from PAHO/EQUIDAD
Health Inequalities: Europein Profile
Prof. Dr Johan P. Mackenbach, Department of Public Health, Erasmus MC
UniversityMedicalCenterRotterdam, The Netherlands
An independent, expert report commissioned by the UKPresidency of the EU
(February 2006)
This report, of which a second and amended revision has just been issued,
can be found at the website of the UK Department of Health
For direct access to the pdf, go to
http://www.dh.gov.uk/assetRoot/04/12/15/84/04121584.pdf
“…..This report provides the most comprehensive overview yet about health
inequalities in Europe. It presents data on socioeconomic inequalities in
mortality for 21 countries, on inequalities in morbidity for 19 countries,
and on inequalities in smoking for 24 countries.
“According to many in Europe, 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. Learning speed can be increased if
countries would exchange their experiences with tackling health
inequalities more systematically than in the past. The European Union can
play an important role in facilitating these exchanges.”
This independent report, commissioned by the UK Presidency of the European
Union, gives a comprehensive overview of patterns and trends.
As a result of this report and a conference held in October 2005, the
European Commission has recently installed an intergovernmental working
group to develop new initiatives to tackle health inequalities….”
Content:
Executive Summary
1. Introduction
• health inequalities were ‘discovered’ in the 19th century
• unexpected widening of health inequalities has raised awareness
2. Mortality
2.1 Total mortality
• inequalities in mortality are omnipresent
• health inequalities start early in life and persist in old age
• inequalities in mortality also exist among women
• life expectancy is shorter in lower socio-economic groups
2.2 Cause-specific mortality
• cardiovascular disease mortality is higher in lower socio-economic groups
• cancer mortality is not always higher in lower socio-economic groups
• injury mortality is higher in lower socio-economic groups, but not among
women
• which diseases account for the excess mortality in lower socio-economic
groups ?
3. Morbidity
3.1 General indicators: self reported morbidity
• inequalities in self-assessed health are omnipresent
• inequalities in self assessed health can be found at all ages
• ‘healthy life expectancy’ is shorter in lower socio-economic groups
3.2 Specific indicators: diseases and disabilities
• most chronic conditions are more prevalent in lower socio-economic groups
• cancer: diverging patterns
• most mental health problems are more prevalent in lower socio-economic
groups
• disability is more prevalent in lower socio-economic groups
4. Determinants of mortality and morbidity
4.1 Some conclusions of explanatory research in various European countries
• ‘selection’ is less important than ‘causation’
• many specific determinants are involved in the explanation
4.2 Health-related behaviours
• smoking plays an important role
• excessive alcohol consumption may play a role too
• role of diet is not yet clear
• obesity may become much more important in the future
• a final word of caution
5. Conclusions
* * * * *
This message from the Pan American Health Organization, PAHO/WHO, is part
of an effort to disseminate
information Related to: Equity; Health inequality; Socioeconomic inequality
in health; Socioeconomic
health differentials; Gender; Violence; Poverty; Health Economics; Health
Legislation; Ethnicity; Ethics;
Information Technology - Virtual libraries; Research & Science issues.
[DD/ IKM Area]
“Materials provided in this electronic list are provided "as is".Unless
expressly stated otherwise, the findings
and interpretations included in the Materials are those of the authors and
not necessarily of The Pan American
Health Organization PAHO/WHO or its country members”.
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