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At least 19 recordsLinked to original sources
PubMed2003

Modelling health, income and income inequality: the impact of income inequality on health and health inequality.

A framework is developed to analyse the impact of the distribution of income on individual health and health inequality, with individual health modelled as a function of income and the distribution of income. It is demonstrated that the impact of income inequality can generate non-concave health production functions resulting in a non-concave health production possibility frontier. In this context, the impact of different health policies are considered and it is argued that if the distribution of income affects individual health, any policy aimed at equalising health, which does not account for income inequality, will lead to unequal distributions of health. This is an important development given current UK government attention to reducing health inequality.

Health Policy↗
PubMedDate not supplied

[Social inequities of health in Spain. Report of the Scientific Commission for the Study of Social Inequities in Health in Spain].

In 1993 the Ministry of Health of the Spanish Government appointed a Scientific Commission to analyze social inequalities in health in Spain, as well as to make recommendations for improving Spanish health, through the practical implementation of public policies to reduce existing inequalities. The present report is the result of the work carried out by the said Commission. It has the following aims: first, to present a general introduction to the topic of social inequalities in health; second, to offer a global vision of the topic in Spain based upon the editing of available information: finally, to encourage the need for an in-depth analysis of the study and the reduction in social inequalities in health in the scientific and social fields, offering illustrative examples. The first chapter points out the importance of the topic, and Spain is located in the international historical and geographical context. The second chapter presents the most important concepts regarding the definition and measurement of health and inequality. The third and fourth chapters review various international and national studies of particular importance, and the Spanish case includes the current limitations to research. The fifth chapter presents two original investigations on the four perspectives of social inequalities in health in Spain: death rate, noticeable health, conducts related to health and the use and access to health services. Chapter six comments on some examples of policies aimed at reducing inequalities in health. Finally, the seventh chapter summarises the main conclusions of the report and makes some recommendations both for the improvement of current information systems as well as for obtaining the main conclusions for the health policies. Amongst the report's main conclusions the following may be pointed out: 1) an ecological study on the social inequalities in the death rate of small areas between 1990-1992 has revealed the existence of inequalities at a small area level. Autonomous Communities and regions. Inequality is confirmed between North-Northwestern Spain (with a high level) and South-Southwestern Spain (with a low level). Likewise, a positive relationship may be observed between various social indicators and the death rate; 2) the analysis of health surveys for 1987 and 1993 according to social class has revealed the existence of inequalities in health. Thus, in most of the health variables studied regarding the state of health-the conducts related to health or health services-the most disadvantaged social classes present greater health problems; 3) the political social and health experiences carried out in the Basque Country and Barcelona respectively, aimed at improving living standards, social welfare and the health of the most vulnerable sectors of the population have been positive and should be expanded and studied in depth; 4) the study and decrease of social inequalities in health by putting into practice social and health public policies should be a main objective of all political and social forces.

Health Status↗
PubMed1997

Socioeconomic inequalities in morbidity and mortality in western Europe. The EU Working Group on Socioeconomic Inequalities in Health.

BACKGROUND: Previous studies of variation in the magnitude of socioeconomic inequalities in health between countries have methodological drawbacks. We tried to overcome these difficulties in a large study that compared inequalities in morbidity and mortality between different countries in western Europe. METHODS: Data on four indicators of self-reported morbidity by level of education, occupational class, and/or level of income were obtained for 11 countries, and years ranging from 1985 to 1992. Data on total mortality by level of education and/or occupational class were obtained for nine countries for about 1980 to about 1990. We calculated odds ratios or rate ratios to compare a broad lower with a broad upper socioeconomic group. We also calculated an absolute measure for inequalities in mortality, a risk difference, which takes into account differences between countries in average rates of illhealth. FINDINGS: Inequalities in health were found in all countries. Odds ratios for morbidity ranged between about 1.5 and 2.5, and rate ratios for mortality between about 1.3 and 1.7. For men's perceived general health, for instance, inequalities by level of education in Norway were larger than in Switzerland or Spain (odds ratios [95% CI]: 2.57 [2.07-3.18], 1.60 [1.30-1.96], 1.65 [1.44-1.88], respectively). For mortality by occupational class, in men aged 30-44, the rate ratio was highest in Finland (1.76 [1.69-1.83]), although there was no large difference in the size of the inequality in those countries with data. For men aged 45-59, for whom France did have data, this country had the largest inequality (1.71 [1.66-1.77]). In the age-group 45-64, the absolute risk difference ranked Finland second after France (9.8% [9.1-10.4], 11.5% [10.7-12.4]), with Sweden and Norway coming out more favourably than on the basis of rate ratios. In a scatter-plot of average rank scores for morbidity versus mortality. Sweden and Norway had larger relative inequalities in health than most other countries for both measures; France fared badly for mortality but was average for morbidity. INTERPRETATION: Our results challenge conventional views on the between-country pattern of inequalities in health in western European countries.

