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- 1. Reducing the Health Gradient The impact of socio-economic status as a determinant of health. Is a policy focus on youth unemployment the key to combat persisting health inequalities? 1 Svenja M. Schneider E-Mail: Svenja-Schneider@gmx.de
- 2. Table of Content • Global Health Inequalities • Socio-economic Determinants of Health • Youth as Target Group of Intervention • Building blocks of successful intervention • Conclusion 2
- 4. Whitehead & Dahlgren’s model of the interacting determinants of health 4Source: Reprinted from Health 2020 policy framework and strategy (EUR/RC62/8) (p. 31), by World Health Organization, 2012, Malta: WHO Regional Committee for Europe.
- 5. Projected crude death rates per 100 000 by World Bank income groups for all ages, 2005 and 2015 Group 1: communicable diseases, nutritional deficiencies, perinatal & maternal conditions Group 2: chronic, noncommunicable diseases. Group 3: injuries Source: Reprinted from “Preventing chronic diseases: how many lives can we save?,” by K. Strong, C. Mathers, S. Leeder and R. Beaglehole, 2005, Lancet, 366(9496), 1580. Copyright 2009 by Elsevier B.V. 5
- 6. Does it really have to be like this? 6
- 7. Youth as Target Group for Intervention
- 8. Building blocks of successful intervention • focus on enhancing disadvantaged people’s chances for occupational advancement in order to improve their living conditions, as well as their health status • Increasing job availability, training or re- training to every young person within a reasonable time period after becoming unemployed or leave formal education • Ensure equal opportunities for young people in the labour market as a countermeasure to the growing levels of youth unemployment 8
- 9. Conclusion To reduce health inequalities, it is insufficient to only buffer the health-damaging effects of poverty and marginalization - correction of the fundamental causes Life course perspective suggests focus on preserving young people‘s health to prevent many health problems in later life before they occur Health status is highly influenced by the socio-economic determinants (e.g. income) Raising socio-economic status of young people by counteracting youth unemployment: Youth Guarantee Better health outcomes among disadvantaged population groups Reduction in health inequalities 9
- 10. Thank you for your attention! • Questions? 10 Let‘s hope everyone will be able to reach the finish line in the future!!!
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- 12. • European Commission. (2012). EU Youth Report. Commission Staff Working Document. Status of the situation of young people in the European Union. Brussels: European Commission. • European Youth Forum. (2012). A Youth Guarantee for Europe. Towards a rights-based approach to youth employment policy. Brussels: European Youth Forum. • Eurostat. (2013). Unemployment statistics. Retrieved from http://epp.eurostat.ec.europa.eu/statistics_explained/index.php/Unemployment_statistics#Youth_unemployment_trends • Eurydice. (2010). Gender Differences in Educational Outcomes: Study on the Measures Taken and the Current Situation in Europe. Brussels: EACEA P9 Eurydice. • International Labour Office. (2012). Global Employment Trends for Youth 2012. Geneva: International Labour Organization. • Irwin, A., Valentine, N., Brown, C., Loewenson, R., Solar, O., Brown, H., … Vega, J. (2006). The commission on social determinants of health: tackling the social roots of health inequities. PLoS Medicine, 3, 0749-0751. doi:10.1371/journal.pmed.0030106 • Jha, P., Mills, A., Hanson, K., Kumaranayake, L., Conteh, L., Kurowski, C., … Sachs, J. D. (2002). Improving the Health of the Global Poor. Science Magazine, 29, 2036-39. doi:10.1126/science.295.5562.2036 • Mackenbach, J.P., Stirbu, I., Roskam, A.-J. R., Schaap, M.M., Menvielle, G., Leinsalu, M., & Kunst, A.E. (2008). Socioeconomic Inequalities in Health in 22 European Countries. The New England Journal of Medicine, 358, 2468-2481. doi:10.1056/NEJMsa0707519 • Paulus, A., & van Raak, A. (2005). Designing and executing health care research. Retrieved from https://eleum.unimaas.nl/bbcswebdav/pid-147529-dt-content-rid421542_1/orgs/Eurotrotter _cohort_2010/Appendix%202%20Paulus%2C%20Van%20Raak%202007 2008%20 Designing %20and%20executing%20health%20care%20research.pdf • Polit, D. F., & Beck, C. T. (2008). Nursing research: generating and assessing evidence for nursing practice (8th ed.). Philadelphia: Lippincott Williams & Wilkins. • Powers, M., & Faden, R. (2006). Social justice. The moral foundations of public health and health policy. New York: Oxford University Press. • Public Health Agency of Canada. (2011). What Determines Health. Retrieved from http://www.phac-aspc.gc.ca/ph-sp/determinants/ • Stafford, M., & Marmot, M. (2003). Neighbourhood deprivation and health: does it affect us all equally? International Journal of Epidemiology, 32, 357–366. doi:10.1093/ije/dyg084 • Strong, K., Mathers C., Leeder, S., & Beaglehole, R. (2005). Preventing chronic diseases: how many lives can we save?. Lancet, 366, 1578-1582. doi:10.1016/S0140-6736(05) 67341-2 • Suhrcke, M., McKee, M., Sauto Arce, R., Tsolova, S., & Mortensen, J. (2005). The contribution of health to the economy in the European Union. Luxembourg: Office for Official Publications of the European Communities. • Irwin, A., Valentine, N., Brown, C., Loewenson, R., Solar, O., Brown, H., … Vega, J. (2006). The commission on social determinants of health: tackling the social roots of health inequities. PLoS Medicine, 3, 0749-0751. doi:10.1371/journal.pmed.0030106 • Jha, P., Mills, A., Hanson, K., Kumaranayake, L., Conteh, L., Kurowski, C., … Sachs, J. D. (2002). Improving the Health of the Global Poor. Science Magazine, 29, 2036-39. doi:10.1126/science.295.5562.2036 • Mackenbach, J.P., Stirbu, I., Roskam, A.-J. R., Schaap, M.M., Menvielle, G., Leinsalu, M., & Kunst, A.E. (2008). Socioeconomic Inequalities in Health in 22 European Countries. The New England Journal of Medicine, 358, 2468-2481. doi:10.1056/NEJMsa0707519 • Paulus, A., & van Raak, A. (2005). Designing and executing health care research. Retrieved from https://eleum.unimaas.nl/bbcswebdav/pid-147529-dt-content-rid421542_1/orgs/Eurotrotter _cohort_2010/Appendix%202%20Paulus%2C%20Van%20Raak%202007 2008%20 Designing %20and%20executing%20health%20care%20research.pdf 12
- 13. • Polit, D. F., & Beck, C. T. (2008). Nursing research: generating and assessing evidence for nursing practice (8th ed.). Philadelphia: Lippincott Williams & Wilkins. • Powers, M., & Faden, R. (2006). Social justice. The moral foundations of public health and health policy. New York: Oxford University Press. • Public Health Agency of Canada. (2011). What Determines Health. Retrieved from http://www.phac-aspc.gc.ca/ph-sp/determinants/ • Stafford, M., & Marmot, M. (2003). Neighbourhood deprivation and health: does it affect us all equally? International Journal of Epidemiology, 32, 357–366. doi:10.1093/ije/dyg084 • Strong, K., Mathers C., Leeder, S., & Beaglehole, R. (2005). Preventing chronic diseases: how many lives can we save?. Lancet, 366, 1578-1582. doi:10.1016/S0140-6736(05) 67341-2 • Suhrcke, M., McKee, M., Sauto Arce, R., Tsolova, S., & Mortensen, J. (2005). The contribution of health to the economy in the European Union. Luxembourg: Office for Official Publications of the European Communities. • United Nations General Assembly. (1948). Universal Declaration of Human Rights. Retrieved from http://www.un.org/en/documents/udhr/ • Vrije Universiteit Amsterdam. (2012). Level C – Humanities: The snowball method. Retrieved from http://webcursus.ubvu.vu.nl/cursus/default.asplettergr=klein&cursus_id=142& pagnr=10 • WHO. (1978). Primary health care. Report of the International Conference on Primary Health Care. Geneva: World Health Organization. • WHO. (2003). Social Determinants of Health: The Solid Facts (2nd ed.). Copenhagen: WHO Regional Office for Europe. • WHO. (2013). Social Determinants of Health – Key Concepts. Retrieved from http://www.who.int/social_determinants/thecommission/finalreport/key_concepts/en/ • WHO Regional Office for Europe. (2006). European strategies for tackling social inequities in health: Levelling up Part 2. Copenhagen: WHO Regional Office for Europe. • WHO Regional Office for Europe. (2009). A Snapshot of the Health of Young People in Europe. A report prepared for the European Commission Conference on Youth Health, Brussels, Belgium, 9-10 July 2009. Copenhagen: WHO Regional Office for Europe. • WHO Regional Office for Europe. (2010). Interim first report on social determinants of health and the health divide in the WHO European Region – Executive summary. Copenhagen: WHO Regional Office for Europe. • WHO Regional Office for Europe. (2011a). Impact of Economic Crises on Mental Health. Copenhagen: WHO Regional Office for Europe. • WHO Regional Office for Europe. (2011b). Interim second report on social determinants of health and the health divide in the WHO European Region. Copenhagen: WHO Regional Office for Europe. • WHO Regional Office for Europe. (2012). Social Determinants of Health and Well-being among Young People. Health Behaviour in School-aged Children (HBSC) Study: International report from the 2009/2010 survey. Copenhagen: WHO Regional Office for Europe. 13
Editor's Notes
- Health is not only a central part of people’s life and a constitutive element of well-being but also a remarkable, unique resource in terms of human capital that needs to be nurtured, in order to deal with present and future economic and social challenges successfully. Nonetheless, to date, major inequalities in health are evident between, as well as within countries. Therefore, I will talk about how the Health Gradient could be reduced. (Definition health gradient: The social gradient in health runs from top to bottom of the socio-economic spectrum, indicating that the lower the socio-economic status, the worse is the status of health)
- I wanted to start with a short video that demonstrates various issues related to Global Health which affect different countries to a varying extent. It is just thought to give a brief overview of what inequalities exist by enlarging those parts of the world that are mostly affected by the particular issues. Show video Health inequalities occur in a systematic fashion and are not randomly distributed. The highest levels of illness and premature mortality are found among the poorest people. The video included education, literacy and poverty among the range of health influencing factors, which form the starting point for my research in which I am trying to answer the question raised in the video.
- There is evidence that a close relationship between socio-economic determinants and health outcomes exists. The Conceptual Framework of the interacting determinants of health by Whitehead and Dahlgren shows that the individual is placed at the centre with a largely fixed set of genes and characteristics, while being surrounded by the theoretically modifiable influences on health. Individual lifestyle and behavioural factors can either promote or damage health (Examples are nutrition, physical activity, sedentary behaviour and smoking habits) The next layer refers to the interactions on the social and community level that have an influence, including the provision of mutual support for members of the community who find themselves in unfavourable conditions. In turn, lack of support has a negative impact and can cause or increase an individual’s distress. Structural factors, such as housing, living and working conditions, access to services and the provision of essential facilities required to maintain health are presented by the third layer. Finally, the overarching layer highlights the role of the prevailing socio-economic, cultural and environmental influences that mediate overall population health.
- The figure on this slide supports this. It shows the worldwide projected crude death rates per 100.000 by World Bank income groups for all ages, according to which the communicable diseases, perinatal and maternal conditions and nutritional deficiencies still have a tremendous impact on low income groups, whereas the rates are significantly lower in lower-middle, upper-middle and high income groups. This indicates that, despite unprecedented global wealth and technological process, health equity gaps exist and continue to grow. While some interventions and policies undoubtedly work, the reality shows that they manifestly fail to reach some groups of the world’s population. In addition, it is equally important to notice that health inequalities do not only exist between different countries but also within population groups of the same country.
