Education and depressive symptoms in 22 European countries

Objectives  

Variations in the association between education and depressive symptoms in 22 European countries are investigated.     

Association between attendance at religious services and self-reported health in 22 European countries

There are consistent reports of protective associations between attendance at religious services and better self-rated health but existing data rarely consider the social or individual context of religious behaviour. This paper investigates whether attendance at religious services is associated with better self-rated health in diverse countries across Europe. It also explores whether the association varies with either individual-level (gender, educational, social contact) or country-level characteristics (overall level of religious practice, corruption, GDP). Cross-sectional data from round 2 of the European Social Survey were used and 18,328 men and 21,373 women from 22 European countries were included in multilevel analyses, with country as higher level.     

Public health in the central and eastern European countries

During the last two decades, the countries of Central and Eastern Europe have been transforming their health systems and built an intermediate model between market and socialised economies. At the same time, they have been trying to establish a system of observed in public health between the countries of the European Union and those of Central and Eastern Europe widened in the last decade. In view of accessing the European Union, this article develops the different points in a context where public health represents a topic of extreme importance for the European Commission.     

Prinicipal health services accessibility risks in the European Union countries

In 1998, MDM, the well-known french NGO advocating for the deprived people social rights, was supported by European funds to compare inegalities in health facilities accessibility in several countries. The NGO objective was to denounciate social exclusions and find arguments to set a partnership between relevant institutions. Social oriented professionals and social scientists were interviewed in eleven European cities. A joint committee including humanitarian deleguees and universitarian researchers gave the guidelines and analysed the results. Facing diversity in health facilities access determinants, a common analytic framework has been proposed to the different European partners. This tool did not benefit from a great success given the amount of work to perform identification and data collecting for a proper use. As it is usual in comparative studies, data collecting process has to fit into the observer's interests scale. Most of the time, humanitarian NGOs know little about phasing, -in, flow and customers distribution? Available informations are no more relevant when the focus changes. In spite of health facilities access impediments and simulation in European health systems confluency, it is hard nowadays to give so refine a design of custudory principles.     

Explaining the differences in income-related health inequalities across European countries

This paper provides new evidence on the sources of differences in the degree of income-related inequalities in self-assessed health in 13 European Union member states. It goes beyond earlier work by measuring health using an interval regression approach to compute concentration indices and by decomposing inequality into its determining factors. New and more comparable data were used, taken from the 1996 wave of the European Community Household Panel. Significant inequalities in health (utility) favouring the higher income groups emerge in all countries, but are particularly high in Portugal and - to a lesser extent - in the UK and in Denmark. By contrast, relatively low health inequality is observed in the Netherlands and Germany, and also in Italy, Belgium, Spain Austria and Ireland. There is a positive correlation with income inequality per se but the relationship is weaker than in previous research. Health inequality is not merely a reflection of income inequality. A decomposition analysis shows that the (partial) income elasticities of the explanatory variables are generally more important than their unequal distribution by income in explaining the cross-country differences in income-related health inequality. Especially the relative health and income position of non-working Europeans like the retired and disabled explains a great deal of 'excess inequality'. We also find a substantial contribution of regional health disparities to socio-economic inequalities, primarily in the Southern European countries.     

Trends in socioeconomic inequalities in self-assessed health in 10 European countries

BACKGROUND: Changes over time in inequalities in self-reported health are studied for increasingly more countries, but a comprehensive overview encompassing several countries is still lacking. The general aim of this article is to determine whether inequalities in self-assessed health in 10 European countries showed a general tendency either to increase or to decrease between the 1980s and the 1990s and whether trends varied among countries. METHODS: Data were obtained from nationally representative interview surveys held in Finland, Sweden, Norway, Denmark, England, The Netherlands, West Germany, Austria, Italy, and Spain. The proportion of respondents with self-assessed health less than 'good' was measured in relation to educational level and income level. Inequalities were measured by means of age-standardized prevalence rates and odds ratios (ORs). RESULTS: Socioeconomic inequalities in self-assessed health showed a high degree of stability in European countries. For all countries together, the ORs comparing low with high educational levels remained stable for men (2.61 in the 1980s and 2.54 in the 1990s) but increased slightly for women (from 2.48 to 2.70). The ORs comparing extreme income quintiles increased from 3.13 to 3.37 for men and from 2.43 to 2.86 for women. Increases could be demonstrated most clearly for Italian and Spanish men and women, and for Dutch women, whereas inequalities in health in the Nordic countries showed no tendency to increase. CONCLUSIONS: The results underscore the persistent nature of socioeconomic inequalities in health in modern societies. The relatively favourable trends in the Nordic countries suggest that these countries' welfare states were able to buffer many of the adverse effects of economic crises on the health of disadvantaged groups.     