Adult↗
PubMed2003

Does inequality in self-assessed health predict inequality in survival by income? Evidence from Swedish data.

This paper empirically addresses two questions using a large, individual-level Swedish data set which links mortality data to health survey data. The first question is whether there is an effect of an individual's self-assessed health (SAH) on his subsequent survival probability and if this effect differs by socioeconomic factors. Our results indicate that the effect of SAH on mortality risk declines with age-probably because of adjustment towards 'milder' overall health evaluations at higher ages-but does not seem to differ by indicators of socioeconomic status (SES) like income or education. This finding suggests that there is no systematic adjustment of SAH by SES and therefore that any measured income-related inequality in SAH is unlikely to be biased by reporting error. The second question is: how much of the income-related inequality in mortality can be explained by income-related inequality in SAH? Using a decomposition method, we find that inequality in SAH accounts for only about 10% of mortality inequality if interactions are not allowed for, but its contribution is increased to about 28% if account is taken of the reporting tendencies by age. In other words, omitting the interaction between age and SAH leads to a substantial underestimation of the partial contribution of SAH inequality by income. These results suggest that the often observed inequalities in SAH by income do have predictive power for the-less often observed-inequalities in survival by income.

Adult↗
PubMedDate not supplied

[Inequities in access to information and inequities in health].

This piece presents evidence that inequities in information are an important determinant of health inequities and that eliminating these inequities in access to information, especially by using new information and communication technologies (ICTs), could represent a significant advance in terms of guaranteeing the right to health for all. The piece reviews the most important international scientific research findings on the determinants of the health of populations, emphasizing the role of socioeconomic inequities and of deteriorating social capital as factors that worsen health conditions. It is noteworthy that Latin America has both socioeconomic inequities and major sectors of the population living in poverty. Among the fundamental strategies for overcoming the inequalities and the poverty are greater participation by the poor in civic life and the strengthening of social capital. The contribution that the new ICTs could make to these strategies is analyzed, and the Virtual Health Library (VHL) is discussed. Coordinated by the Latin American and Caribbean Center on Health Sciences Information (BIREME), the VHL is a contribution by the Pan American Health Organization that takes advantage of the potential of ICTs to democratize information and knowledge and consequently promote equity in health. The "digital gap" is discussed as something that can produce inequity itself and also increase other inequities, including ones in health. Prospects are discussed for overcoming this gap, emphasizing the role that governments and international organizations should play in order to expand access to the global public good that information for social development is.

Caribbean Region↗
PubMed2002

[Data aggregation in measuring inequalities and inequities in the health of populations].

OBJECTIVES: To compare how different degrees of data aggregation influence the measurement of health inequalities and health inequities within a population, and to assess the appropriateness of those different degrees of data aggregation in performing studies on inequalities and inequities. METHODS: As an example, we used data on the infant mortality rate in Costa Rica in 1973 and in 1984 and calculated measurements that are frequently used to quantify inequalities and inequities. RESULTS: According to our results, the inequality measures presented (except for those that were derived using regression models) are not sensitive to data aggregation by socioeconomic groups. However, when geographic areas are compared, more disaggregation of the data results in the measures indicating greater inequality. CONCLUSIONS: Our results show that some measures can vary widely depending on the level of data aggregation. It is thus crucial to know how to select these measures and also how to aggregate the data in a way that is consistent with the objectives of each study.

Costa Rica↗
PubMed2003

Is exposure to income inequality a public health concern? Lagged effects of income inequality on individual and population health.

OBJECTIVE: To examine the health consequences of exposure to income inequality. DATA SOURCES: Secondary analysis employing data from several publicly available sources. Measures of individual health status and other individual characteristics are obtained from the March Current Population Survey (CPS). State-level income inequality is measured by the Gini coefficient based on family income, as reported by the U.S. Census Bureau and Al-Samarrie and Miller (1967). State-level mortality rates are from the Vital Statistics of the United States, other state-level characteristics are from U.S. census data as reported in the Statistical Abstract of the United States. STUDY DESIGN: We examine the effects of state-level income inequality lagged from 5 to 29 years on individual health by estimating probit models of poor/fair health status for samples of adults aged 25-74 in the 1995 through 1999 March CPS. We control for several individual characteristics, including educational attainment and household income, as well as regional fixed effects. We use multivariate regression to estimate the effects of income inequality lagged 10 and 20 years on state-level mortality rates for 1990, 1980, 1970, and 1960. PRINCIPAL FINDINGS: Lagged income inequality is not significantly associated with individual health status after controlling for regional fixed effects. Lagged income inequality is not associated with all cause mortality, but associated with reduced mortality from cardiovascular disease and malignant neoplasms, after controlling for state fixed-effects. CONCLUSIONS: In contrast to previous studies that fail to control for regional variations in health outcomes, we find little support for the contention that exposure to income inequality is detrimental to either individual or population health.

Adult↗
PubMed2001

World Health Report 2000: inequality index and socioeconomic inequalities in mortality.

Monitoring of inequality in health has become an increasingly important task of development agencies. We compared the inequality index as published in the World Health Report 2000 with available evidence on socioeconomic inequalities in mortality in 15 industrialised and 43 less-developed countries. We found that the World Health Report index does not correspond with international variations in the size of socioeconomic inequalities in mortality. These findings indicate that the index should not be interpreted as a reflection of socioeconomic inequalities in health, nor should the index be used to replace the indices developed to monitor socioeconomic inequalities in health.

Bias↗
PubMed2003

Income related inequalities in mental health in Great Britain: analysing the causes of health inequality over time.

Using regression techniques this paper estimates the level of income related health inequality in GB in 1992 and 1998. Inequality is decomposed to investigate which socio-demographic factors are important contributors to health differences. The paper includes a range of measured and subjective income variables to control for absolute income. A relative deprivation measure is included to test the impact of income inequality on health inequality. It is found that subjective financial status is a major determinant of ill-health and makes a major contribution to income related inequalities in health. Relative deprivation is an important contributor for women but not for men.

Adult↗
PubMed1991

Leg-length inequality in people of working age. The association between mild inequality and low-back pain is questionable.

Leg-length inequality was measured from radiographs at the level of the vertices of the femoral heads in 247 men and women aged 35-54 years. Of these, 53 had never had any low-back problem, but they had considerable variation in leg-length inequality (mean SD, 5.5 +/- 4.1 mm; range, up to 20 mm). This group of symptom-free individuals did not differ from a group of 78 persons who had disabling low-back pain (LBP) during the previous 12 months (mean SD, 5.3 +/- 4.0 mm; range, up to 17 mm). The adjusted relative risks (odds ratios) of having LBP ever and of disabling pain during the last 12 months were 0.78 (95% confidence interval, 0.43-1.17) and 1.02 (0.68-1.38), respectively, for an increase of 5 mm in leg-length inequality. The results from this study make an association between mild leg-length inequality and LBP questionable.

Adult↗
PubMed1999

Economics and justice: the ethical aspects of inequity or inequality in health care.

Inequality in access to health care exists under a variety of aspects in different parts of the world. In the USA, the absence of universal health insurance leaves 15% of the population, including 12 million children, unprotected. Managed care and health maintenance organisations (HMOs) tend to further deepen this inequality. In Europe, where state-regulated Social Security covers most of the population, welfare policies affect income-related inequalities leaving others untouched, namely inequalities related to family history, education and occupation. In developing countries, poverty is the main cause of inaccessibility to health care and both internal structural reforms and international support could contribute to alleviating such an appalling injustice.

Developing Countries↗
PubMed2002

Inequality aversion, health inequalities and health achievement.

This paper addresses two issues. The first is how health inequalities can be measured in such a way as to take into account policymakers' attitudes towards inequality. The Gini coefficient and the related concentration index embody one particular set of value judgements. By generalising these indices, alternative sets of value judgements can be reflected. The other issue addressed is how information on health inequality can be used together with information on the mean of the relevant distribution to obtain an overall measure of health "achievement".

Adult↗
PubMed2003

Selective migration from deprived areas in Northern Ireland and the spatial distribution of inequalities: implications for monitoring health and inequalities in health.

Much of the evidence suggesting that inequalities in health have been increasing over the last two decades has come from studies that compared the changes in relative health status of areas over time. Such studies ignore the movement of people between areas. This paper examines the population movement between small areas in Northern Ireland in the year prior to the 1991 census as well as the geographical distribution of migrants to Northern Ireland over the same period. It shows that deprived areas tended to become depopulated and that those who left these areas were the more affluent residents. While immigrants differed a little from the indigenous population, the overall effect of their distribution would be to maintain the geographical socio-economic status quo. The selective movement of people between areas would result in the distribution of health and ill-health becoming more polarized, i.e. produce a picture of widening inequalities between areas even though the distribution between individuals is unchanged. These processes suggest potential significant problems with the area-based approaches to monitoring health and inequalities in health.

Censuses↗
PubMed2000

Inequalities in health, inequalities in health care: four generations of discussion about justice and cost-effectiveness analysis.

The focus of questions of justice in health policy has shifted during the last 20 years, beginning with questions about rights to health care, and then, by the late 1980s, turning to issues of rationing. More recently, attention has focused on alternatives to cost-effectiveness analysis. In addition, health inequalities, and not just inequalities in access to health care, have become the subject of moral analysis. This article examines how such trends have transformed the philosophical landscape and encouraged some in bioethics to seek guidance on normative questions from outside of the contours of traditional philosophical arguments about justice.

Cost-Benefit Analysis↗
PubMed1998

Socioeconomic inequalities in stroke mortality among middle-aged men: an international overview. European Union Working Group on Socioeconomic Inequalities in Health.

BACKGROUND AND PURPOSE: Several studies observed that people from lower socioeconomic groups have higher chances of dying of stroke. There are reasons to expect that these differences are relatively small in southern European countries or in Nordic welfare states. This report therefore presents an international overview of socioeconomic differences in stroke mortality. METHODS: Unpublished data on mortality by occupational class were obtained from national longitudinal studies or cross-sectional studies. The data refer to deaths among men aged 30 to 64 years in the 1980s. A common occupational class scheme was applied to most countries. The mortality difference between manual classes and nonmanual classes was measured in relative terms (by rate ratios) and in absolute terms (by rate differences). RESULTS: In all countries, manual classes had higher stroke mortality rates than nonmanual classes. This difference was relatively large in England and Wales, Ireland, and Finland and relatively small in Sweden, Norway, Denmark, Italy, and Spain. Differences were intermediate in the United States, France, and Switzerland. In Portugal, mortality differences were intermediate in relative terms but large in absolute terms. In most countries, inequalities were much larger for stroke mortality than for ischemic heart disease mortality. CONCLUSIONS: Socioeconomic differences in stroke mortality are a problem common to all countries studied. There are probably large variations, however, in the contribution that different risk factors, such as tobacco and alcohol consumption, make to the stroke mortality excess of lower socioeconomic groups. Medical services can contribute to reducing socioeconomic differences in stroke mortality.

Adult↗