- To come back to the question raised in the video: Does it really have to be like this? The WHO Commission on the Social Determinants of Health has stated that the vast majority of health inequalities between and within countries are avoidable, but where to start tackling them? A commitment to health necessarily implies a commitment to reducing social inequalities, given the strong and pervasive relationship between the two. It is insufficient to only buffer the health-damaging effects of poverty and marginalization to achieve equal opportunities for health. A correction of the fundamental causes of the systematic disparities in health is essential. Some of the major determinants of health at stake are education, living standards, and environmental exposures. These determinants form an interdependent chain of influences upon each other and have the power to determine people's chances in life and health at the same time. Pre-conditions that are unequal in the first place consequentially lead to social inequalities that intensify over the life-course. As such, many health problems of disadvantaged population groups have their origins in the living conditions experienced during childhood and adolescence between 13-25 years of age and accumulate over time, which suggests to focus on youth as the primary target group to prevent adverse health outcomes from developing at all
- Adolescents have a clear tendency to engage in risky, health-damaging behaviours, that can have tremendous effects on their health outcomes in later adult life by nature already, including smoking, alcohol or drug abuse. (Click for pictures) They are especially at risk to suffer the adverse consequences of socio-economic disadvantages because this tendency was found to be additionally driven by a lower socio-economic status, which raises serious concerns in times of global economic crisis and rising youth unemployment rates. By the way: The graph in the background shows the increasing trend of youth unemployment rates in Europe from 2000-2013 (EU-27 and EA-17, seasonally adjusted) (Example if requested) To give an example, the European Commission (2012) has reported that with over 25 per cent, more young Europeans aged 15-24 are smoking on a regular basis as compared to the total population Cigarette smoking, like alcohol use, has been found to be associated with stressful socioeconomic conditions such as unemployment. There is some evidence that job loss is a risk factor for increasing smoking and that these effects may be long lasting (Source: http://www.biomedcentral.com/1471-2458/9/77/#B27).
- However, currently, a great share of the 15 and 29 years old Europeans on which the immediate future of Europe depends is faced with a lack of opportunities to raise their socio-economic position. Educational opportunities are understood as key factors in fostering individual empowerment and also to increase the capability of making informed decisions about health-related behaviours. Consequently, an effective approach to reduce socio-economic differences reflected in income, education and social connectedness should employ this knowledge as a tool. Successful interventions targeting the health gradient should focus on enhancing disadvantaged people’s chances for occupational advancement in order to improve their living conditions, as well as their health status. Increasing job availability and providing training or re-training to every young person within a reasonable time period after becoming unemployed or leaving formal education would help this process. Furthermore, it is important to ensure equal opportunities for young people in the labour market as a countermeasure to the growing levels of youth unemployment. This would give young people the chance to move up the social ladder by improving their socio-economic status, which was found to be associated with the tendency to report higher levels of life satisfaction and this, in turn, positively affects health. (Example: The European Union has taken action in the form of a Youth Guarantee that focuses on enhancing disadvantaged people’s chances for occupational advancement in order to improve their living conditions, as well as their health status. The Guarantee requires governments, regional authorities and public employment services to commit to offer a high quality job, training or re-training to every young person within a reasonable time period of 4 months after they become unemployed or leave formal education)
- We have seen how health status depends on the socio-economic conditions and we have seen why it makes most sense to focus on young people whose health behaviours should be brought on track in order to prevent many health problems in later life before they occur. To reduce health inequalities, it is insufficient to only buffer the health-damaging effects of poverty and marginalization In addition, correction of the fundamental causes of the systematic disparities in health is essential to achieve equal opportunities for health on the long-term. The life course perspective suggests to focus on preserving young people‘s health, in order to prevent many health problems in later life before they occur. Their health status is highly influenced by the socio-economic determinants (e.g. income) Thus, raising the socio-economic status of young people by counteracting youth unemployment (as it is the aim of theYouth Guarantee) is a promising approach to improve health outcomes among disadvantaged population groups and to reduce social inequalities in health.