Linking public health research with policy and practice in three European countries

Aim

To transform knowledge from public health and health services research into actual improvement of services is highly relevant for spending public research resources effectively. Fostering stakeholder interaction throughout the entire research process is one potential avenue towards this aim. The objective of this paper is to look for established practices with the aim to promote the usability of research in policy and practice through interaction.

Subject and methods

We conducted 11 semi-structured telephone-interviews with senior experts from the same number of public health and health services research institutions in the Netherlands, the United Kingdom and Norway.

Results

Practice patterns are manifold, but three key domains were identified:

1. Research implementation is explicitly part of the organisation’s mission. Research commissioning institutions serve as intermediaries between research, policy and practice.
2. Funds are earmarked for implementation activities. In regular evaluation cycles special consideration is given to the impact of research.
3. Multiple forums for interaction support the ability of researchers to actively communicate with stakeholders. Network-building skills are developed alongside scientific competence.

Conclusion

Promising initiatives can be found in practice. Further research is needed into what difference it makes how the exchange between research and policy is organised.     

Job insecurity and health: A study of 16 European countries

Although the number of insecure jobs has increased considerably over the recent decades, relatively little is known about the health consequences of job insecurity, their international pattern, and factors that may modify them. In this paper, we investigated the association between job insecurity and self-rated health, and whether the relationship differs by country or individual-level characteristics. Cross-sectional data from 3 population-based studies on job insecurity, self-rated health, demographic, socioeconomic, work-related and behavioural factors and lifetime chronic diseases in 23,245 working subjects aged 45–70 years from 16 European countries were analysed using logistic regression and meta-analysis. In fully adjusted models, job insecurity was significantly associated with an increased risk of poor health in the Czech Republic, Denmark, Germany, Greece, Hungary, Israel, the Netherlands, Poland and Russia, with odds ratios ranging between 1.3 and 2.0. Similar, but not significant, associations were observed in Austria, France, Italy, Spain and Switzerland. We found no effect of job insecurity in Belgium and Sweden. In the pooled data, the odds ratio of poor health by job insecurity was 1.39. The association between job insecurity and health did not differ significantly by age, sex, education, and marital status. Persons with insecure jobs were at an increased risk of poor health in most of the countries included in the analysis. Given these results and trends towards increasing frequency of insecure jobs, attention needs to be paid to the public health consequences of job insecurity.     

Demand and supply for psychological help in general practice in different European countries: access to primary mental health care in six European countries

BACKGROUND: The general practitioner is usually the first health care contact for mental problems. The position of a general practitioner may vary between health care systems, depending on the referral system (gatekeepers versus directly accessible specialists), presence of fixed lists and the payment system. This may influence patients' expectations and requests for help and GPs' performance. In this paper the effects of working in different health care systems on demand and supply for psychological help were examined. METHODS: Data were collected in six European countries with different health care system characteristics (Belgium, Germany, The Netherlands, Spain, Switzerland and the UK). For 15 consecutive contacts with 190 GPs in the six countries, each patient completed questionnaires concerning reason for visit and expectations (before) and evaluation (after consultation). General practitioners completed registration forms on each consultation, indicating familiarity with the patient and diagnosis. General practitioners completed a general questionnaire about their personal and professional characteristics as well. RESULTS: Practices in different countries differed considerably in the proportion of psychological reasons for the visit by the patient and psychological diagnoses by the GP. Agreement between patients' self-rated problems and GPs' diagnoses also varied. Patients in different countries evaluated their GPs' psychological performance differently as well, but evaluation was not correlated with agreement between request for help and diagosis. In gatekeeping countries, patients had more psycho-social requests, GPs made more psychological diagnoses and agreement between both was relatively high. Evaluation, however, was more positive in non-gatekeeping countries. Individual characteristics of doctors and patients explained only a relatively small part of variance. CONCLUSIONS: Health care system characteristics do affect GPs' performance in psycho-social care.     

Introduction: mass screening, health technology assessment, and health policy in some European countries

OBJECTIVE: The series of papers in this issue was developed to examine the use of health technology assessment in policies toward prevention-specifically toward mass screening-in European countries. The papers actually examined three screening strategies: mammography screening for breast cancer, prostate-specific antigen screening for prostate cancer, and routine ultrasound in normal pregnancy. METHODS: Papers were sought from the member states of the European Union, plus Switzerland. Ultimately, nine acceptable papers were received, and were reviewed, revised, and edited. RESULTS: Screening is an accepted strategy in many countries for reducing the burden of disease through early detection and intervention. In part, this is because of successful screening programs that have been evaluated and implemented in many countries. At the same time, unevaluated and even useless and harmful screening programs-unjustified medically or economically-are widespread. Health technology assessment could help assure that only effective and cost-effective screening programs are implemented. CONCLUSION: The main conclusion is that screening is an important preventive strategy. Any screening program, however, should be carefully assessed before implementation.     

Prevalence of subjective health complaints in the Nordic European countries in 1993

Background: Subjectively reported health complaints accountfor approximately 50% of all long-term sickness compensationand permanent disability in Northern European countries. Theprevalence of these complaints in the population at large wasexamined. Methods: Data from national surveys conducted in 1993of 2, 030 men and 2, 016 women above 15 years of age in Denmark,Finland, Norway, and Sweden were analysed. Results: As manyas 75% of our sample had at least some subjective health complaintsfor the previous 30 days. More than 50% had experienced tiredness,42% headache, 37% worry, 35% low back pain and 33% pain in theirarms or shoulders. The prevalence was higher in women than inmen. In general, substantial muscle pain was more common inolder subjects, but tiredness, headache, worry and depressivemood were more common in young subjects. Conclusion: The veryhigh prevalence of these complaints in the general populationshould be taken into account whenever these complaints are reportedto be due to any new environmental factor or disease.     

Public health in eight European countries: an international comparison of terminology

OBJECTIVES: The aim of this paper was to assess the use of different terms pertaining to public health in selected Member States of the European Union. STUDY DESIGN AND METHODS: Qualitative research methods were used to compare the terminology among eight Member States. Seven to nine core terms were defined for each country, and a search was performed for these terms in the names of institutions and professional titles, organized into three comparable categories. RESULTS: The data analysis showed considerable diversity in terminology. The three most commonly used terms for each country, and the frequency distribution of the core terms for all eight countries were determined. CONCLUSION: Public health terminology and underlying concepts vary among Member States of the European Union. A large number of loosely related terms are in use, indicating the lack of a common conceptual framework for the discipline of public health. The most commonly used terms pertaining to public health are 'health sciences' and 'health promotion'. 'Public health' is not among the most commonly used terms.     

Preventive youth health care in 11 European countries: an exploratory analysis

Objective

To systematically identify similarities and differences in the way preventive youth health care (YHC) is organized in 11 European countries.

Method

Questionnaire survey to EUSUHM (European Union for School and University Health and Medicine) representatives.

Results

The greatest similarities were found in the age range of the YHC target group and the separation of curative and preventive services. Croatia, Germany and Switzerland show the greatest differences when compared to other European countries, for example, in the access to medical records, YHC professional input and the number of examinations, immunizations and screenings. In eight countries YHC is financed by national insurances or taxation. In Germany, FYR Macedonia, the Netherlands, Russia and Switzerland, different forms of financing exist in parallel.

