health inequalities in adolescence matthias richter, matthias richter, department of prevention and...

Health inequalities in adolescence

Matthias Richter, Department of Prevention and Health Promotion School of Public health | WHO CC University of Bielefeld Germany

from description to explanation

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• Socioeconomic inequalities in health have been observed in all industrialised countries.

• They are observable in most measures of health and longevity using different measures of SES.

Socioeconomic inequalitiesin health (Overview_part 1)

Socioeconomic inequalitiesin health (Overview_part 2)

• Health and longevity tend to have a stepwise, not threshold, relationship with SES (social gradient).

• Inequalities in health are observable in childhood and adulthood

Do we find a similar patternin adolescence?

Health inequalities in adolescence (Part 1)• Compared to childhood and adulthood there

is no consistent pattern of inequalities in health - esp. for early youth (11 to 16 year-olds).

• Where inequalities exist, they are less pronounced than in any other part of the life-course.

The pattern of inequalities in health might changes in adolescence.

Health inequalities in adolescence (Part 2)

Health inequalities in adolescence (Part 3)

There are a number of exceptions and variations (gender, age groups, countries and social indicators)

The most important variation is across health outcomes.

... but:

Theoretical models of the relationship between SES and health in childhood and adolescence Source: Chen et al. 2002

1. The persistent model

low SES medium SES high SES

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for example: Mortality (due to accidents/injuries), severe asthma

adolescencechildhood

2. The childhood-limitedmodel

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for example: injuries, Infectious diseases

adolescencechildhood

low SES medium SES high SES

3. The adolescent-emergent model

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for example: passive smoking - smoking, physical activity

adolescencechildhood

low SES medium SES high SES

Two different patterns of inequalities in health in adolescence:

2. Changing inequalities in health

1. Persistent inequalities in health

What we need are two different explanatory models:

2. to explain changing/ equalising inequalities in health

1. to explain (persisting)inequalities in health

Explanations for persisting inequalities in health(Source: Macinytre 1997)

1. Artefact

Magnitude of observed class gradients will depend on themeasurement of both class andhealth

2. Social selection

Health can contribute to achievedclass position via social mobilityand help to explain observedgradients

Selection (Health influences SES)

3. Behavioural factors

Health damaging behaviours aredifferentially distributed across social classes and contribute toobserved gradients

Causation (SES influences health)(Part 1)

4. Material/ structural factors

Physical and psychosocial featuresassociated with class structureinfluence health and contribute toobserved gradients

Causation (SES influences health)(Part 2)

Causation hypothesis(Source: Richter/Mielck 2000)

Socio-economic status

Behavioural factors e.g. Tobacco, Alcohol

Structural factors e.g. working conditions,

social support

Health

(social) unequal distribution of

Explanations for changing/ equalising inequalities in healthin adolescence

1. Latent differences

Inequalities in health are already present, but not (yet) measurable with currentoutcome measures of health.

The prelude is visible in the unequaldistribution of different determinants(behavioural/ structural factors) of healthamong social groups.

2. Buffer hypothesisCentral elements of adolescence (school, peers, youth culture) and related mechanisms„break“ the traditional SES-barriers and forma buffer form young people against the health-damaging effect of SES.

As children develop, other factors (may)play a more important role in determiningadolescent health while the strength of(parent) SES decreases.

Conclusion Understanding those factorscontributing to the existenceor absence of socioeconomicdifferences in health can provide a better insight into themechanisms which shape thehealth of youth.

Interested tolearn more ?

Gecková, A. (2002). Inequality in health among Slovak adolescents.Groningen: Proefschrift Rijksuniversiteit Groningen. Download

Tuinstra, J. (1998). Health in adolescence: an empirical study of social inequality in health, health risk behaviour and decision making styles. Groningen: Proefschrift Rijksuniversiteit Groningen. Download

Recommended readings:

Socioeconomic Determinants of Healthbmj.com collected resources

and more collected resources onSocioeconomic Determinants of Health

Recommended links: