Socioeconomic inequalities in injury mortality in small areas of 15 European cities

This study analysed socioeconomic inequalities in mortality due to injuries in small areas of 15 European cities, by sex, at the beginning of this century.A cross-sectional ecological study with units of analysis being small areas within 15 European cities was conducted. Relative risks of injury mortality associated with the socioeconomic deprivation index were estimated using hierarchical Bayesian model.The number of small areas varies from 17 in Bratislava to 2666 in Turin. The median population per small area varies by city (e.g. Turin had 274 inhabitants per area while Budapest had 76,970). Socioeconomic inequalities in all injury mortality are observed in the majority of cities and are more pronounced in men. In the cities of northern and western Europe, socioeconomic inequalities in injury mortality are found for most types of injuries. These inequalities are not significant in the majority of cities in southern Europe among women and in the majority of central eastern European cities for both sexes.The results confirm the existence of socioeconomic inequalities in injury related mortality and reveal variations in their magnitude between different European cities.     

Educational differentials in mortality from cardiovascular disease among men and women: the Israel Longitudinal Mortality Study

PURPOSE: While socioeconomic inequalities in cardiovascular disease have been observed in most industrialized countries, available information in Israel centers on ethnic variations and the role of education has yet to be investigated. This study examines educational differentials in cardiovascular mortality in Israel for both men and women aged 45 to 69 and 70 to 89 years. METHODS: Data are based on a linkage of records from a 20% sample of the 1983 census with the records of deaths occurring until the end of 1992. The study population includes 152,150 individuals and the number of cardiovascular deaths was 14,651. Educational differentials were assessed for mortality of diseases of the circulatory system, ischemic heart diseases, cerebrovascular diseases, hypertensive diseases, and sudden death. RESULTS: Substantial mortality differentials were found among individuals aged 45 to 69 years, with larger inequalities among women. The age-adjusted relative risk for mortality of cardiovascular diseases among those with elementary education (< or =8 years) compared with those with high education (> or=13 years) was 1.46 (95% CI: 1.32-1.61) for men and 2.06 (95% CI: 1.76-2.41) for women. Differentials among the elderly were markedly narrower than those for younger adults. Similar trends were observed for mortality of subgroups of causes including cerebrovascular diseases and ischemic heart diseases. Educational differentials were not affected by adjustment for ethnic origin and car ownership. CONCLUSIONS: Those with 8 years of education or less suffer higher risk of cardiovascular mortality compared with adults with 13 or more years of education. Young, less educated women are more vulnerable, and health and social policies oriented towards this group are needed.     

Socioeconomic inequalities in mortality among elderly people in 11 European populations

STUDY OBJECTIVE: To describe mortality inequalities related to education and housing tenure in 11 European populations and to describe the age pattern of relative and absolute socioeconomic inequalities in mortality in the elderly European population. DESIGN AND METHODS: Data from mortality registries linked with population census data of 11 countries and regions of Europe were acquired for the beginning of the 1990s. Indicators of socioeconomic status were educational level and housing tenure. The study determined mortality rate ratios, relative indices of inequality (RII), and mortality rate differences. The age range was 30 to 90+ years. Analyses were performed on the pooled European data, including all populations, and on the data of populations separately. Data were included from Finland, Norway, Denmark, England and Wales, Belgium, France, Austria, Switzerland, Barcelona, Madrid, and Turin. MAIN RESULTS: In Europe (populations pooled) relative inequalities in mortality decreased with increasing age, but persisted. Absolute educational mortality differences increased until the ages 90+. In some of the populations, relative inequalities among older women were as large as those among middle aged women. The decline of relative educational inequalities was largest in Norway (men and women) and Austria (men). Relative educational inequalities did not decrease, or hardly decreased with age in England and Wales (men), Belgium, Switzerland, Austria, and Turin (women). CONCLUSIONS: Socioeconomic inequalities in mortality among older men and women were found to persist in each country, sometimes of similar magnitude as those among the middle aged. Mortality inequalities among older populations are an important public health problem in Europe.     