Conclusion

The results should be interpreted as a preliminary step in mapping organizational features of YHC in Europe.     

Equity in socioeconomic areas with impact on health in countries of European Union

It may sometimes be more appropriate to correct inequalities in the domains of education, lifestyles, or nutrition than that of health. The current study proposes to measure existing inequalities in European Union member countries in socioeconomic areas with an impact on the population's health. The Gini coefficient was used to quantify inequalities among member countries with regard to education and cultural activities, lifestyles, nutrition, unemployment, use of health care services, and health expenditures. The indicators with the highest Gini coefficients are the percentage of the population with a secondary school education (level of schooling just preceding the university), per capita butter consumption, and per capita consumption of packaging for medications. It is cause for concern to the health sector that education displays such great inequality in the percentage of individuals enrolled in secondary education within the European Union. Existing inequality in per capita butter consumption is equally important due to the impact nutrition has on the incidence of cardiovascular and cerebral vascular diseases, for example, and the weight these diseases have on the mortality profile.     

Standards for health promotion in hospitals: development and pilot test in nine European countries

PURPOSE: To describe the process of development of standards for health promotion in hospitals, including pilot study, method and results. DESIGN/METHODOLOGY/APPROACH: A set of standards for health promotion in hospitals was developed by a task force of the International Network of Health Promoting Hospitals, following the recommendations of the ALPHA programme. The standards were pilot tested and assessed qualitatively and quantitatively in 36 hospitals in nine European countries. Subsequently, standards were reviewed by representatives from the piloting hospitals. A self-assessment tool was produced to evaluate whether hospital managers and professionals perceive the standards to be relevant and applicable and whether they are currently met. Participants provided comments from their national health system perspective and rated the standards. FINDINGS: General comments and specific comments were provided for each standard regarding its relevance, applicability and current level of compliance. A total of 35 standards' criteria were assessed and 86 per cent (30/35) were rated > 80 per cent relevant and applicable, while 14 per cent (5/35) were rated > 60 per cent relevant. The degree of current fulfilment of the criteria, however, was low. RESEARCH LIMITATIONS/IMPLICATIONS: While the standards should be applicable to other regions (South America, Africa, Asia) additional testing may be required to adapt them to prevailing health care challenges. PRACTICAL IMPLICATIONS: The pilot test revealed that the standards are applicable and were considered relevant, and showed that current compliance is low. It also showed that there is a clear need to facilitate continuous monitoring and improvement of compliance. The standards are regarded as being public domain, are applicable to other organisations and can be incorporated into existing quality systems. ORIGINALITY/VALUE: Standards are a common tool for quality assurance in health care, but so far have considered health promotion activities only partly, if at all. The standards for health promotion in hospitals developed by WHO fill this important gap.     

欧洲国家健康水平的关键影响因素分析——基于欧洲36个国家的定性比较分析(QCA)

国家健康水平受多个健康的社会决定因素共同影响。通过收集36个欧洲国家健康水平的相关数据,展示欧洲国家间健康不平等的差异,运用定性比较分析（QCA）,旨在探究对于国家健康水平而言,哪些是核心影响条件,哪些因素共同作用及如何作用于健康水平。研究发现,欧洲地区经济发达的国家健康水平更高,风险、质量（效用）、卫生经济和卫生可及性这四个维度共同影响健康总体水平,在诸多指标中找出四个关键指标分别代表四个维度,包括成人饮酒量（-）、可避免死亡人数（-）、人均卫生支出（+）和未被满足的健康需求（-）,前三个指标所代表的三个维度对于健康水平的影响是核心条件,高于欧盟平均健康水平的国家,在质量（效用）维度全部优于欧盟平均水平,而其他三个维度相较于欧盟平均水平而言情况各异。从实现更好的国家健康水平的影响因素两条组合路径来看,高支出和高质量作为核心条件的类型组合,比低风险和高质量作为核心条件的类型组合所代表的国家案例略多。欧洲的证据可以为发展中国家实现健康跨越式发展提供发展经验,并对我国区域间健康均等化发展提供有益借鉴。