What Does Eurostat's Labour Force Survey Say About Health and Health Inequalities in the European Union?
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What does Eurostat’s Labour Force Survey say about health and health inequalities in the European Union? Stefano Mazzuco, Department of Statistics, Padua University, Italy Marc Suhrcke, School of Medicine, Health Policy and Practice, University of East Anglia, United Kingdom What does Eurostat’s Labour Force Survey say about health and health inequalities in the European Union? Stefano Mazzuco, Department of Statistics, Padua University, Italy Marc Suhrcke, School of Medicine, Health Policy and Practice, University of East Anglia, United Kingdom Keywords HEALTH STATUS DISPARITIES HEALTH STATUS INDICATORS DATA COLLECTION EMPLOYMENT - statistics and numerical data SOCIOECONOMIC FACTORS EUROPEAN UNION ISBN 978 92 890 0218 9 Suggested citation Mazzuco S, Suhrcke M (2010). What does Eurostat’s Labour Force Survey say about health and health inequalities in the European Union? Copenhagen, WHO Regional Offi ce for Europe. Address requests about publications of the WHO Regional Offi ce for Europe to: Publications WHO Regional Offi ce for Europe Scherfi gsvej 8 DK-2100 Copenhagen Ø, Denmark Alternatively, complete an online request form for documentation, health information, or for permission to quote or translate, on the Regional Offi ce web site (http://www.euro.who.int/pubrequest). © World Health Organization 2010 All rights reserved. The Regional Offi ce for Europe of the World Health Organization welcomes requests for permission to reproduce or translate its publications, in part or in full. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specifi c companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either express or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use. The views expressed by authors, editors, or expert groups do not necessarily represent the decisions or the stated policy of the World Health Organization. Edited by Elizabeth Goodrich Book design and layout by Marta Pasqualato Cover photo ©iStockphoto.com/james knighten The photographs in this material are used for illustrative purposes only; they do not imply any particular health status, attitudes, behaviours, or actions on the part of any person who appears in the photographs. Abstract This publication presents extensive analysis of newly available data from Eurostat’s Labour Force Survey (LFS) to measure health and socioeconomic inequalities in health in 25 European countries, in a period including 1983–2004 at most. The study fi rst defi ned several, predominantly labour market-related health indicators plus one weighted, overall health index. The authors documented the limitations of using this information for the measurement of average national health status, and focused on the use of the health information for the assessment of socioeconomic inequalities in health. Standard concentration indices were calculated using fi ve different proxies for socioeconomic status. After decomposing the inequality data into its trend and seasonal component, health inequalities were found to have been increasing for most but by no means all countries and health indicators. These results do not appear to be sensitive to the various proxies for socioeconomic status employed. Overall, while not without problems, the LFS may well add a useful and hitherto unexploited resource for measuring socioeconomic inequalities in health across European countries and over time. Acknowledgements We gratefully acknowledge the fi nancial and other support provided by the Department of Health of England (United Kingdom) and the WHO European Offi ce for Investment for Health and Development, WHO Regional Offi ce for Europe for the production of this report. We thank in particular Cristina Comunian (WHO European Offi ce for Investment for Health and Development , WHO Regional Offi ce for Europe) for her continued advice and her (almost) infi nite patience. We have benefi ted greatly from the comments by Teresa Lavin (Institute of Public Health in Ireland), Margaret Whitehead and Frances M. Drever (Division of Public Health, University of Liverpool), and Enrique Loyola (Health Intelligence Service, WHO Regional Offi ce for Europe). We are also indebted to Elizabeth Goodrich who copy-edited the text. Any errors are the sole responsibility of the authors. Stefano Mazzuco, Department of Statistics, Padua University, Italy Marc Suhrcke, School of Medicine, Health Policy and Practice, University of East Anglia, United Kingdom WHO European Offi ce for Investment for Health and Development The WHO European Offi ce for Investment for Health and Development, which coordinated the activities leading to this publication, was set up by the WHO Regional Offi ce for Europe, with cooperation and support from the Ministry of Health and the Veneto Region of Italy. One of its key responsibilities is to provide evidence on and act upon the social and economic determinants of health. The Offi ce systematically reviews what is involved in drawing together the concepts, scientifi c evidence, technology and policy action necessary to achieve effective investment for the promotion of health and synergy between social, economic and health development. The Offi ce fulfi ls two interrelated main functions: • to monitor, review and systematize the policy implications of the social and economic determinants of population health; and • to provide services to help Member States in the WHO European Region increase their capacity to invest in health by addressing these policy implications and integrating them into the agenda for development. iii Contents Abbreviations iv List of tables v List of fi gures v Executive summary vi 1. Introduction 1 2. Related literature 3 3. Description of the LFS data 4 4. A fi rst look at our data 6 5. A second look at our data 14 6. Socioeconomic inequalities in health 18 7. Concluding remarks 24 References 25 Annex 1. Average health indices by country and sex 27 Annex 2. Health inequality indices by country and sex 58 Abbreviations CRWA continued reduction in working ability EAP exclusion from active population ECHP European Community Household Panel EGP Erikson and Goldthorpe’s class categories EU European Union EU-25 countries belonging to the European Union prior to 2007 EU-SILC European Union-Statistics on Income and Living Conditions ISCED International Standard Classifi cation of Education ISCO International Standard Classifi cation of Occupations ISEI International Socio-Economic Index of Occupational Status LFS Labour Force Survey PIW permanent inability to work SES socioeconomic status SHARE Survey of Health, Ageing and Retirement in Europe SIOPS Standard International Occupational Prestige Scale THLI Total Health Limitation Index TIW temporary inability to work TRWA temporary reduction in working ability UNESCO United Nations Educational, Scientifi c and Cultural Organization iv List of tables Table 1. LFS questions relating to health issues 5 Table 2. Health indicators defi ned on the basis of LFS health questions 5 Table 3. Health limitation indices (standardized by age) for European countries, men, 2004 6 Table 4. Health limitation indices (standardized by age) for European countries, women, 2004 7 Table 5. Results of generalized additive model for generosity index 15 Table 6. Inequality of several health indices in European countries, men, second quarter, 2004 19 Table 7. Inequality of several health indices in European countries, women, second quarter, 2004 20 List of fi gures Fig. 1. TIW index (standardized by age) for representative European countries 8 Fig. 2. TRWA index (standardized by age) for representative European countries 8 Fig. 3. CRWA index (standardized by age) for representative European countries 9 Fig. 4. EAP index (standardized by age) for representative European countries 10 Fig. 5. PIW1 index (standardized by age) for representative European countries 10 Fig. 6. PIW2 index (standardized by age) for representative European countries 11 Fig. 7. THLI (standardized by age) for representative European countries 11 Fig. 8. Scatter plots of THLI and prevalence of self-reported chronic illness 12 Fig. 9. Scatter plots of THLI and log of standardized mortality ratio 13 Fig. 10. Scatter plots of THLI and log of life expectancy at 15 13 Fig. 11. THLI before and after weighting with the inverse of generosity score, men, six countries 16 Fig. 12. Decomposition of THLI time series, Italy, men 17 Fig. 13. Health inequality index, Italy 21 Fig. 14. Decomposition of CRWA inequality time series, Italy 22 Fig. 15. Average level and inequality index of TRWA in European countries, second quarter, 2004 23