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Health for All? in Recent Years, a Considerable Number of Countries Have Developed and Implemented Strategies Aiming at Reducing Inequalities in Health

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Health for All? in Recent Years, a Considerable Number of Countries Have Developed and Implemented Strategies Aiming at Reducing Inequalities in Health Health for all? In recent years, a considerable number of countries have developed and implemented strategies aiming at reducing inequalities in health. However, knowledge of effective policies or strategies to reduce socioeconomic inequalities in health is still very fragmented. The aim of this book is to describe and compare different European health equity strategies and their potential successes. The main part of the material comes from a comparative study of national public health strategies for equity in health with the following participating countries: Denmark, Finland, England, Italy, Netherlands, Norway, Spain and Sweden. National experts wrote the country chapters which not only cover questions concerning whether their countries were taking measures on the individual public health problems – such as smoking, alcohol or physical activity – but also if the policies had considered the wider, social determinants of health and experiences of the potential implementation processes. This publication presents an up-to-date picture concerning equity- oriented public health policies in Europe. However, there is considerable lack of relevant data to enable comprehensive comparisons and analyses of successes and problems with the implementation and monitoring of health equity policies. We hope the book will stimulate continued efforts to harmonise relevant data collections and improve collaborative analyses aiming at shaping an evidence base for policy decisions about the most effective ways to promote equity in health. Health for all? A critical analysis of public health policies in eight European countries R 2008 : 21 Statens folkhälsoinstitut Fax 08-449 88 11 R 2008:21 Editors: Christer Hogstedt, Henrik Moberg, Distributionstjänst [email protected] ISSN 1651-8624 120 88 Stockholm www.fhi.se ISBN 978-91-7257-572-1 Bernt Lundgren and Mona Backhans Health for all? A critical analysis of public health policies in eight European countries Editors: Christer Hogstedt, Henrik Moberg, Bernt Lundgren and Mona Backhans © swedish national institute of public health östersund r 2008:21 isbn: 978-91-7257-572-1 issn: 1651-8624 editors: christer hogstedt, henrik moberg, bernt lundgren and mona backhans cover photo: johnér bildbyrå ab/stefan berg photos: page 88, 124, 160, 240 and 292 christer hogstedt. page 60 scanpix/andré maslennikov, page 202 bildhuset/scanpix/alexander ruas and page 266 scanpix/ vesa moilanen. graphic production: ab typoform print: åtta45 tryckeri ab Contents Foreword ____________________________________________________________ 9 Contributors __________________________________________________________ 11 Comparative studies of policies on health inequalities – a literature review ________14 Introduction __________________________________________________________14 Method ______________________________________________________________ 15 Material _____________________________________________________________ 15 Results ______________________________________________________________16 Comments and conclusions _____________________________________________21 References __________________________________________________________ 29 Health inequities – concepts, measures and pathways ________________________32 Background and objective _______________________________________________32 Some concepts _______________________________________________________32 Measuring inequality in health ___________________________________________33 Manner of approaches to characterise different segments of the population ______ 34 Socioeconomic status ________________________________________________ 34 Grouping by professional categories _______________________________________35 Education _________________________________________________________ 36 Income ___________________________________________________________ 36 Material assets _______________________________________________________37 Classification of individuals by the social character of the residential area __________37 Gender_____________________________________________________________38 Age _______________________________________________________________38 Ethnicity ___________________________________________________________38 Geographically or administratively defined areas ____________________________ 39 Information on health status ___________________________________________ 39 Mortality __________________________________________________________ 39 Occurrence of disease_________________________________________________ 39 Self-reported health __________________________________________________ 40 DALY/DALE/QALY __________________________________________________ 40 Analysis of differences __________________________________________________41 Absolute measures ____________________________________________________41 Relative differences – epidemiological methods ______________________________41 Relative differences – methods in economic science __________________________ 43 Descriptions of the total variation _______________________________________ 44 Explanatory models ___________________________________________________ 46 Access to resources ___________________________________________________ 46 Exposure to risk factors ________________________________________________ 47 Interaction between different determinants ________________________________ 48 Psychobiological mechanisms __________________________________________ 49 Increased vulnerability ________________________________________________ 50 Genetics ___________________________________________________________ 50 Reversed causal relation ________________________________________________ 51 A lifecycle perspective of social differences __________________________________ 51 Direct biological effects during the lifecycle _________________________________ 51 Psychological agents during the lifecycle ___________________________________52 References ___________________________________________________________54 Denmark _____________________________________________________________61 Economical and social development ______________________________________61 Health development ___________________________________________________61 Social inequality in health _____________________________________________ 63 Development of policy focus on equity in health ____________________________ 65 Health determinants __________________________________________________ 67 Economic growth, poverty and social security ______________________________ 67 Education _________________________________________________________ 68 Working conditions __________________________________________________ 69 Unemployment ______________________________________________________71 Environmental determinants (social and physical) __________________________ 72 Healthcare__________________________________________________________73 Behavioural risk factors _______________________________________________ 74 Tobacco ___________________________________________________________ 76 Alcohol ___________________________________________________________ 76 Diet, exercise and overweight ____________________________________________77 Disease-specific strategies _____________________________________________ 78 Cancer ____________________________________________________________ 79 Cardiovascular disease ________________________________________________ 79 Other diseases ______________________________________________________ 79 Group-specific strategies _______________________________________________ 79 Arena approaches ____________________________________________________ 80 Implementation _______________________________________________________81 Monitoring __________________________________________________________ 82 Concluding remarks __________________________________________________ 82 References __________________________________________________________ 84 England _____________________________________________________________ 89 Development of society and the present political environment _________________ 89 Magnitude, trends and analysis on social inequalities in health ________________ 93 Strategies focusing on specific health determinants _________________________ 96 Disease-specific strategies _____________________________________________110 Group-specific strategies _______________________________________________ 113 Arena approaches ____________________________________________________114 Implementation: methods, resources and main actors _______________________116 Monitoring and evaluation _____________________________________________ 117 Concluding remarks __________________________________________________ 117 Research suggestions _________________________________________________119 References _________________________________________________________ 120 Finland _____________________________________________________________ 125 Development of society and the present policy environment __________________ 125 Magnitude, trends and analysis as regards social inequality in health ___________129 Strategies focusing on health determinants ________________________________132 Disease-specific strategies to reduce social inequalities in health _______________144 Group-specific strategies for reducing social inequalities in health ______________145 Arena approaches for reducing social inequalities in health ___________________145 Implementation: methods, resources and main actors ______________________ 146 Monitoring and evaluation _____________________________________________148 Concluding remarks _________________________________________________
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