|
An independent, expert report commissioned by the UKPresidency of the EU (February 2006) by Prof. Dr Johan P. Mackenbach, Department of Public Health, Erasmus MC University Medical Center Rotterdam, The Netherlands.
At the start of the 21st century, all European countries are faced with substantial inequalities in health within their populations. People with a lower level of education, a lower occupational class, or a lower level of income tend to die at a younger age, and to have a higher prevalence of most types of health problems.
This report was written at the request of the UK Presidency of the European Union (EU), and aims to review the evidence on the existence of socioeconomic inequalities in health in the EU and its immediate neighbours. It presents data on inequalities in mortality in 21 countries, on inequalities in self-assessed health in 19 countries, and on inequalities in smoking in 24 countries.
Rates of mortality are consistently higher among those with a lower, than among those with a higher socio-economic position. Not only is the size of these inequalities often substantial, but inequalities in mortality have also increased in many European countries in the past decades. Inequalities in mortality:
• start early in life and persist into old age,
• affect both men and women, but tend to be larger among men,
• are found for most but not all specific causes of death.
Inequalities in mortality from cardiovascular disease account for almost half of the excess mortality in lower socio-economic groups in most countries.
Inequalities in cancer mortality are often less clear, particularly among women.
Rates of morbidity are also usually higher among those with a lower educational, occupational, or income level. No clear trends have been found in these inequalities. Inequalities in morbidity are found for many morbidity indicators:
• prevalence of less-than-‘good’ self-assessed health,
• incidence and prevalence of many chronic conditions,
• prevalence of most mental health problems, and
• prevalence of functional limitations and disabilities.
As a result, people with lower socio-economic positions not only live shorter lives, but also spend a larger number of years in ill-health.
During the past decade, great progress has been made in unravelling the determinants of health inequalities. This research has shown that health inequalities are mainly caused by a higher exposure of lower socio-economic groups to a wide range of unfavourable material, psychosocial and behavioural risk factors.
This report reviews the evidence on some behavioural risk factors, for which comparable data on social patterning are available from many European countries. Smoking is likely to be an important contributor to health inequalities in many European countries, because the prevalence of smoking tends to be higher in lower socioeconomic groups, particularly among men. There are important differences between countries, however, in these inequalities.
According to many, socio-economic inequalities in health are unacceptable, and represent one of Europe’s greatest challenges for public health. The omnipresence and persistence of these inequalities should warn against unrealistic expectations of a substantial reduction within a short period of time, and by using conventional approaches. New and more powerful approaches need to be developed.
The report does not pay much attention to the working conditions. To a certain extent, it reflects the very partial approach adopted by some public health analysts on the social determinants in health.
|