Regional variations in homicide mortality in Jalisco,Mexico

The present study describes regional variations in homicide rates in Jalisco State, Mexico, in 1989-1991, 1994-1996, and 1999-2000, analyzing the trends by gender and socioeconomic stratum. Using mortality data generated by the National Institute for Statistics, Geography, and Information Technology, homicide rates adjusted by age and gender were calculated, along with rate/female rate ratios; rate ratios by socioeconomic stratum and 95% confidence intervals were also calculated. According to the results, the homicide rate showed: a downward trend in the 1990s; a regional homicide mortality pattern, with the highest rates in peripheral regions, considered among the poorest areas in the State; municipalities with the lowest socioeconomic conditions also presenting a statistically significant excess homicide mortality; and an evident over-mortality from homicide among males. The results point to tasks and challenges for public health and law enforcement institutions, including the need to implement different inter-institutional policies that take into consideration the characteristics of homicide and violent crime in Jalisco.     

Inequalities in the prevalence of smoking in the European Union: comparing education and income

BACKGROUND: The aim of the study was to determine whether education or income was more strongly related to smoking in the European Union at large, and within the individual countries of the EU, at the end of the 1990s. METHODS: We related smoking prevalence to education and income level by analyzing cross-sectional data on a total of 48,694 men and 52,618 women aged 16 and over from 11 countries of the European Union in 1998. RESULTS: Both education and income were related to smoking within the European Union at large. After adjustment of the other socioeconomic indicator, education remained related to smoking in the EU at large, but income only remained so among men. Educational inequalities were larger than income-related inequalities among younger and middle-aged men and women. Educational inequalities were larger than income-related inequalities among men in all individual countries, and among women in Northern Europe. For women from Southern European countries, the magnitude of education- and income-related inequalities was similar. CONCLUSIONS: Education is a strong predictor of smoking in Europe. Interventions should aim to prevent addiction to smoking among the lower educated, by price policies, school-based programs, and smoking cessation support for young adults.     

Socioeconomic inequalities in mortality among women and among men: an international study

OBJECTIVES: This study compared differences in total and cause-specific mortality by educational level among women with those among men in 7 countries: the United States, Finland, Norway, Italy, the Czech Republic, Hungary, and Estonia. METHODS: National data were obtained for the period ca. 1980 to ca. 1990. Age-adjusted rate ratios comparing a broad lower-educational group with a broad upper-educational group were calculated with Poisson regression analysis. RESULTS: Total mortality rate ratios among women ranged from 1.09 in the Czech Republic to 1.31 in the United States and Estonia. Higher mortality rates among lower-educated women were found for most causes of death, but not for neoplasms. Relative inequalities in total mortality tended to be smaller among women than among men. In the United States and Western Europe, but not in Central and Eastern Europe, this sex difference was largely due to differences between women and men in cause-of-death pattern. For specific causes of death, inequalities are usually larger among men. CONCLUSIONS: Further study of the interaction between socioeconomic factors, sex, and mortality may provide important clues to the explanation of inequalities in health.     

Occupational class and ischemic heart disease mortality in the United States and 11 European countries.

OBJECTIVES: Twelve countries were compared with respect to occupational class differences in ischemic heart disease mortality in order to identify factors that are associated with smaller or larger mortality differences. METHODS: Data on mortality by occupational class among men aged 30 to 64 years were obtained from national longitudinal or cross-sectional studies for the 1980s. A common occupational class scheme was applied to most countries. Potential effects of the main data problems were evaluated quantitatively. RESULTS: A north-south contrast existed within Europe. In England and Wales, Ireland, and Nordic countries, manual classes had higher mortality rates than nonmanual classes. In France, Switzerland, and Mediterranean countries, manual classes had mortality rates as low as, or lower than, those among nonmanual classes. Compared with Northern Europe, mortality differences in the United States were smaller (among men aged 30-44 years) or about as large (among men aged 45-64 years). CONCLUSIONS: The results underline the highly variable nature of socioeconomic inequalities in ischemic heart disease mortality. These inequalities appear to be highly sensitive to social gradients in behavioral risk factors. These risk factor gradients are determined by cultural as well as socioeconomic developments.     

An analysis of the role of health care in reducing socioeconomic inequalities in health: the case of the Netherlands.

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, paticularly 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 car 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.     

The socioeconomic determinants of cancer

This paper provides a synthesis on socioeconomic inequalities in cancer incidence, mortality and survival across countries and within countries, with particular focus on the Italian context; the paper also describes the underlying mechanisms documented for cancer incidence, and reports some remarks on policies to tackle inequalities.From a worldwide perspective, the burden of cancer appears to be particularly increasing in developing countries, where many cancers with a poor prognosis (liver, stomach and oesophagus) are much more common than in richer countries. As in the case of incidence and mortality, also in cancer survival we observe a great variability across countries. Different studies have suggested a possible impact of health care on the social gradients in cancer survival, even in countries with a National Health System providing equitable access to care.In developed countries, there is increasing awareness of social inequalities as an important public health issue; as a consequence, there is a variety of strategies and policies being implemented throughout Europe. However, recent reviews emphasize that present knowledge on effectiveness of policies and interventions on health inequalities is not sufficient to offer a robust and evidence-based guide to the choice and design of interventions, and that more evaluation studies are needed.The large disparities in health that we can measure within and between countries represent a challenge to the world; social health inequalities are avoidable, and their reduction therefore represents an achievable goal and an ethical imperative.     

Suicide mortality: gender and socioeconomic differences

OBJECTIVE: To describe suicide mortality trend and sociodemographic patterns identifying gender and socioeconomic differences. METHODS: The trend of crude rates of suicide mortality by sex in the city of Campinas, Brazil, for the period 1976-2001 was assessed. Data from the Mortality Registry were used for sociodemographic analyses in the period 1996-2001. An ecological approach was used to examine socioeconomic differences and the 42 city areas of health care units were classified into 4 homogeneous strata. Rates were age-adjusted using direct method. RESULTS: The city has a low suicide rate (less than 5/100,000) in comparison with other countries. Male excess mortality was over 2.7 male suicides for each female suicide. While in 1980-1985 the older group (55 years and older) had the highest suicide rates, in 1997-2001 the middle-aged adult group (35-54 years old) showed the highest ones. As for suicide methods, men used hanging (36.4%) and firearms (31.8%), while women used poisoning (24.2%) and firearms and hanging (21.2% each). Hangings led to death at home, while firearms or poisoning deaths took place more often in hospitals. Suicide is different from homicide in that there is no rate increase with lower socioeconomic level. CONCLUSIONS: Suicide rates are low with successive increments and decrements without consistent growing or lowering trends. The risk of dying by suicide is higher among men and does not increase with lower socioeconomic condition.     

Socioeconomic inequalities in old-age mortality: a comparison of Denmark and the USA

Previous studies have reported important variations in the magnitude of health inequalities between countries that belong to different welfare systems. This suggests that there is scope for reducing health inequalities by means of country-level interventions. The present study adds to this literature by exploring whether the magnitude of socioeconomic inequalities in mortality is associated with social inequality levels. Denmark and the USA belong to fundamentally different welfare systems (social democratic and liberal) and our study thereby contributes to the ongoing debate on whether welfare systems are linked to health inequalities. We analyze Denmark and the USA in terms of socioeconomic differences in mortality above age 58. The data sources were Danish register data from 1980 to 2002 (n = 2,029,324), and survey data from the US Health and Retirement Study (HRS) from 1992 to 2006 (n = 9374). Survival analysis was used to study the impact of socioeconomic status on mortality and the magnitude of mortality differences between the two countries was compared. The results showed surprisingly that mortality differentials were larger in Denmark than in the USA even after controlling for a number of covariates: The poorest 10 percent of the Danish elderly population have a mortality rate ratio of 3.32 (men) and 3.70 (women) compared to the richest 25 percent. In the USA the corresponding rate ratios are 1.67 and 1.56. Low income seems to be a more powerful risk factor for mortality than low education. A number of possible explanations for higher mortality differences in Denmark are discussed: unintended positive correlation between generous health services and health inequality, early life influences, mortality selection, and relative deprivation.     

Changes in social inequalities in health in the Basque Country

STUDY OBJECTIVE: To determine the extent of the inequalities in self reported health between socioeconomic groups and its changes over time in the Basque Country (Spain). DESIGN: Cross sectional data on the association between occupation, education and income and three health indicators was obtained from the Basque Health Surveys of 1986 and 1992. Representative population samples were analysed. In 1986 the number of respondents was 24 657 and in 1992, 13 277. SETTING: Basque Country, Spain. MAIN OUTCOME MEASURES: The effect of socioeconomic position on health and the magnitude of social inequalities in health were quantified using the odds ratios based on logistic regression analysis, and the Relative Index of Inequality. RESULTS: As was expected, social inequalities in self reported health existed in both surveys, but the social gradient was greater in 1992. Social differences varied according to gender and health indicator. According to education an increase in social inequalities was observed consistently in all the health indicators except long term conditions in women. A consistent increase in inequalities in limiting longstanding illness was also observed according to all socioeconomic indicators. CONCLUSIONS: These results agree to a large extent with those of previous studies in other countries. In this context the unequal distribution of material circumstances and working conditions between socioeconomic groups seem to play a major part in health inequalities. The worsening of the labour market during this period and the onset of a new economic recession may explain the increase in social inequalities over time.     

Trends in socioeconomic health inequalities in the Netherlands, 1981-1999

STUDY OBJECTIVE: To determine changes in socioeconomic inequalities in self reported health in both the 1980s and the 1990s in the Netherlands. DESIGN: Analysis of trends in socioeconomic health inequalities during the last decades of the 20th century were made using data from the Health Interview Survey (Nethhis) and the subsequent Permanent Survey on Living Conditions (POLS) from Statistics Netherlands. Socioeconomic inequalities in self assessed health, short-term disabilities during the past 14 days, long term health problems and chronic diseases were studied in relation to both educational level and household income. Trends from 1981 to 1999 were studied using summary indices for both the relative and absolute size of socioeconomic inequalities in health. SETTING: The Netherlands. PARTICIPANTS: For the period 1981-1999 per year a random sample of about 7000 respondents of 18 years and older from the non-institutionalised population. MAIN RESULTS: Socioeconomic inequalities in self assessed health showed a fairly consistent increase over time. Socioeconomic inequalities in the other health indicators were more or less stable over time. In no case did socioeconomic inequalities in health seemed to have decreased over time. Socioeconomic inequalities in self assessed health increased both in the 1980s and the 1990s. This increase was more pronounced for income (as compared with education) and for women (as compared with men). CONCLUSION: There are several possible explanations for the fact that, in addition to stable health inequalities in general, income related inequalities in some health indicators increased in the Netherlands, especially in the early 1990s. Most influential were perhaps selection effects, related to changing labour market policies in the Netherlands. The fact that the health inequalities did not decrease over recent years underscores the necessity of policies that explicitly aim to tackle these inequalities.     

Factors associated with self-care activities among adults in the United Kingdom: a systematic review

Background

Higher prevalence rates of unhealthy behaviours among lower socioeconomic groups contribute substantially to socioeconomic inequalities in health in adults. Preventing the development of these inequalities in unhealthy behaviours early in life is an important strategy to tackle socioeconomic inequalities in health. Little is known however, about health promotion strategies particularly effective in lower socioeconomic groups in youth. It is the purpose of project TEENAGE to improve knowledge on the prevention of socioeconomic inequalities in physical activity, diet, smoking and alcohol consumption among adolescents in Europe. This paper describes the background, design and methods to be used in the project.

Methods/design

Through a systematic literature search, existing interventions aimed at promoting physical activity, a healthy diet, preventing the uptake of smoking or alcohol, and evaluated in the general adolescent population in Europe will be identified. Studies in which indicators of socioeconomic position are included will be reanalysed by socioeconomic position. Results of such stratified analyses will be summarised by type of behaviour, across behaviours by type of intervention (health education, environmental interventions and policies) and by setting (individual, household, school, and neighbourhood). In addition, the degree to which effective interventions can be transferred to other European countries will be assessed.

Discussion

Although it is sometimes assumed that some health promotion strategies may be particularly effective in higher socioeconomic groups, thereby increasing socioeconomic inequalities in health-related behaviour, there is little knowledge about differential effects of health promotion across socioeconomic groups. Synthesizing stratified analyses of a number of interventions conducted in the general adolescent population may offer an efficient guidance for the development of strategies and interventions to prevent socioeconomic inequalities in health early in life.     

Widening socioeconomic inequalities in mortality in six Western European countries

OBJECTIVES: During the past decades a widening of the relative gap in death rates between upper and lower socioeconomic groups has been reported for several European countries. Although differential mortality decline for cardiovascular diseases has been suggested as an important contributory factor, it is not known what its quantitative contribution was, and to what extent other causes of death have contributed to the widening gap in total mortality. METHODS: We collected data on mortality by educational level and occupational class among men and women from national longitudinal studies in Finland, Sweden, Norway, Denmark, England/Wales, and Italy (Turin), and analysed age-standardized death rates in two recent time periods (1981-1985 and 1991-1995), both total mortality and by cause of death. For simplicity, we report on inequalities in mortality between two broad socioeconomic groups (high and low educational level, non-manual and manual occupations). RESULTS: Relative inequalities in total mortality have increased in all six countries, but absolute differences in total mortality were fairly stable, with the exception of Finland where an increase occurred. In most countries, mortality from cardiovascular diseases declined proportionally faster in the upper socioeconomic groups. The exception is Italy (Turin) where the reverse occurred. In all countries with the exception of Italy (Turin), changes in cardiovascular disease mortality contributed about half of the widening relative gap for total mortality. Other causes also made important contributions to the widening gap in total mortality. For these causes, widening inequalities were sometimes due to increasing mortality rates in the lower socioeconomic groups. We found rising rates of mortality from lung cancer, breast cancer, respiratory disease, gastrointestinal disease, and injuries among men and/or women in lower socioeconomic groups in several countries. CONCLUSIONS: Reducing socioeconomic inequalities in mortality in Western Europe critically depends upon speeding up mortality declines from cardiovascular diseases in lower socioeconomic groups, and countering mortality increases from several other causes of death in lower socioeconomic groups.     

Trends in injury mortality among young people in the European Union: a report from the EURORISC working group.

PURPOSE: To examine the trends in injury mortality among young people aged 15-24 years residing in the 15 current member states of the European Union between 1984 and 1993. METHODS: As part of a European Commission-funded project entitled European Review of Injury Surveillance and Control (EURORISC), mortality data for all externally caused physical injuries (International Classification of Disease Codes E800-999) were obtained from the World Health Organization. Data were analyzed to generate age-specific injury mortality rates and proportional differences in rates over the study period. Linear regression was used to represent the linear component of the mortality profile. RESULTS: Almost a quarter of a million young people died as a result of sustaining an externally caused physical injury (either unintentional or intentional) in the study countries between 1984 and 1993. Injury accounted for two-thirds of all deaths in this age group. Over three-quarters (76%) of deaths were due to unintentional injury, a further 17% to self-inflicted injuries, and the remaining 7% to homicide and other violent causes. Motor vehicle traffic fatalities accounted for 84% of unintentional injury deaths. Although a decline in injury mortality was observed throughout Europe, rates of mortality owing to both unintentional injuries and suicide varied widely among study countries at both the beginning and end of the study period. CONCLUSIONS: Whereas injury mortality rates in young people in most European countries are lower than in other parts of the world (including the United States), injuries represent a major public health problem in the European Union. The death toll from motor vehicle traffic crashes is a particular cause for concern.     

Socioeconomic inequalities in morbidity among the elderly; a European overview

There is some evidence on socioeconomic inequality in morbidity among elderly people, but this evidence remains fragmentary. This study aims to give a comprehensive overview of educational and income inequalities in morbidity among the elderly of eleven European countries. Data from the first wave of 1994 of the European Community Household Panel were used. The study population comprised a total of 14,107 men and 17,243 women, divided into three age groups: 60-69, 70-79 and 80+. Three health indicators were used: self-assessed health, cut down in daily activities due to a physical or mental problem, and long-term disability. The results indicate that socioeconomic inequalities in morbidity by education and income exist among the elderly in Europe, in all the countries in this study and all age groups, including the oldest old. Inequalities decline with age among women, but not always among men. Greece, Ireland, Italy and The Netherlands most often show large inequalities among men, and Greece, Ireland and Spain do so among women. To conclude, inequalities in morbidity decrease with age, but a substantive part persists in old age. To improve the health of elderly people it is important that the material, social and cultural resources of the elderly are improved.     

Socioeconomic inequalities in mental health and health-related quality of life (HRQOL) in children and adolescents from 11 European countries

Objectives

To assess the presence and magnitude of social inequalities in mental health and health-related quality of life (HRQOL) in the population aged 8–18 years in 11 European countries.

Methods

Cross-sectional surveys were carried out in representative samples of children/adolescents (8–18 years) from the participating countries of the KIDSCREEN project. Mental health was assessed using the Strengths and Difficulties Questionnaire (SDQ), and HRQOL by means of the KIDSCREEN-10. Socioeconomic status (SES) was assessed using the Family Affluence Scale and parental level of education. The association between health outcomes and SES was analyzed with the regression-based relative index of inequalities (RII) and population attributable risk.

Results

A total of 16,210 parent–child pairs were included. The SDQ showed inequalities in mental health according to family level of education in all countries (RII = 1.45; 1.37–1.53). The RII for HRQOL was 2.15 (1.79–2.59) in the whole sample, with less consistent results by age and country.

Conclusions

Socioeconomic inequalities in mental health were consistently found across Europe. Future research should clarify the causes of these inequalities and define initiatives which prevent them continuing into adulthood.     

Population vulnerabilities and capacities related to health: a test of a model

Variability in the health of human populations is greater in economically vulnerable areas. We tested whether this variability reflects and can be explained by: (1) underlying vulnerabilities and capacities of populations and/or (2) differences in the distribution of individual socioeconomic status between populations. Health outcomes were rates of mortality from 12 causes (cardiovascular disease, malignant neoplasms, accidents, chronic lower respiratory disease, cerebrovascular disease, pneumonia and influenza, diseases of the nervous system, suicide, chronic liver disease and cirrhosis, diabetes, homicide, HIV/AIDS) for 59 New York City neighborhoods in 2000. Negative binomial regression models were fit with a measure of socioeconomic vulnerability, median income, predicting each mortality rate. Overdispersion of each model was used to assess whether variability in mortality rates increased with increasing neighborhood socioeconomic vulnerability. To assess the two hypotheses, we examined changes in the variability of mortality rates (as indicated by changes in overdispersion of the models) for outcomes with significant non-constant variability after accounting for (1) vulnerabilities and capacities (social control, quality of local schools, unemployment, low education), and (2) the distribution of individual socioeconomic status (low income, poverty, socioeconomic distribution, high income). Some variability in all mortality rates was explained by accounting for a range of potential vulnerabilities and capacities, supporting the first explanation. However, variability in some causes of mortality was also explained in part by accounting for the distribution of individual resources, supporting the second explanation. The results are consistent with a theory of underlying socioeconomic vulnerabilities of human populations. In areas with lower levels of income, other characteristics of those neighborhoods exacerbate or temper the economic vulnerability, leading to more or less healthy conditions. Understanding the vulnerabilities and capacities that characterize populations may help us better understand the production of population health, and may inform efforts aimed at improving population health.     

Is patriarchy the source of men's higher mortality?

OBJECTIVE: To examine the relation between levels of patriarchy and male health by comparing female homicide rates with male mortality within countries. HYPOTHESIS: High levels of patriarchy in a society are associated with increased mortality among men. DESIGN: Cross sectional ecological study design. SETTING: 51 countries from four continents were represented in the data-America, Europe, Australasia, and Asia. No data were available for Africa. RESULTS: A multivariate stepwise linear regression model was used. Main outcome measure was age standardised male mortality rates for 51 countries for the year 1995. Age standardised female homicide rates and GDP per capita ranking were the explanatory variables in the model. Results were also adjusted for the effects of general rates of homicide. Age standardised female homicide rates and ranking of GDP were strongly correlated with age standardised male mortality rates (Pearson's r=0.699 and Spearman's 0.744 respectively) and both correlations achieved significance (p<0.005). Both factors were subsequently included in the stepwise regression model. Female homicide rates explained 48.8% of the variance in male mortality, and GDP a further 13.6% showing that the higher the rate of female homicide, and hence the greater the indicator of patriarchy, the higher is the rate of mortality among men. CONCLUSION: These data suggest that oppression and exploitation harm the oppressors as well as those they oppress, and that men's higher mortality is a preventable social condition, which could be tackled through global social policy measures.