DISCRIMINATION – A THREAT TO PUBLIC HEALTH Final report – Health and Discrimination Project

Discrimination – a threat to public health is the final report of the “Health and Discrimination” (HD) project conducted jointly from 2004 to 2006 by the National Institute of Public Health (FHI), the Office of the Ombudsman against Ethnic Discrimination (DO), the Office of the Disability Ombudsman (HO) and the Office of the Ombudsman against Discrimination on grounds of Sexual Orientation (HomO). The principal aims of the HD project have been to develop methods for measuring health and discrimination, to shed light on the correlations between health and discrimination, to develop indicators for discrimination, and subsequently to disseminate the results at the national, regional and local levels. HD has employed reports of self-reported discrimination at the individual level to quantify the incidence of discrimination and clarify the correlation with health issues. Posing questions on experiences of discrimination in population surveys makes it possible to relate such experiences with other measures of health based on person experience. HD considers that self-reported discrimination is a good indicator for monitoring the development and prevalence of discrimination since the sum total of such experiences reveals structures in society related to gender, age, ethnic background, religion, disabilities and sexual orientation.http://www.fhi.s

Institutional trust and alcohol consumption in Sweden: The Swedish National Public Health Survey 2006

<p>Abstract</p> <p>Background</p> <p>Trust as a measure of social capital has been documented to be associated with health. Mediating factors for this association are not well investigated. Harmful alcohol consumption is believed to be one of the mediating factors. We hypothesized that low social capital defined as low institutional trust is associated with harmful alcohol consumption.</p> <p>Methods</p> <p>Data from the 2006 Swedish National Survey of Public Health were used for analyses. The total study population comprised a randomly selected representative sample of 26.305 men and 30.584 women aged 16–84 years. Harmful alcohol consumption was measured using a short version the Alcohol Use Disorders Identification Test (AUDIT), developed and recommended by the World Health Organisation. Low institutional trust was defined based on trust in ten main welfare institutions in Sweden.</p> <p>Results</p> <p>Independent of age, country of birth and socioeconomic circumstances, low institutional trust was associated with increased likelihood of harmful alcohol consumption (OR (men) = 1.52, 95% CI 1.34–1.70) and (OR (women) = 1.50, 95% CI 1.35–1.66). This association was marginally altered after adjustment for interpersonal trust.</p> <p>Conclusion</p> <p>Findings of the present study show that lack of trust in institutions is associated with increased likelihood of harmful alcohol consumption. We hope that findings in the present study will inspire similar studies in other contexts and contribute to more knowledge on the association between institutional trust and lifestyle patterns. This evidence may contribute to policies and strategies related to alcohol consumption.</p

Sociala determinanter för hälsa -en fråga om socialt eller ekonomiskt kapital

Bakgrund:Sociala och ekonomiska strukturer och förhållanden är viktiga determinanter för hälsa, men få tidigare studier har inkluderat både "sociala" och "ekonomiska" determinanter. Syfte: att analysera oberoende samband, och interaktioner, mellan lågt ekonomiskt kapital (ekonomiska svårigheter) och lågt socialt kapital på individnivå (socialt deltagande, interpersonell och institutionell tillit) i relation till olika hälsoutfall (självskattad hälsa, psykisk och fysisk ohälsa). Studien baseras på data från den nationella folkhälsoenkäten, år 2009 (N=51,414). Resultat: Multivariat logistisk regression visar att både ekonomiska svårigheter och lågt socialt kapital är signifikant associerade med dålig hälsa, med endast ett fåtal undantag. Interaktionseffekter mätta som SI (Synergy Index) observerades mellan ekonomiska svårigheter och socialt kapital, med SI som varierade från 1,4 till 2,3. Slutsatser: Både ekonomiskt och socialt kapital på individnivå har samband med ohälsa, både psykisk och fysisk. I kombination förefaller de dessutom bidra till ytterligare ökad ohälsa

Is cumulative exposure to economic hardships more hazardous to women's health than men's? A 16‐year follow‐up study of the Swedish Survey of Living Conditions

