Socioeconomic inequalities in health in high-income countries

2021 ◽  
pp. 123-138
Author(s):  
Frank J. van Lenthe ◽  
Johan P. Mackenbach
Keyword(s):  
Health Inequalities ◽  
Socioeconomic Inequalities ◽  
High Income ◽  
Health Expectancy ◽  
Inequalities In Health ◽  
Mortality And Morbidity ◽  
Socioeconomic Groups ◽  
The Past ◽  
Underlying Causes ◽  
Made In

Socioeconomic inequalities in health have been studied extensively in the past decades. In all high-income countries with available data, mortality and morbidity rates are higher among those in less advantaged socioeconomic positions, and as a result differences in health expectancy between socioeconomic groups typically amount to 10 years or more. Good progress has been made in unravelling the determinants of health inequalities, and a number of specific determinants (particularly material, psychosocial, and lifestyle factors) have been identified which contribute to explaining health inequalities in many high-income countries. Although further research is necessary, our understanding of what causes health inequalities has progressed to a stage where rational approaches to reduce health inequalities are becoming feasible. Evidence of a reduction of health inequalities via interventions and policies based on the underlying causes remains scarce, and point to a need to increase efforts.

Global Oral Health Inequalities

2011 ◽  
Vol 23 (2) ◽  
pp. 259-267 ◽  
Author(s):  
A. Sheiham ◽  
D. Alexander ◽  
L. Cohen ◽  
V. Marinho ◽  
S. Moysés ◽  
...  
Keyword(s):  
Oral Health ◽  
Health Inequalities ◽  
Social Determinants ◽  
Health Research ◽  
Oral Diseases ◽  
Major Health ◽  
Inequalities In Health ◽  
Limited Success ◽  
The Social ◽  
Underlying Causes

This paper reviews the shortcomings of present approaches to reduce oral diseases and inequalities, details the importance of social determinants, and links that to research needs and policies on implementation of strategies to reduce oral health inequalities. Inequalities in health are not narrowing. Attention is therefore being directed at determinants of major health conditions and the extent to which those common determinants vary within, between, and among groups, because if inequalities in health vary across groups, then so must underlying causes. Tackling inequalities in health requires strategies tailored to determinants and needs of each group along the social gradient. Approaches focusing mainly on downstream lifestyle and behavioral factors have limited success in reducing health inequalities. They fail to address social determinants, for changing people’s behaviors requires changing their environment. There is a dearth of oral health research on social determinants that cause health-compromising behaviors and on risk factors common to some chronic diseases. The gap between what is known and implemented by other health disciplines and the dental fraternity needs addressing. To re-orient oral health research, practice, and policy toward a ‘social determinants’ model, a closer collaboration between and integration of dental and general health research is needed. Here, we suggest a research agenda that should lead to reductions in global inequalities in oral health.

Generating evidence on interventions to reduce inequalities in health: the Dutch case

2002 ◽  
Vol 30 (59_suppl) ◽  
pp. 20-25 ◽  
Author(s):  
Karien Stronks
Keyword(s):  
Experimental Studies ◽  
Research Programme ◽  
Socioeconomic Inequalities ◽  
The Political ◽  
Inequalities In Health ◽  
Socioeconomic Groups ◽  
Political Feasibility ◽  
Research Programmes ◽  
Quasi Experimental ◽  
Policy Measures

The aim of this paper is to refl ect on the type of evidence that is required to design policy measures and interventions to reduce inequalities in health. This issue will be discussed in the context of the Dutch national research programmes on inequalities in health. The fi rst type of evidence relates to the background of socioeconomic inequalities in health. From a very simple conceptual scheme, four policy options can be derived: (1) reducing inequalities in socioeconomic goods; (2) changing the distribution of specifi c risk factors across socioeconomic groups; (3) diminishing the effect of health on socioeconomic status; (4) offering extra healthcare for people in lower socioeconomic groups. Whereas the evidence on the background of socioeconomic inequalities in health has increased enormously, there is clearly a lack of evidence on the effectiveness of interventions to tackle inequalities in health, which is the second type of evidence that is required. The Dutch fi ve-year programme, including 12 (quasi) experimental studies on specifi c interventions in different policy fi elds, showed that this second type of evidence is more difficult to collect, partly because of the methodological complexity of these studies. The third type of evidence relates to the political feasibility of policy measures. It is not enough to know that a specifi c determinant of socioeconomic inequalities in health might be effectively addressed by a specifi c intervention. The political will to implement that intervention is obviously a necessary prerequisite for actually reducing inequalities in health. Within the Dutch research programme, the political feasibility of policy measures was explored during a number of conferences, for several policy fi elds. The lack of evidence on, in particular, the effectiveness of interventions to reduce inequalities in health is clearly an obstacle to tackling inequalities in health. On the other hand, it should be ensured that the lack of evidence is not used as an excuse for not taking policy measures at all.

