Socioeconomic inequalities
in Health in 22 European Countries
Johan P. Mackenbach...
The article by Mackenbach et al. link documents the extraordinary pervasiveness of socioeconomic inequalities in health as well as the varying magnitude of risks among countries. The compilation of data from western and eastern European countries on mortality, morbidity, smoking, and obesity in relation to socioeconomic status allows the authors to provide the broadest international portrait to date of the association between socioeconomic status and health. The link between socioeconomic disadvantage and poor health has been observed repeatedly, but until now we have lacked data that would permit us to make consistent comparisons of these linkages across many countries. Comparisons among countries invite us to examine the features that are shared from country to country that contribute to the overall patterns of disease, as well as to explore the unique features of a nation that contribute to variability in the magnitude of the risks across countries. Mackenbach et al. provide us with a comparative inter-country study that harmonizes data and analytic approaches, allowing reasonable comparisons. The results are provocative for what they tell us, as well as for what they do not tell us.
First, the results show that in all 16 countries with mortality data, socioeconomically disadvantaged men and women had higher overall mortality rates than did persons with a higher socioeconomic status. The universal link between social class and mortality seems remarkable, given the differing disease prevalence and risk factors in these countries. Moreover, relationships between class and mortality are consistent for almost every cause of death, with only a few exceptions, notably certain cancers.
Second, the study clearly shows that the magnitude of risks varies substantially across countries. The ratio in overall mortality rates between those at opposite ends of the socioeconomic spectrum ranged from just over 1.0 (women in Basque country) to nearly 5.0 (men in the Czech Republic). In many instances, the patterns of variation are not easy to explain. For example, the risk of death according to class in Nordic countries is greater than that in southern Europe, despite welfare policies in the north, particularly for the most disadvantaged persons, that are aimed at reducing socioeconomic differences. In the United States, socioeconomic conditions are usually most strongly related to the risk of cardiovascular disease, yet in countries such as France and Italy, socioeconomic conditions are more strongly related to the risk of cancer than to the risk of cardiovascular disease. Socioeconomic status as it relates to differences in rates of smoking also does not appear to explain differences in mortality from causes generally attributable to smoking (e.g., chronic obstructive pulmonary disease and various cancers). For example, in Hungary, differences in rates of smoking according to socioeconomic status are very small, whereas differences in mortality according to socioeconomic status for conditions related to smoking are large.
Finally, the study shows that among men and women in lower socioeconomic positions, the proportion of excess deaths related to diseases that are potentially amenable to medical intervention was strikingly low. This proportion was somewhat higher in eastern European countries, but no more than 10% in any country. Although one could argue that the list of medical conditions identified as potentially amenable to medical intervention was too restricted, the findings are consistent with those of previous studies. In the United States we have very few examples of health care interventions that have reduced disparities in health care, not to mention health. (...) link
Johan P. Mackenbach, Ph.D., Irina Stirbu, M.Sc., Albert-Jan R. Roskam, M.Sc., Maartje M. Schaap, M.Sc., Gwenn Menvielle, Ph.D., Mall Leinsalu, Ph.D., Anton E. Kunst, Ph.D., for the European Union Working Group on Socioeconomic Inequalities in Health, NEJM , n.º 23 05.06.08
Johan P. Mackenbach...
The article by Mackenbach et al. link documents the extraordinary pervasiveness of socioeconomic inequalities in health as well as the varying magnitude of risks among countries. The compilation of data from western and eastern European countries on mortality, morbidity, smoking, and obesity in relation to socioeconomic status allows the authors to provide the broadest international portrait to date of the association between socioeconomic status and health. The link between socioeconomic disadvantage and poor health has been observed repeatedly, but until now we have lacked data that would permit us to make consistent comparisons of these linkages across many countries. Comparisons among countries invite us to examine the features that are shared from country to country that contribute to the overall patterns of disease, as well as to explore the unique features of a nation that contribute to variability in the magnitude of the risks across countries. Mackenbach et al. provide us with a comparative inter-country study that harmonizes data and analytic approaches, allowing reasonable comparisons. The results are provocative for what they tell us, as well as for what they do not tell us.First, the results show that in all 16 countries with mortality data, socioeconomically disadvantaged men and women had higher overall mortality rates than did persons with a higher socioeconomic status. The universal link between social class and mortality seems remarkable, given the differing disease prevalence and risk factors in these countries. Moreover, relationships between class and mortality are consistent for almost every cause of death, with only a few exceptions, notably certain cancers.