Background: There is currently a growing interest in the role of social structures, social conditions and social relationships in explaining patterns of population health, as well as the need to connect individual health outcomes to their socio-economic context. This thesis contributes to this young, but fast growing field by analyzing the role of social and economic conditions in determining health. Aim: To study the socioeconomic determinants of health by focusing on the relevance of economic and social capital. Methods: The thesis comprises four studies, three of which are based on cross-sectional data from the National Public Health Survey 2006 (N= 56,889) and 2009 (N= 51,414) (Study II, III and IV) and one based on longitudinal data from the Swedish Survey of Living Conditions (ULF) panel study from the years 1981–1997 (N= 3,780) (Study I). While Study I and II analyzed associations between measures of economic capital and health outcomes, Study III focused on associations between measures of social capital and health outcomes. Finally, in Study IV independent associations, and interactions, of a lack of economic capital and social capital on health outcomes were analyzed. Low economic capital (i.e. economic hardships) was measured by low household income and self-reported financial stress (inability to meet expenses and a lack of cash reserves). Social capital was measured on the individual level by social participation, interpersonal (horizontal) and institutional (vertical) trust. Health outcomes included self-rated health, psychological health (severe anxiety, GHQ-12, anti-depressant medication), physical health (musculoskeletal disorders) and health behaviors (harmful alcohol consumption). Results: In Study I, based on longitudinal data, a dose-response effect on women‟s health was observed with an increasing score of cumulative exposure to financial stress, but not for low income. The results for men were more inconclusive. Cumulative exposure to financial stress seemed to affect men‟s self-rated health, while exposure to low income seemed to affect men‟s psychological distress, and neither exposure to low income nor financial stress seemed to affect men‟s musculoskeletal disorders. In Study II, financial stress (but not low income) was significantly associated with both women‟s and men‟s mental health problems (all indicators). Additionally, a graded association was found between mental health problems and levels of economic hardships (as measured by a combined economic hardships measure capturing both self-reported financial stress and low income). In Study III, low social capital (as measured by institutional trust in ten main welfare institutions in Sweden) was associated with increased likelihood of harmful alcohol consumption. Furthermore, a graded association was found between harmful alcohol consumption and levels of institutional trust. In Study IV, a measure of economic hardships (including both self-reported financial stress and low income) and low social capital (i.e., low interpersonal and institutional/political trust and low social participation) were significantly associated with men‟s and women‟s poor health status, with only a few exceptions. Furthermore, statistically significant interaction effects measured as a synergy index were observed between economic hardships and all different types of social capital. Gender differences in health outcomes related to low economic and social capital were analyzed in all studies. However, only very small gender differences were revealed throughout the studies with the exception of Study I where financial stress was consistently associated with poor health outcomes for women, but not for men. Conclusions: This thesis adds to the scientific evidence that economic and social capital at the individual level are multifaceted concepts independently connected to poor health outcomes, both physical and mental. However, when combined they seem to be associated with a further increased magnitude of poorer health. Hence, the social and the economic determinants should not be considered as exclusive and separate in relation to health. Policy initiatives minimizing the extent to which individuals perceive themselves as excluded in several dimensions in society, e.g., by channeling resources at improving the economic conditions under which people live and encouraging social connectedness and social cohesion, are desirable

Social determinants of health - A question of social or economic capital? Interaction effects of socioeconomic factors on health outcomes

Social structures and socioeconomic patterns are the major determinants of population health. However, very few previous studies have simultaneously analysed the "social" and the "economic" indicators when addressing social determinants of health. We focus on the relevance of economic and social capital as health determinants by analysing various indicators. The aim of this paper was to analyse independent associations, and interactions, of lack of economic capital (economic hardships) and social capital (social participation, interpersonal and political/institutional trust) on various health outcomes. Data was derived from the 2009 Swedish National Survey of Public Health, based on a randomly selected representative sample of 23,153 men and 28,261 women aged 16-84 year, with a participation rate of 53.8%. Economic hardships were measured by a combined economic hardships measure including low household income, inability to meet expenses and lacking cash reserves. Social capital was measured by social participation, interpersonal (horizontal) trust and political (vertical/institutional trust) trust in parliament. Health outcomes included; (i) self-rated health, (i) psychological distress (GHQ-12) and (iii) musculoskeletal disorders. Results from multivariate logistic regression show that both measures of economic capital and low social capital were significantly associated with poor health status, with only a few exceptions. Significant interactive effects measured as synergy index were observed between economic hardships and all various types of social capital. The synergy indices ranged from 1.4 to 2.3. The present study adds to the evidence that both economic hardships and social capital contribute to a range of different health outcomes. Furthermore, when combined they potentiate the risk of poor health. (C) 2012 Elsevier Ltd. All rights reserved

What has trust in the health-care system got to do with psychological distress? Analyses from the national Swedish survey of public health

Mental health disorders are a rapidly growing public health problem. Despite the fact that lack of trust in the health-care system is considered to be an important determinant of health, there is scarcity of empirical evidence demonstrating its associations with health outcomes. This is the first study which aims to evaluate the association between trust in the health-care system and psychological distress. Cross-sectional study. The association between trust in the health-care system and psychological distress was analysed with multiple logistic regression analysis adjusting for other factors. A randomly selected representative sample of women and men aged 16-84 years from the Swedish population who responded to the 2006 Swedish National Survey of Public Health. A total of 26 305 men and 30 584 women participated in the study. None. The main outcome measure was psychological distress measured by the General Health Questionnaire. Very low trust in health-care services was associated with an increased risk for psychological distress among men (odds ratio = 1.59, 95% confidence intervals 1.25-2.02) and among women (odds ratio = 1.83, 95% confidence intervals 1.47-2.27) after controlling for age, country of birth, socioeconomic circumstances, long-term illness and interpersonal trust. Our results suggest that health-care system mistrust is associated with an increased likelihood of psychological distress. Although causal relationships cannot be established, patient mistrust of health-care providers may have detrimental implications on health. Public health policies should include strategies aimed at increasing access to health-care services, where trust plays a substantial role