrating the growing interest in time trends of health inequalities. The empirical results of the 44 studies could be summarised in the following way: All in all, 184 empirical results are reported about time trends in health inequalities and 112 of them show increasing inequalities; decreasing inequalities are shown in 13 reports. The studies from Germany point in the same direction (i. e., most results indicate increasing health inequalities). It is also important to stress that there is great -heterogeneity concerning the methodical approaches. Some studies analyse health inequalities by individual socio-economic status (e. g., educational level), others by regional deprivation. Sometimes changes in the extent of health inequalities over time are not calculated explicitly. Some papers do not include absolute and relative measures of inequalities, but just one of them.In Germany, there is a need for more empirical studies looking at time trends of health inequalities; the available datasets should be used more often for this type of analysis. If possible, further studies should include individual SES and regional deprivation, measures of absolute and relative inequality (stratified by sex, with significance tests for time trend), and they should cover as many points in time as possible. Also, it would be important to relate the chang-es in health inequalities to the other changes in the society.

Addressing health inequalities in the United States: Key data trends and policy action

Health inequalities, which have been well documented for decades, have recently become policy targets in the United States. This report summarizes current patterns and trends in health inequalities, commitments to reduce health inequalities, and progress made to eliminate health inequalities. Time trend data indicate improvements in health status and major risk factors but increases in morbidity, with black and lowereducation individuals experiencing a disproportionate burden of disease. A common policy response has been priority setting in the form of national objectives or goals to address health inequalities. More research and better methods are needed to precisely measure relationships between stated policy goals and observed trends in health inequalities. Despite these challenges, the United States has made commitments to advancing research and policy to eliminate health inequalities. There remain considerable opportunities for local public health systems and practioners to develop innovative solutions to address the problem of health inequalities, particularly related to action steps, and for researchers to address knowledge gaps in the scientific literature related to the evaluation and measurement of progress aimed at addressing health inequalities.

Inequality trends in health and future health risk among English children and young people, 1999–2009

ObjectiveTo investigate trends in health inequality among children and young people between 1999 and 2009, using outcomes consistent with the current NHS reforms.Design/dataSecondary analysis of participants aged 0–24 in the...

Impact of Selective Evidence Presentation on Judgments of Health Inequality Trends: An Experimental Study

Reducing health inequalities is a key objective for many governments and public health organizations. Whether inequalities are measured on the absolute (difference) or relative (ratio) scale can have a significant impact on judgments about whether health inequalities are increasing or decreasing, but both of these measures are not often presented in empirical studies. In this study we investigated the impact of selective presentation of health inequality measures on judgments of health inequality trends among 40 university undergraduates. We randomized participants to see either a difference or ratio measure of health inequality alongside raw mortality rates in 5 different scenarios. At baseline there were no differences between treatment groups in assessments of inequality trends, but selective exposure to the same raw data augmented with ratio versus difference inequality graphs altered participants’ assessments of inequality change. When absolute inequality decreased and relative inequality increased, exposure to ratio measures increased the probability of concluding that inequality had increased from 32.5% to 70%, but exposure to difference measures did not (35% vs. 25%). Selective exposure to ratio versus difference inequality graphs thus increased the difference between groups in concluding that inequality had increased from 2.5% (95% CI −9.5% to 14.5%) to 45% (95% CI 29.4 to 60.6). A similar pattern was evident for other scenarios where absolute and relative inequality trends gave conflicting results. In cases where measures of absolute and relative inequality both increased or both decreased, we did not find any evidence that assignment to ratio vs. difference graphs had an impact on assessments of inequality change. Selective reporting of measures of health inequality has the potential to create biased judgments of progress in ameliorating health inequalities.

Resistance in Unjust Times: Archer, Structured Agency and the Sociology of Health Inequalities.

Few sociologists dissent from the notion that the mid- to late 1970s witnessed a shift in capitalism’s modus operandi. Its association with a rapid increase of social and material inequality is beyond dispute. This article opens with a brief summation of contemporary British trends in economic inequalities, and finds an echo of these trends in health inequalities. It is suggested that the sociology of health inequalities in Britain lacks an analysis of agency, and that such an analysis is crucial. A case is made that the recent critical realist contribution of Margaret Archer on ‘internal conversations’ lends itself to an understanding of agency that is salient here. The article develops her typology of internal conversations to present characterizations of the ‘focused autonomous reflexives’ whose mind-sets are causally efficacious for producing and reproducing inequalities, and the ‘dedicated meta-reflexives’ whose casts of mind might yet predispose them to mobilize resistance to inequalities.

Impact on health inequalities of rising prosperity in England 1998-2007, and implications for performance incentives: longitudinal ecological study

Objective To investigate whether the uneven rise in prosperity between 1999 and 2008 accounted for differential increases in life expectancy in English local authorities.Design Longitudinal ecological study.Setting 324 local authorities...

OP32 Health Inequalities in Japan 1986 to 2007 Based on Self-Rated Health, Household Income and a Novel Occupational Classification

BackgroundWhile widening or stable inequalities have often been found in relation to economic stagnation in the west, time trends in health inequalities in Japan over the past two decades of...

Health inequalities: trends, progress, and policy.

Health inequalities, which have been well documented for decades, have more recently become policy targets in developed countries. This review describes time trends in health inequalities (by sex, race/ethnicity, and socioeconomic status), commitments to reduce health inequalities, and progress made to eliminate health inequalities in the United States, United Kingdom, and other OECD countries. Time-trend data in the United States indicate a narrowing of the gap between the best- and worst-off groups in some health indicators, such as life expectancy, but a widening of the gap in others, such as diabetes prevalence. Similarly, time-trend data in the United Kingdom indicate a narrowing of the gap between the best- and worst-off groups in some indicators, such as hypertension prevalence, whereas the gap between social classes has increased for life expectancy. More research and better methods are needed to measure precisely the relationships between stated policy goals and observed trends in health inequalities.

Socioeconomic Inequalities in Birth and Pregnancy Outcomes in the Czech Republic between 1990 and 2007: An Exploration of Trends

This article explores the impact of the post-socialist transformation of Czech society on the health of newborns from different socioeconomic groups. The authors used six different measures of child health—various con- structs based on birth weight, length of gestation, and vitality—as dependent variables and the mother's educational attainment as the key predictor. They used birth certifi cate data on all singleton births in 1990, 1992, 1994, 1996, 1998, 2000, 2002, 2004 and 2007 (N=912 591). They estimated a series of random-inter- cept multi-level models and report the observed trends in health inequality by maternal education. The analysis consistently and persistently showed large gaps in health between children born to mothers with elementary education on the one hand and all other children on the other hand. While the trends are not entirely congruent across all measures of child health, the authors found more evidence of growing inequality than of declining or stable inequality. Inequality grew most in the 1990s and then stabilised or even declined. They offer two tentative explanations for observed growth in inequality: the selec- tive adjustment hypothesis and the selective childlessness hypothesis.