Socioeconomic inequalities and health

Ozren PolašekDepartment of Public Health

Basics

Equality – ethically and logcally neutral term denoting the same (value or worth)

Equity – morally defined term, denoting judgement made by the individuals, societies or international public

SIE

Differential health-related status and outcomes among people with different socioeconomic status (SES)

Health determinants

The Acheson Report (1998)

Main SES determinants

Education Employment Marital status Material status

(objective vs. subjective) Social networks…

Racial / ethnical status

SEI are natural…

Postoje oduvijek

Social stratification in UK

I professionals – physicians, lawyers, etc.II intermediate – managers, nurses, teachersIII N skilled non-manual – clerks, administratorsIII M skilled manual – drivers, butchers, minersIV partly skilled – agricultural, postmen, controllorsV unskilled – cleaners, harbour workers

Townsend and Davidson 1982

Principal reseacrh sources

The Black Report (1980) The Health Divide (1987) Working Together for a Healthier Scotland

(1998) The Acheson Report (1998)

The Black Report (1980)

The Black Report (1980)

The Black Report (1980)

Comparability?

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Theoretical background

Material / neomaterial Social / Social network Educational Life-long theory

SEI today

Nearly systematic indication of worse health status and outcomes among people with poor SES

Smoking of children, depending on SES of the father

HBSC Survey, 2001

Not staticLife expectancy

Growing inequalities

Izvor: Državni zavod za statistiku

… istraživanja nikad dosta…

Screening use

Polasek O, Voncina L, Kolcic I, Strnad M, Vuletic S, Kern J. Social disparities related to breast, colon and prostate cancer screening in the adult population of Croatia – Does rural origin matter? Rural and Remote Health 2007:7(3);749.

Polašek O et al. Rural Remote Health 2007;7;e749

Rural origin and student outcomes

Polašek O. et al. Rural Remote Health. 2006;6(2):e530.

Gender-related differences

Smoljanovic A, et al. Croatian Medical Journal. 2007;48(5):734-40.

SES; 16 items: WC, wooden floors, 2 TVs, art collection, second flat, boat, ….

Spousal diferences

Men reported nearly 10% better SES than their corresponding spouses

Kolcic I, et al. Journal of Epidemiology and Community Health. 2009;63(2):175-6.

Subjective assessment, men

Polasek O, et al. Collegium Antropologicum. 2009;33 (Suppl 1):171-6.

Subjective assessment, women

Polasek O, et al. Collegium Antropologicum. 2009;33 (Suppl 1):171-6.

Survey participation, M

Kolčić I and Polašek O. Do public health surveys provide representative data? Comparison of three different sampling approaches in the adult population of Croatia? Collegium Antropologicum, In Press 2009.

Survey participation, W

Kolčić I and Polašek O. Do public health surveys provide representative data? Comparison of three different sampling approaches in the adult population of Croatia? Collegium Antropologicum, In Press 2009.

SEI reduction?

Social policy measures: increase in salaries, reduction of unemployment, improvement of housing, …

Healthy living measures: healthier lifestyles promotion

Improvement of the health care system through better health services

Accessability of health care

Polašek O et al. Rural Remote Health 2007;7;e749

Targeted interventions

A simple intervention across the entire population often promote disparities

Why? These need to be investigated, thinked through

and then a designed approach needs to be undertaken in order for a successfull result

Measures towards poor and wealthy can’t be the same

Basic research is still needed

Local specifics Croatia especially Comparisons questionable Time-dependent

Lastly

SEI can’t be removed, but we have to act to reduce their effects on health

Equality can’t be achieved, but equity within health MUST be achieved