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Latest & greatest articles for inequality
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Effect of exposure to natural environment on health inequalities: an observational population study. Studies have shown that exposure to the natural environment, or so-called green space, has an independent effect on health and health-related behaviours. We postulated that income-related inequality in health would be less pronounced in populations with greater exposure to green space, since access to such areas can modify pathways through which low socioeconomic position can lead to disease.We (...) stratified models to identify the nature of this variation.The association between income deprivation and mortality differed significantly across the groups of exposure to green space for mortality from all causes (p<0.0001) and circulatory disease (p=0.0212), but not from lung cancer or intentional self-harm. Health inequalities related to income deprivation in all-cause mortality and mortality from circulatory diseases were lower in populations living in the greenest areas. The incidence rate ratio
Addressing social determinants of health inequities: what can the state and civil society do? In this Health Policy article, we selected and reviewed evidence synthesised by nine knowledge networks established by WHO to support the Commission on the Social Determinants of Health. We have indicated the part that national governments and civil society can play in reducing health inequity. Government action can take three forms: (1) as provider or guarantor of human rights and essential services (...) and civil society can have important positive roles in addressing health inequity if political will exists.
Effect of financial incentives on inequalities in the delivery of primary clinical care in England: analysis of clinical activity indicators for the quality and outcomes framework. The quality and outcomes framework is a financial incentive scheme that remunerates general practices in the UK for their performance against a set of quality indicators. Incentive schemes can increase inequalities in the delivery of care if practices in affluent areas are more able to respond to the incentives than (...) are those in deprived areas. We examined the relation between socioeconomic inequalities and delivered quality of clinical care in the first 3 years of this scheme.We analysed data extracted automatically from clinical computing systems for 7637 general practices in England, data from the UK census, and data for characteristics of practices and patients from the 2006 general medical statistics database. Practices were grouped into equal-sized quintiles on the basis of area deprivation in their locality
Socioeconomic inequalities in health in 22 European countries. Comparisons among countries can help to identify opportunities for the reduction of inequalities in health. We compared the magnitude of inequalities in mortality and self-assessed health among 22 countries in all parts of Europe.We obtained data on mortality according to education level and occupational class from census-based mortality studies. Deaths were classified according to cause, including common causes (...) , such as cardiovascular disease and cancer; causes related to smoking; causes related to alcohol use; and causes amenable to medical intervention, such as tuberculosis and hypertension. Data on self-assessed health, smoking, and obesity according to education and income were obtained from health or multipurpose surveys. For each country, the association between socioeconomic status and health outcomes was measured with the use of regression-based inequality indexes.In almost all countries, the rates of death
The contribution of job characteristics to socioeconomic inequalities in incidence of myocardial infarction The current study estimated the contribution of job characteristics to socioeconomic inequalities in incidence of myocardial infarction (MI) during a 12-year follow-up period. Data were from the working population (aged 25-64 years) in the Netherlands longitudinal GLOBE study (N=5757). Self-reported information was available from baseline measurement (in 1991) for education, occupation
Inequity of access to investigation and effect on clinical outcomes: prognostic study of coronary angiography for suspected stable angina pectoris. To determine whether coronary angiography for suspected stable angina pectoris is underused in older patients, women, south Asian patients, and those from socioeconomically deprived areas, and, if it is, whether this is associated with higher coronary event rates.Multicentre cohort with five year follow-up.Six ambulatory care clinics in England.1375
Inequalities in mortality during and after restructuring of the New Zealand economy: repeated cohort studies. To determine whether disparities between income and mortality changed during a period of major structural and macroeconomic reform and to estimate the changing contribution of different diseases to these disparities.Repeated cohort studies.1981, 1986, 1991, 1996, and 2001 censuses linked to mortality data. Population Total New Zealand population, ages 1-74 years.Mortality rates (...) standardised for age and ethnicity were calculated for each census cohort by level of household income. Standardised rate differences and rate ratios, and slope and relative indices of inequality (SII and RII), were calculated to measure disparities on both absolute and relative scales.All cause mortality rates declined over the 25 year study period in all groups stratified by sex, age, and income, except for 25-44 year olds of both sexes on low incomes among whom there was little change. In all age groups
