Advisable Guidelines for Reducing Inequalities in Health

Socio-economic inequalities in health are a major challenge for health policy, not only because most of these inequalities can be considered unfair, but also because reducing the burden of health problems in disadvantaged groups offers a great potential for improving the average health status of the population as a whole. However, it seems that public health professionals are not enough aware of inequalities in health or they are not trained enough to handle them. It can be partially explained by the fact, that there is neither postgraduate education nor training in the field of socioeconomic inequalities for public health personnel. This module consists of four workshops, one workshop for every learning objective (workshop 1 - Assessment process of the availability of data, Workshop 2 - Existing data resources, Workshop 3 - Methodological guidelines, Workshop 4 - Formulating a public health policy

Oral Health and Oral Health Promotion

World Health Organization recognizes oral health as an important component of general health, and furthermore, oral health is essential for well-being. The majority of oral diseases is related to lifestyles and reducing these mostly chronic diseases relies much on changing behaviour. Changes for the better in behaviour can and do occur, but require commitment and expertise within health promotion. Customs, practices and lifestyle issues play a role in the oral health of a community and should be considered when national policies and programmes are being formulated. Oral health and general health share common factors related to diet, the use of tobacco, and the excessive consumption of alcohol and the solutions to control oral disease are to be found through shared approaches with integrated chronic disease prevention. Oral health promotion is an integral part of general health promotion. Together, oral health promotion and general health promotion address the inseparable issues of systemic and oral diseases, general and oral hygiene, general and oral health care attitudes, and general health services as well as dental services. Thus, oral health promotion and oral disease prevention should embrace what is termed ‘the common risk factor approach’; leading to the integration of oral health promotion into broader health promotion. Each country should produce a thorough description of its population in terms of demographics, socioeconomics, health, diet, nutrition, and cultural factors affecting oral health knowledge, attitudes, beliefs, and behaviours. The case of Slovenia is used as an example

Advisable Guidelines for Reducing Inequalities in Health

Socio-economic inequalities in health are a major challenge for health policy, not only because most of these inequalities can be considered unfair, but also because reducing the burden of health problems in disadvantaged groups offers a great potential for improving the average health status of the population as a whole. However, it seems that public health professionals are not enough aware of inequalities in health or they are not trained enough to handle them. It can be partially explained by the fact, that there is neither postgraduate education nor training in the field of socioeconomic inequalities for public health personnel. This module consists of four workshops, one workshop for every learning objective (workshop 1 - Assessment process of the availability of data, Workshop 2 - Existing data resources, Workshop 3 - Methodological guidelines, Workshop 4 - Formulating a public health policy

Oral Health and Oral Health Promotion

World Health Organization recognizes oral health as an important component of general health, and furthermore, oral health is essential for well-being. The majority of oral diseases is related to lifestyles and reducing these mostly chronic diseases relies much on changing behaviour. Changes for the better in behaviour can and do occur, but require commitment and expertise within health promotion. Customs, practices and lifestyle issues play a role in the oral health of a community and should be considered when national policies and programmes are being formulated. Oral health and general health share common factors related to diet, the use of tobacco, and the excessive consumption of alcohol and the solutions to control oral disease are to be found through shared approaches with integrated chronic disease prevention. Oral health promotion is an integral part of general health promotion. Together, oral health promotion and general health promotion address the inseparable issues of systemic and oral diseases, general and oral hygiene, general and oral health care attitudes, and general health services as well as dental services. Thus, oral health promotion and oral disease prevention should embrace what is termed ‘the common risk factor approach’; leading to the integration of oral health promotion into broader health promotion. Each country should produce a thorough description of its population in terms of demographics, socioeconomics, health, diet, nutrition, and cultural factors affecting oral health knowledge, attitudes, beliefs, and behaviours. The case of Slovenia is used as an example

Advisable Guidelines for Reducing Inequalities in Health

Socio-economic inequalities in health are a major challenge for health policy, not only because most of these inequalities can be considered unfair, but also because reducing the burden of health problems in disadvantaged groups offers a great potential for improving the average health status of the population as a whole. However, it seems that public health professionals are not enough aware of inequalities in health or they are not trained enough to handle them. It can be partially explained by the fact, that there is neither postgraduate education nor training in the field of socioeconomic inequalities for public health personnel. This module consists of four workshops, one workshop for every learning objective (workshop 1 - Assessment process of the availability of data, Workshop 2 - Existing data resources, Workshop 3 - Methodological guidelines, Workshop 4 - Formulating a public health policy

Premature Mortality in Slovenia in Relation to Selected Biological, Socioeconomic, and Geographical Determinants

Aim: To determine biological (sex and age), socioeconomic (marital status, education, and mother tongue) and geographical (region) factors connected with causes of death and lifespan (age at death, years-of-potential-life-lost, and mortality rate) in Slovenia in the 1990s. Methods: In this population-based cross-sectional study, we analyzed all deaths in the 25-64 age group (N = 14 816) in Slovenia in 1992, 1995, and 1998. Causes of death, classified into groups according to the 10th revision of International Classification of Diseases, were linked to the data on the deceased from the 1991 Census. Stratified contingency-table analyses were performed. Years-of-potential-life-lost (YPLL) were calculated on the basis of population life-tables stratified by region and linearly modeled by the characteristics of the deceased. Poisson regression was applied to test the differences in mortality rate. Results: Across all socioeconomic strata, men died at younger age than women (index of excess mortality in men exceeded 200 for all studied years) and from different prevailing causes (injuries in men aged 35 years). For men, higher education was associated with fewer deaths from digestive and respiratory system diseases. The least educated women died relatively often from circulatory diseases, but rarely from neoplasms. Single people died from neoplasms less often. Marriage in comparison with divorce reduced the mortality rate by 1.9-fold in both men and women (P<0.001). Mortality rate in both men and women decreased with increasing education level (P<0.001). Mortality rate of ethnic Slovenians was half the mortality rate of ethnic minority members and immigrants (P<0.001). Analysis of YPLL revealed limited and nonlinear impact of education level on premature mortality. The share of neoplasms was the highest in the cluster of socioeconomically prosperous regions, whereas the share of circulatory diseases was increased in poorer regions. Significant differences were found between individual regions in age at death and mortality rate, and the differences decreased over the studied period. Conclusion: These data may aid in understanding the nature, prevalence and consequences of mortality as related to socioeconomic inequalities, and thus serve as a basis for setting health and social policy goals and planning health measures