An Analysis of the Role of Health Care in Reducing Socioeconomic Inequalities in Health: The Case of the Netherlands

2003 ◽  
Vol 33 (3) ◽  
pp. 523-541 ◽  
Author(s):  
Johan P. MaCkenbach
Keyword(s):  
Health Care ◽  
Health Care System ◽  
Health Care Services ◽  
Health Problems ◽  
Socioeconomic Inequalities ◽  
Care Utilization ◽  
Inequalities In Health ◽  
Socioeconomic Groups ◽  
Care Services ◽  
Care System

The aim of this article is to analyze the role of the health care system in reducing socioeconomic inequalities in health in countries with good access to health services, using the Dutch example. In the past, health care has contributed substantially to reducing a number of health problems in the population, particularly health problems leading to mortality. Data on trends in mortality from selected conditions by socioeconomic group show that both higher and lower socioeconomic groups have profited from these mortality reductions, probably because of largely equal access to essential health care services, and that absolute inequalities in mortality from these conditions have declined notably. The current situation is still one of largely equal financial access to health care services, with relatively small differences between socioeconomic groups in health care utilization, after adjustment for differences in prevalence of health problems. There is no evidence that inequalities in health care utilization contribute to a widening of socioeconomic inequalities in health. Financing of the health care system, however, is slightly regressive, and out-of-pocket payments contribute to the poor financial situation of the chronically ill. For the future, three possible contributions of the health care system to reducing socioeconomic inequalities in health are described: preservation of equal access to high-quality health care; development of specific care packages for lower socioeconomic groups; promotion and support of intersectoral activities.

National nutrition policy in high-income countries: is health equity on the agenda?

2020 ◽  
Author(s):  
Christina Zorbas ◽  
Jennifer Browne ◽  
Alexandra Chung ◽  
Phillip Baker ◽  
Claire Palermo ◽  
...  
Keyword(s):  
Health Equity ◽  
Health Inequalities ◽  
Nutrition Policy ◽  
Socioeconomic Inequalities ◽  
High Income ◽  
Analysis Framework ◽  
Data Synthesis ◽  
Policy Documents ◽  
Purposive Sample

Abstract Objective: Equity-oriented policy actions are a key public health principle. In this study, how equity and socioeconomic inequalities are represented in policy problematizations of population nutrition were examined. Data Sources: We retrieved a purposive sample of government nutrition-policy documents (n = 18) from high-income nations. Data Synthesis: Thematic analysis of policy documents was informed by a multitheoretical understanding of equitable policies and Bacchi’s “What’s the Problem Represented to be?’ analysis framework. Despite common rhetorical concerns about the existence of health inequalities, these concerns were often overshadowed by greater emphasis on lifestyle “problems” and reductionist policy actions. The notion that policy actions should be for all and reach everyone were seldom backed by specific actions. Rhetorical acknowledgements of the upstream drivers of health inequalities were also rarely problematized, as were government responsibilities for health equity and the role of policy and governance in reducing socioeconomic inequalities in nutrition. Conclusion: To positively influence health equity outcomes, national nutrition policy will need to transition toward the prioritization of actions that uphold social justice and comprehensively address the upstream determinants of health.

Socioeconomically Disadvantaged People

2019 ◽  
pp. 23-44
Author(s):  
Michael Marmot ◽  
Ruth Bell
Keyword(s):  
Health Status ◽  
Health Inequalities ◽  
Social Determinants ◽  
Mortality Rates ◽  
Socioeconomically Disadvantaged ◽  
Inequalities In Health ◽  
Socioeconomic Groups ◽  
Healthcare It ◽  
Infant And Child Mortality ◽  
Disadvantaged People

This chapter addresses health inequalities and focuses on social determinants of health. Inequalities in health relate fundamentally to inequalities in society. Overall health and inequalities in health in a population are indicators of how successful a society is meeting the needs of its members. The chapter describes the substantial differences among socioeconomic groups in life expectancy, infant and child mortality rates, and other measures of health status. It describes in detail various studies that provide an understanding of the role that social determinants play in affecting health status and access to healthcare. It examines the roles that lifestyle factors, such as smoking, poor diet, and sedentary habits, play in affecting health status. The chapter concludes by addressing what needs to be done to address health inequalities. Governments can address health inequalities by the way they channel resources to improve the conditions under which people live and work.

scholarly journals Social inequalities in health expectancy and the contribution of mortality and morbidity: the case of Irish Travellers

2013 ◽  
Vol 35 (4) ◽  
pp. 533-540 ◽  
Author(s):  
Safa Abdalla ◽  
Cecily Kelleher ◽  
Brigid Quirke ◽  
Leslie Daly ◽  
Fran Cronin ◽  
...  
Keyword(s):  
Social Inequalities ◽  
Health Expectancy ◽  
Social Inequalities In Health ◽  
Inequalities In Health ◽  
Mortality And Morbidity

Socioeconomic inequalities in health expectancy in Finland and Norway in the late 1980s

1998 ◽  
Vol 47 (3) ◽  
pp. 303-315 ◽  
Author(s):  
Ari-Pekka Sihvonen ◽  
Anton E. Kunst ◽  
Eero Lahelma ◽  
Tapani Valkonen ◽  
Johan P. Mackenbach
Keyword(s):  
Socioeconomic Inequalities ◽  
Health Expectancy ◽  
Inequalities In Health
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