Population tobacco control interventions and their effects on social inequalities in smoking Population tobacco control interventions and their effects on social inequalities in smoking Population tobacco control interventions and their effects on social inequalities in smoking Centre for Reviews and Dissemination CRD summary This well-conducted review assessed the effects of population level tobacco control interventions on smoking related health inequalities. The authors concluded (...) that these interventions have the potential to reduce health inequalities for disadvantaged groups. A need for further rigorous research in a number of specific areas was identified. Given the level of evidence presented, the authors' conclusions are likely to be reliable. Authors' objectives To evaluate the effects of population tobacco control interventions on social inequalities of smoking. Searching BIOSIS Previews, CINAHL, Cochrane library, EMBASE, EconLit, HMIC, HTA, ISI Technology Assessment database, MEDLINE
Population tobacco control interventions and their effects on social inequalities in smoking Population tobacco control interventions and their effects on social inequalities in smoking Population tobacco control interventions and their effects on social inequalities in smoking Fayter D, Main C, Misso K, Ogilvie D, Petticrew M, Sowden A, Stirk L, Thomas S, Whitehead M, Worthy G Record Status This is a bibliographic record of a published health technology assessment from a member of INAHTA (...) . No evaluation of the quality of this assessment has been made for the HTA database. Citation Fayter D, Main C, Misso K, Ogilvie D, Petticrew M, Sowden A, Stirk L, Thomas S, Whitehead M, Worthy G. Population tobacco control interventions and their effects on social inequalities in smoking. York: University of York. CRD Report 39. 2008 Authors' objectives The overall aims of this project were: To synthesise the best available evidence about the differential effects of population tobacco control interventions
Child wellbeing and income inequality in rich societies: ecological cross sectional study. To examine associations between child wellbeing and material living standards (average income), the scale of differentiation in social status (income inequality), and social exclusion (children in relative poverty) in rich developed societies.Ecological, cross sectional studies.Cross national comparisons of 23 rich countries; cross state comparisons within the United States.Children and young people.The (...) Unicef index of child wellbeing and its components for rich countries; eight comparable measures for the US states and District of Columbia (teenage births, juvenile homicides, infant mortality, low birth weight, educational performance, dropping out of high school, overweight, mental health problems).The overall index of child wellbeing was negatively correlated with income inequality (r=-0.64, P=0.001) and percentage of children in relative poverty (r=-0.67, P=0.001) but not with average income (r
The global impact of income inequality on health by age: an observational study. To explore whether the apparent impact of income inequality on health, which has been shown for wealthier nations, is replicated worldwide, and whether the impact varies by age.Observational study.126 countries of the world for which complete data on income inequality and mortality by age and sex were available around the year 2002 (including 94.4% of world human population).Data on mortality were from the World (...) Health Organization and income data were taken from the annual reports of the United Nations Development Programme.Mortality in 5-year age bands for each sex by income inequality and income level.At ages 15-29 and 25-39 variations in income inequality seem more closely correlated with mortality worldwide than do variations in material wealth. This relation is especially strong among the poorest countries in Africa. Mortality is higher for a given level of overall income in more unequal nations.Income
Resources for mental health: scarcity, inequity, and inefficiency. Resources for mental health include policy and infrastructure within countries, mental health services, community resources, human resources, and funding. We discuss here the general availability of these resources, especially in low-income and middle-income countries. Government spending on mental health in most of the relevant countries is far lower than is needed, based on the proportionate burden of mental disorders (...) inefficiencies in financing mechanisms and interventions, and an overconcentration of resources in large institutions. Scarcity of available resources, inequities in their distribution, and inefficiencies in their use pose the three main obstacles to better mental health, especially in low-income and middle-income countries.
Social inequalities in self reported health in early old age: follow-up of prospective cohort study. To describe differences in trajectories of self reported health in an ageing cohort according to occupational grade.Prospective cohort study of office based British civil servants (1985-2004).10 308 men and women aged 35-55 at baseline, employed in 20 London civil service departments (the Whitehall II study); follow-up was an average of 18 years.Physical component and mental component scores (...) was only 4.5 years. Although mental health improved with age, the rate of improvement is slower for men and women in the lower grades.Social inequalities in self reported health increase in early old age. People from lower occupational grades age faster in terms of a quicker deterioration in physical health compared with people from higher grades. This widening gap suggests that health inequalities will become an increasingly important public health issue, especially as the population ages.