Premature Mortality in Slovenia in Relation to Selected Biological, Socioeconomic, and Geographical Determinants

Aim To determine biological (sex and age), socioeconomic (marital status, edu­ cation, and mother tongue) and geographical (region) factors connected with causes of death and lifespan (age at death, years-of-potential-life-lost, and mor­ tality rate) in Slovenia in the 1990s. Methods In this population -based cross-sectional study, we analyzed all deaths in the 25-64 age group (N = 14 816) in Slovenia in 1992, 1995, and 1998. Causes of death, classified into groups according to the 10th revision oflnternational Classification of Diseases, were linked to the data on the deceased from the 1991 Census. Stratified contingency-table analyses were performed . Years-of-poten ­ tial-life-lost (YPLL) were calculated on the basis of population life-tables strati­ fied by region and linearly modeled by the characteristics of the deceased . Pois­ son regression was applied to test the differences in mortality rate. Results Across all socioeconomic strata, men died at younger age than women (index of excess mortality in men exceeded 200 for all studied years) and from different prevailing causes (injuries in men aged 35 years). For men, higher education was associated with fewer deaths from digestive and respiratory system diseases.The least educated women died relatively often from circulatory diseases, but rarely from neoplasms . Single peo­ ple died from neoplasms less often. Marriage in comparison with divorce reduced the mortality rate by 1.9-fold in both men and women (P<0.001). Mortality rate in both men and women decreased with increasing education level (P<0.001) . Mortality rate of ethnic Slovenians was half the mortality rate of ethnic minor­ ity members and immigrants (P<0.001).Analysis ofYPLL revealed limited and nonlinear impact of education level on premature mortality. The share of neo­ plasms was the highest in the cluster of socioeconomically prosperous regions, whereas the share of circulatory diseases was increased in poorer regions. Sig­ nificant differences were found between individual regions in age at death and mortality rate, and the differences decreased over the studied period . Conclusion These data may aid in understanding the nature, prevalence and consequences of mortality as related to socioeconomic inequalities, and thus serve as a basis for setting health and social policy goals and planning health measures

The contribution of educational inequalities to lifespan variation

Peer reviewe

Educational expansion and inequalities in mortality-A fixed-effects analysis using longitudinal data from 18 European populations

Objective The aim of this paper is to empirically evaluate whether widening educational inequalities in mortality are related to the substantive shifts that have occurred in the educational distribution. Materials and methods Data on education and mortality from 18 European populations across several decades were collected and harmonized as part of the Demetriq project. Using a fixed-effects approach to account for time trends and national variation in mortality, we formally test whether the magnitude of relative inequalities in mortality by education is associated with the gender and age-group specific proportion of high and low educated respectively. Results The results suggest that in populations with larger proportions of high educated and smaller proportions of low educated, the excess mortality among intermediate and low educated is larger, all other things being equal. Conclusion We conclude that the widening educational inequalities in mortality being observed in recent decades may in part be attributed to educational expansion.Peer reviewe

Changes in mortality inequalities over two decades : register based study of European countries

OBJECTIVE:To determine whether government efforts in reducing inequalities in health in European countries have actually made a difference to mortality inequalities by socioeconomic group. DESIGN:Register based study. DATA SOURCE:Mortality data by level of education and occupational class in the period 1990-2010, usually collected in a census linked longitudinal study design. We compared changes in mortality between the lowest and highest socioeconomic groups, and calculated their effect on absolute and relative inequalities in mortality (measured as rate differences and rate ratios, respectively). SETTING:All European countries for which data on socioeconomic inequalities in mortality were available for the approximate period between years 1990 and 2010. These included Finland, Norway, Sweden, Scotland, England and Wales (data applied to both together), France, Switzerland, Spain (Barcelona), Italy (Turin), Slovenia, and Lithuania. RESULTS:Substantial mortality declines occurred in lower socioeconomic groups in most European countries covered by this study. Relative inequalities in mortality widened almost universally, because percentage declines were usually smaller in lower socioeconomic groups. However, as absolute declines were often smaller in higher socioeconomic groups, absolute inequalities narrowed by up to 35%, particularly among men. Narrowing was partly driven by ischaemic heart disease, smoking related causes, and causes amenable to medical intervention. Progress in reducing absolute inequalities was greatest in Spain (Barcelona), Scotland, England and Wales, and Italy (Turin), and absent in Finland and Norway. More detailed studies preferably using individual level data are necessary to identify the causes of these variations. CONCLUSIONS:Over the past two decades, trends in inequalities in mortality have been more favourable in most European countries than is commonly assumed. Absolute inequalities have decreased in several countries, probably more as a side effect of population wide behavioural changes and improvements in prevention and treatment, than as an effect of policies explicitly aimed at reducing health inequalities.Peer reviewe