Health and social inequities in Belgium

This paper presents two different yet complementary on-going studies related to the understanding of the mechanisms leading to social inequalities in health. The first part is devoted to a differential morbidity survey held in southern Belgium. It confirms that striking differences exist in the period around birth between social categories, and between the three districts under study. In a multivariate approach, differences remain between the social categories and between the district samples, which classically studied socio-demographical, behavioural and medical characteristics cannot fully explain. The role of cultural factors is analysed and discussed through the concept of 'health culture' and alternative hypotheses are reviewed in the light of the results. The second part reviews the studies conducted on the so-called avoidable mortality in the EEC and more specifically in Belgium. The concept of avoidable mortality is discussed, as well as its utility from the standpoint of the present concern on social inequalities. Differences between EEC countries are large, and even within Belgium there are important disparities between the districts. The role of health care supply has not been demonstrated yet in these two contexts. For Belgium, it appears that a major part of the unequally distributed mortality is constituted by causes of death considered as avoidable. Moreover, the most discriminating causes of death are overrepresented in socially deprived districts. The two perspectives are confronted in order to delineate perspectives for future research and operational outcomes for policy making and interventions.     

Health and social inequities in Switzerland

Despite standards of living and life expectancy amongst the highest in Europe, Switzerland exhibits fairly substantial social inequities in health. As regards male mortality by socio-economic group, these differentials are both marked and independent of cause of death. There is a wealth of information on morbidity and disability supporting the hypothesis that people in lower socio-economic groups tend to age faster and suffer more at younger ages. It is similarly evident that infants of low class mothers, particularly those unwed, underprivileged immigrant, are at excess risk. The Swiss results are of political and scientific interest in that they suggest that the average wealth of a community does not determine health differentials.     

Health and social inequities in Spain

This article examines the relationship between health and social differences in Spain. The dominant explanatory models (medical, health system oriented and economical) have focused on health care as the main source of health. They have disregarded the role of socioeconomic variables in the genesis, development and cure of illness. In relation to the distribution of health, the variables analysed here are those of poverty, social class, sex, age, living conditions, lifestyles and some existential indicators using both official aggregated data and survey data. We conclude that Spain is a country with major economic, social and regional differences and manifests important variations in the health of its population. The evidence taken from the data presented here seems to indicate that poverty, living conditions and income play a relevant explanatory role.     

Health and social inequities in Sweden

Sweden is one of Europe's most egalitarian countries. The social inequities in living conditions have been gradually reduced to a level that is more equal than in most countries in Europe. Even if general health development has been positive during recent years, data reviewed here indicate that there may be adverse effects for some groups which may increase inequities. This article presents results on inequities in health from the Public Health Report of Sweden 1987 and discusses causal mechanisms and implications for health policy.     

Health and social inequities in Turkey

Social and economic policies of governments directly influence the health of the people. These policies, in turn, are determined by the national and foreign controllers of power. Economic and social factors in Turkey during the late 1970s led to a new modelling of the economic system, from a Keynesian to a market-oriented and monetarist model. The state mechanism was also altered to form a centralized, authoritarian regime in order to enforce the requirements of the economy. As a result, the middle class diminished in size, inequalities in income distribution increased, unemployment climbed, the purchasing power of wage earners decreased, government spending for education and health was cut and new oppressive laws were enacted. Health services were already urban-biased and hospital-oriented, but new free-market measures were instituted which promoted private health institutions and attempted to transform state-owned and financed hospitals into self-supporting, independent business enterprises. The only school of public health was closed down; preventive medicine expenditures were lowered while hospital rates and drug prices were increased. All these changes affected the health status of the population. Mortality and morbidity inequalities had already existed between the rich and the poor, men and women, urban and rural settlements, educated and illiterate, West and East, always in favour of the former. However, the new policies exacerbated the inequities. Infectious diseases including tuberculosis increased, nutrition worsened, occupational diseases and work accidents rose to be the highest in Europe. The power-holding minority is not interested in the health of populations and is committed to pursue its social and economic policies. Ad hoc research, especially cross-sectional mortality studies repeated at regular intervals can provide data on the most vulnerable groups as no other valid information exists. There is little hope of these data being used for intervention unless democratic changes take place.     

Health inequities and social justice

Recently we argued that social justice is concerned with human well-being, which is best understood as involving plural, irreducible dimensions, each of which represents something of independent moral significance. Health is one of these distinct dimensions of well-being, as is personal security, the development and exercise of cognitive capacities for reasoning, living under conditions of social respect, developing and sustaining deep personal attachments, and being able to lead self-determining lives. In this paper, we address why considerations of justice, and not utilitarian aims as applied narrowly to health outcomes, are most foundational to public health. In particular, we argue that the aspiration for improvement of the health of populations defines the positive aim of justice in public health, along with the negative aim of reducing or combating systematic disadvantage that affects adversely historically situated social groups and, more generally, children across the normal life span when their well-being is not assigned a special priority in the development of public health policies.     

Health and social inequities in Yugoslavia

In Yugoslavia the problem of social inequities comes on the political agenda every time when society is in a crisis. This paper describes the pattern of social inequities in health. Data are mostly used from statistics. The features of health inequalities are shown. The marked inequalities exist regionally, among republics and provinces, in spite of the reallocation of resources. Health inequalities exist also among social classes however they are measured. Individually based measurement shows inequalities in health between all individuals of the population. As Yugoslav society is passing through severe economic crisis when social structure polarizes and becomes rigid--inequalities in health tend to increase.     

Health and social inequities in Ireland

This paper attempts to discuss the shape of inequalities in health in the Republic of Ireland by focusing on social class, gender and regional inequalities in health outcomes as shown in annual publications of vital statistics and in various research studies. The Republic of Ireland has a demographic profile of rapid population increase, unique in Europe. While the birth rate is the highest in Europe, the infant mortality rate is relatively low, yet the perinatal mortality rate is relatively high. Attempts are made to analyse social class variations in mortality and morbidity rates but, except for psychiatric care, Irish data on health by social class are scarce. There exist more data on gender inequalities which pinpoint the particular vulnerability of Irish women to ischaemic heart disease and certain types of cancer. Regional analysis of vital statistics reveals the vulnerability of people in urban areas (compared to rural areas) to cancer of the trachea, bronchus and lung, cirrhosis of the liver, tuberculosis of the respiratory system, pneumonia, and bronchitis, emphysema and asthma. In comparison to several European countries, Irish standardized mortality rates were the worst for urban women dying from lung cancer, and for urban men and women, Irish standardized mortality rates were the worst for non-rheumatic heart disease and respiratory tuberculosis. Various studies of morbidity of the elderly clearly reveal the hidden clinical iceberg of symptoms which are not presented to the health care system. Unfortunately, there is relatively little evidence of the health situation of disabled people, the travelling community or the long term unemployed.(ABSTRACT TRUNCATED AT 250 WORDS)     

Health and social inequities in the Federal Republic of Germany

The close relationship between social class and health status makes for the fact that indicators of health are supposed to tell something about the general conditions of life in the social structure of a particular country. This is one reason why trends in health and social inequities are to the foremost interest of the sociologist. Because the epidemiological literature in the Federal Republic does not allow one to consider trends over time, this paper tries to construct indicators from official statistics which have been regularly collected. The set of indicators discussed include data on mortality, age-at-death, morbidity as well as data related to health care and health risks. This discussion shows that, despite improving life expectancy and age-at-death figures, the major social class differential in health status has remained relatively stable over time, with a minor trend toward reduction in some figures. Since official statistics focus mainly on persons who are integrated in the labour market, only some groups with special risks may be detected. More information is certainly needed on disadvantaged groups with probably high health risks like the unemployed and those who subsist on welfare payments.     

The difficulties of dealing with social inequities at the Family Health Program in Natal,Brazil

The paper will present data from research on the Family Health Program in a low-income district of Natal, Brazil. Through an institutional ethnographic perspective at the three Family Health Units in the district, it has been possible to create a joint construction of knowledge where the following are evident: (1) the need to consider the limitations of the biomedical approach; (2) the naturalization of social inequities and the lack of agency of health care users; and (3) the need to reflect on unfair power relations being reproduced through hierarchical interactions.     

Health inequities in the United States: prospects and solutions

An overview of the role that social determinants of health play in influencing health is provided. Emphasis is on the impact of economic inequality in creating health inequities among Americans. Economic inequality is seen as impacting health in three ways: increasing economic inequality weakens population health by creating poverty; weakening communal social structures that support health such as social and health services; and decreasing social cohesion and civil commitment. Documentation is provided of the growing degree of economic inequality in the USA and complicating issues of racial segregation are considered. Specific recommendations for addressing economic inequality, from USA, British, and Canadian sources, are presented. These recommendations indicate the need to move from epidemiologic research to public health action, from demonstrating the major impact of economic inequality on community health to the development and implementation of specific policies and programs to reverse the continuing increase in economic inequality.     

Health inequities: evaluation of two paradigms

Social work practice in health is shaped by underlying paradigms.To effectively target health inequities, practitioners need to consider appropriate paradigms. In this exploration of how six health paradigms shape theory and practice, the two health paradigms that most attended to health inequalities are social determinants of health and political economy. The article undertakes a critical review of the social determinants of health paradigm and the political economy paradigm regarding how they might shape social work theory and practice targeting health inequities.     

Socioeconomic inequities in invasive cardiac procedures after first myocardial infarction in Finland in 1995

OBJECTIVE: We examined socioeconomic disparities in coronary procedure rates after first events among hospitalized myocardial infarction (MI) patients. STUDY DESIGN AND SETTING: Information on MI patients in 1995 in Finland was obtained from the Finnish Cardiovascular Disease Register Project. Data on comorbidity, invasive treatments, hospitalizations, mortality, and socioeconomic status were obtained by linking data from the Finnish Hospital Discharge Register, cause of death register, population census, and the health insurance register using personal identity numbers. RESULTS: In 1995, 5172 patients aged 40 to 74 years were hospitalized for first MI. This corresponds to age-standardized event rates of 354/100,000 for men and 152/100,000 for women. Within 2 years, 33% of men and 21% of women underwent an invasive coronary procedure. Men in the lowest income third underwent 25% (95% confidence interval [CI] 12-36) fewer procedures than men in the highest third. Among women, the corresponding difference was 43% (95% CI 24-57). These disparities persisted throughout the 2-year follow-up, and they were not reduced by adjustment for comorbidity or hospital district. CONCLUSION: Socioeconomic disparities were observed in receipt of invasive cardiac procedures. More attention should be paid to equitable distribution of scarce health care resources.