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Health inequalities: underlying factors and different ways of addressing them

Health inequalities: underlying factors and different ways of addressing them. health is unequally distributed in Europe – between and within countries focus here on health inequalities within countries, between socioeconomic groups highlight 5 key points.

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Health inequalities: underlying factors and different ways of addressing them

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  1. Health inequalities: underlying factors and different ways of addressing them

  2. health is unequally distributed in Europe – between and within countries • focus here on health inequalities within countries, between socioeconomic groups • highlight 5 key points

  3. 1. Health inequalities exist in all European countries

  4. Mortality rates (per 1000 person years) of lower & higher educated groups, women aged 60-69 high low Source: unpublished estimates by M. Huisman, A.E. Kunst and J.P. Mackenbach for the EU Working Group on  Socioeconomic Inequalities in Health

  5. Mortality rates (per 1000 person years) of lower & higher educated groups, men aged 60-69 high low Source: unpublished estimates by M. Huisman, A.E. Kunst and J.P. Mackenbach for the EU Working Group on  Socioeconomic Inequalities in Health

  6. 2. Health inequalities take the form of a social gradient

  7. Sweden: rates of limiting longstanding illness by educational level, 1994-5 Source: Lungberg et al, 2001

  8. England: rates of limiting longstanding illness bysocioeconomic group (based on occupation), 1998 Source: General Household Survey, 1998

  9. 3. Health inequalities reflect inequalities in the distribution of health determinants

  10. Health strategy of the European community 2001-06 • ‘addressing health determinants, the underlying factors which affect people’s health’ • ‘life-style related health determinants’ : cigarette smoking, diet etc • ‘socio-economic determinants’: life chances (childhood circumstances, education, employment), working & living conditions, health & welfare services

  11. What is important about these determinants for health inequalities is their social distribution • health determinants display a socioeconomic gradient

  12. Risk factors by social class at birth, 1958 birth cohort Source: Power 1997

  13. 4. Multiple understandings of what it means to tackle health inequalities • improving the health of disadvantaged groups • reducing health differences between socioeconomic groups

  14. improving the health of disadvantaged groups • focus on marginal & minority groups (immigrant communities, homeless people) • sets boundaries around ‘the problem’

  15. improving the health of disadvantaged groups • absolute improvements in their health may not narrow the gap between them & the wider population (because overall health is improving at a faster rate) • obscures health inequalities across the population

  16. Deaths among men aged 20-64, England and Wales, 1991-3 social classproportion death rates of pop (%)(per 100000) I 7 282 II 27 302 IIInm 9 432 IIIm 31 496 IV 14 500 V 5 816 54 Source: Drever and Whitehead, 1997

  17. reducing health differences between socioeconomic groups • encompasses goals of improving poor & poorer health of most disadvantaged • tackling health inequalities is a population-wide strategy • policies which equalise the distribution of health determinants • too ambitious - or in line with welfare policy?

  18. Effect of major fiscal reforms on disposable household income, 1997 to 2002 Source: IFS, 2001

  19. 5. Tackling health inequalities requires multi-sectoral commitment • health inequalities reflect the unequal distribution of health determinants • broader social and policy changes are often widening inequalities in key determinants • new interventions & existing policies will have an impact on the distribution of health determinants

  20. Getting and keeping health inequalities on the policy agenda is a key challenge for an enlarged Europe

  21. Proportion of households with pre-transfer incomes below 50% of average income, circa 1990 % poor Source: Bradshaw & Chen, 1997

  22. Proportion of households with post-transfer incomes below 50% of average income, circa 1990 % poor Source: Bradshaw & Chen, 1997

  23. Percentage of lone parent households with pre-transfer incomes below 50% of average income, circa 1990 % poor Source: Bradshaw & Chen, 1997

  24. Percentage of lone parent households with post-transfer incomes below 50% of average income, circa 1990 % poor Source: Bradshaw & Chen, 1997

  25. Benefits in kind for non-retired households by income quintile groups, UK, 1998-99 benefits in kind1 as % of post-tax income bottom 2nd 3rd 4th top all households income quintile 1education, NHS, housing, travel subsidies, school meals and welfare milk Source: Harris, 2000

  26. Cigarette smoking among women aged 16 and over by socioeconomic group 1958-2000, Britain Sources: Wald and Nicolaides-Bouman, 1993; Bridgewood et al, 2000

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