Reductions in child mortality levels and inequalities in Thailand: analysis of two censuses. Thailand's progress in reducing the under-five mortality rate (U5MR) puts the country on track to achieve the fourth Millennium Development Goal (MDG). Whether this success has been accompanied by a widening or narrowing of the child mortality gap between the poorest and richest populations is unknown. We aimed to measure changes in child-mortality inequalities by household-level socioeconomic strata (...) of the Thai population between 1990 and 2000.We measured changes in the distribution of the U5MR by economic strata using data from the 1990 and 2000 censuses. Economic status was measured using household assets and characteristics. The U5MR was estimated using the Trussell version of the Brass indirect method.Average household economic status improved and inequalities declined between the two censuses. There were substantially larger reductions in U5MR in the poorer segments of the population. Excess
Tackling inequalities through the social determinants of health: Building the evidence base 1 Petticrew M., 1 Bambra C., 2 Gibson M., 3 Sowden A., 4 Whitehead M., 5 Wright K. 4 1. Public and Environmental Health Research Unit, London School of Hygiene and Tropical Medicine 2. Centre for Public Policy & Health, Durham University 3. MRC Social and Public Health Sciences Unit, Glasgow 4. Centre for Reviews and Dissemination, University of York 5. Division of Public (...) . Conclusions 49 8. Dissemination/Outputs 54 Acknowledgements 54 References………………………………………………………….……………….56 Appendices………………………………………………………………………….57 3 Preface: What this study adds to knowledge We know already that there are few evaluations of “wider public health” interventions, such as policies which affect the social determinants of health and health inequalities. From this project we find some suggestive evidence that certain categories of intervention may impact positively on inequalities
Effect of insulating existing houses on health inequality: cluster randomised study in the community. To determine whether insulating existing houses increases indoor temperatures and improves occupants' health and wellbeing.Community based, cluster, single blinded randomised study.Seven low income communities in New Zealand.1350 households containing 4407 participants.Installation of a standard retrofit insulation package.Indoor temperature and relative humidity, energy consumption, self
Do area-based interventions to reduce health inequalities work: a systematic review of evidence Do area-based interventions to reduce health inequalities work: a systematic review of evidence Do area-based interventions to reduce health inequalities work: a systematic review of evidence O'Dwyer LA, Baum F, Kavanagh A, Macdougall C CRD summary This review assessed whether area-based interventions reduced health inequalities with the finding that there was some evidence that area-based (...) interventions reduced inequalities. The authors' conclusions are suitably cautious in reflecting the available evidence and their recommendations for further research are likely to be reliable. Authors' objectives To assess whether area-based interventions reduce health inequalities. Searching More than 20 electronic databases and selected websites were searched (dates not reported). Reference lists of retrieved studies were screened. National and international organisations and individuals were contacted
Reducing inequalities from injuries in Europe. Injuries cause 9% of deaths and 14% of ill health in the WHO European Region. This problem is neglected; injuries are often seen as part of everyday life. However, although western Europe has good safety levels, death and disability from injury are rising in eastern Europe. People in low-to-middle-income countries in the Region are 3.6 times more likely to die from injuries than those in high-income countries. Economic and political change have led (...) to unemployment, income inequalities, increased traffic, reduced restrictions on alcohol, and loss of social support. Risks such as movement of vulnerable populations and transfer of lifestyles and products between countries also need attention. In many countries, the public-health response has been inadequate, yet the cost is devastating to individuals and health-service budgets. More than half a million lives could be saved annually in the Region if recent knowledge could be used to prevent injuries
Social inequalities in male mortality, and in male mortality from smoking: indirect estimation from national death rates in England and Wales, Poland, and North America. There are substantial social inequalities in adult male mortality in many countries. Smoking is often more prevalent among men of lower social class, education, or income. The contribution of smoking to these social inequalities in mortality remains uncertain.The contribution of smoking to adult mortality in a population can (...) and bottom social strata involved differences in risks of being killed at age 35-69 years by smoking (England and Wales 4%vs 19%, USA 4%vs 15%, Canada 6%vs 13%, Poland 5%vs 22%: four-country mean 5%vs 17%, four-country mean absolute difference 12%). Smoking-attributed mortality accounted for nearly half of total male mortality in the lowest social stratum of each country.In these populations, most, but not all, of the substantial social inequalities in adult male mortality during the 1990s were due
What is the contribution of smoking and socioeconomic position to ethnic inequalities in mortality in New Zealand? Mortality rates for Māori are twice those for non-Māori in New Zealand. We have assessed the contribution of tobacco smoking and socioeconomic position to these inequalities in 45-74-year-old census respondents during 1981-84 and 1996-99 (2.3 and 2.7 million person-years, respectively).We used linked census and mortality cohort datasets with measures of socioeconomic position (...) . The corresponding reductions in men were 5% in 1996-99 and -1% in 1981-84. The apparent contribution of socioeconomic factors to mortality differences between Māori and non-Māori non-Pacific was greatest for men (39% in 1981-84 and 37% in 1996-99) and increased over time for women (from 23% in 1981-84 to 32% in 1996-99).Although small, the contribution of smoking to ethnic inequalities in mortality increased over time and might grow more during the next two decades if differences in smoking between ethnic