Second, the study clearly shows that the magnitude of risks varies substantially across countries. The ratio in overall mortality rates between those at opposite ends of the socioeconomic spectrum ranged from just over 1.0 (women in Basque country) to nearly 5.0 (men in the Czech Republic). In many instances, the patterns of variation are not easy to explain. For example, the risk of death according to class in Nordic countries is greater than that in southern Europe, despite welfare policies in the north, particularly for the most disadvantaged persons, that are aimed at reducing socioeconomic differences. In the United States, socioeconomic conditions are usually most strongly related to the risk of cardiovascular disease, yet in countries such as France and Italy, socioeconomic conditions are more strongly related to the risk of cancer than to the risk of cardiovascular disease. Socioeconomic status as it relates to differences in rates of smoking also does not appear to explain differences in mortality from causes generally attributable to smoking (e.g., chronic obstructive pulmonary disease and various cancers). For example, in Hungary, differences in rates of smoking according to socioeconomic status are very small, whereas differences in mortality according to socioeconomic status for conditions related to smoking are large.
Finally, the study shows that among men and women in lower socioeconomic positions, the proportion of excess deaths related to diseases that are potentially amenable to medical intervention was strikingly low. This proportion was somewhat higher in eastern European countries, but no more than 10% in any country. Although one could argue that the list of medical conditions identified as potentially amenable to medical intervention was too restricted, the findings are consistent with those of previous studies. In the United States we have very few examples of health care interventions that have reduced disparities in health care, not to mention health. (...) link
Johan P. Mackenbach, Ph.D., Irina Stirbu, M.Sc., Albert-Jan R. Roskam, M.Sc., Maartje M. Schaap, M.Sc., Gwenn Menvielle, Ph.D., Mall Leinsalu, Ph.D., Anton E. Kunst, Ph.D., for the European Union Working Group on Socioeconomic Inequalities in Health, NEJM , n.º 23 05.06.08
Etiquetas: NEJM
1 Comments:
SOCIOECONOMICS INEQUALITIES...
- Near Problems!
São interessantes as voltas que o Mundo dá…
Durante anos lutou-se contra a ideologia comunista que defendia uma sociedade igualitária, diga-se de passagem, sem nunca o conseguir.
Hoje, o liberalismo traz-nos gritantes desigualdades sociais. Que nos preocupam e, mais do que isso, nos envergonham.
Portugal é colocado no fim da tabela do Eurostat (2004), a decalage é pouco relevante, porque a sensação que perpassa é que, neste campo, a evolução tem sido – apesar das políticas sociais postas em prática – pouco significativa.
Dá a impressão que caímos num atoleiro. Começamos por combater o analfabetismo muito tarde, mantemos altos níveis de iletracia, não fizemos a revolução industrial a tempo e com todos estes condicionalismos não estaremos na fila da frente na revolução tecnológica, apesar das Novas Oportunidades, tão badaladas pelo Governo.
Entramos num infindável ciclo de estagnação económica (classificação de favor) e daí não arrancamos.
Entramos na “fugas semânticas”. Na realidade, os números não mostram só desigualdades com os outros 25 Países europeus.
Mostram um facto mais duro e mais contundente:
- temos 2 milhões de pobres.
A pobreza é, sejamos claros, uma terrível opressão humana.
E o Homem oprimido, ao longo da história, sempre teve a mesma atitude – revoltou-se, resistiu.
Por isso, considero que a jornada de ontem no Teatro da Trindade, é o fermento para acelerarmos o encarar deste vergonhoso problema. Manuel Alegre, tão criticado pela Direita do PS – Vitalino Canas, José Lello, p. exº. esteve bem em associar a sua voz a este combate. Já o “Kérensky” António Vitorino ficou cheio de dúvidas e bóia nas meias tintas (falará na TV na próxima 2º. Feira).
Sócrates ficou em casa. Já fez muito (julgará na sua arrogância) e os 2 milhões não têm nada a ver com ele. São a consequência dos governos anteriores.
O erro de Sócrates é pensar muito restritivamente na área social. Sob a pressão de Manuel Alegre que já encabeçava uma petição a favor do SNS, mudou o Ministro da Saúde.
Pensa que isso basta!
Mas, na verdade, não chega e os próximos tempos o dirão.
Enviar um comentário
<< Home