Helse og helseulikheter i politiske regimer : En studie basert på European Social Survey

Flere studier har undersøkt forbindelsen mellom politisk ideologi og helse. Disse studiene kan kategoriseres som individstudier og kontekststudier. Individstudiene har generelt kommet fram til at de som har en høyreorientert ideologi, i gjennomsnitt har bedre helse sammenliknet  med de som har en venstreorientert ideologi. Kontekststudiene har vist at land som styres av mer progressive regimer, i gjennomsnitt har bedre helseforhold sammenliknet med de som styres av mer konservative regimer. Det har blitt argumentert for å inkludere både individnivået og kontekstnivået i samme studie. Hovedformålet med masteroppgaven har vært å undersøke hvordan politisk ideologi påvirker helseforskjeller i og mellom politiske regimer, og hvor stor betydning utdanning har for disse forskjellene. Dataene i denne undersøkelsen er basert på modul 4 og modul 5 av European Social Survey (ESS). Helsevariabelen beskriver folks generelle helsetilstand, og er basert på egenrapportering. Det er benyttet logistisk regresjon, hvor den opprinnelige helsevariabelen har blitt dikotomisert til "veldig god eller god" helse og "mindre enn god" helse. I tillegg er det gjennomført deskriptive analyser som beskriver helseforhold i de enkelte landene og regimene. Utvalget består av 90 125 respondenter i 27 europeiske land, som er 25 år og eldre. Politisk ideologi har på individnivå blitt målt gjennom egenplassering på en venstre/høyreskala, som videre har blitt omkodet til en kategorisk variabel for venstre, sentrum og høyre. På aggregert nivå har politisk ideologi blitt operasjonalisert ved å gruppere de europeiske landene inn i seks politiske regimer med utgangspunkt i dominerende politisk tradisjon de siste tiårene. I tillegg til sosialdemokratisk, kristendemokratisk og liberalt regime omfattes også Sør-Europa, Øst-Europa og tidligere Sovjetrepublikker. Utdanning ble målt gjennom fullført utdanningsnivå, inndelt i de tre kategoriene grunnskole, videregående skole og høyskole/universitet. Helse og helseforskjeller varierte mellom politiske regimer i Europa. Prevalens av dårlig helse var størst i tidligere Sovjetrepublikker og minst i det liberale regimet. De relative helseforskjellene mellom politiske grupperinger var størst blant menn i det sosialdemokratiske regimet, mens disse forskjellene var minst i det liberale regimet. Utdanning hadde ikke nevneverdig betydning for helseforskjellene mellom de politiske grupperingene i de politiske regimene. Helseforskjellene som eksisterer mellom de europeiske landene, kan både forklares på individuelt og kontekstuelt nivå. På et individuelt nivå eksisterer det helseforskjeller mellom politiske grupperinger. Utdanning hadde liten betydning for disse helseforskjellene, og kan ikke regnes som et mål på politisk ideologi. Det indikerer at politisk ideologi har god forklaringskraft som selvstendig variabel. Videre studier bør undersøke hvilke mekanismer som leder fra politisk ideologi til helseatferd

Inequalities in Health Care Utilization in Europe

Equal access to health care is an important principle in European welfare states. However, previous studies have shown that health care utilization is related to socioeconomic position, such as income and education. Social inequalities in health care utilization may translate into social inequalities in morbidity and mortality. It is therefore important to gain knowledge about how health care is used by different social groups in different welfare states. In addition, such knowledge may provide greater understandings of which aspects of welfare state institutions are most likely to influence health and health inequalities. This study has two overarching aims. The first aim is to identify barriers for health care use, both at the individual and institutional level. The second aim is to identify the role of health care as a determinant of health and health inequalities between countries with different health care systems. Based on the seventh round of the European Social Survey (ESS), Papers I – IV address health care utilization in 21 countries. Four indicators are examined in more detail: unmet need for health care, general practitioner (GP) and specialists use, informal caregiving and use of alternative health care. Paper V uses mortality data for 21 European countries/regions. This paper examine mortality amenable to health care (also known as amenable mortality), defined as causes of death which should not occur in the presence of available health care. The findings showed significant socioeconomic inequalities in health care utilization. Financial strain represented a major determinant for all types of unmet health care needs. This may suggest that higher income groups are more able to bypass waiting lists. For GP and specialist utilization, higher socioeconomic groups were more likely to use specialists. Here, education and occupation appeared to be particularly important factors. Informal caregiving was more common among the unemployed and persons with low self-reported health. Use of alternative health care, on the other hand, was more common among higher socioeconomic groups, such as those with higher education, those with less financial strain and among the employed. Socioeconomic inequalities in health care utilization varied between welfare regimes. In particular, informal caregiving (providing care for more than 10 hours a week) was high in the Southern European regime. Moreover, there were inequalities in amenable mortality between different health care systems. However, these inequalities were observed in all European countries, implying that there is not any health care system that can fully prevent such inequalities. In addition, a significant association was found between inequalities in intensive informal caregiving and inequalities in amenable mortality

The use of complementary and alternative medicine (CAM) in Europe

Background While the use of complementary and alternative medicine (CAM) has become increasingly popular in western societies, we do not understand why CAM use is more frequent in some countries than in others. The aim of this article is to examine the determinants of CAM use at the individual and country-level. Methods Logistic multilevel regressions were applied analyzing data from 33,371 respondents in 21 European countries (including Israel) from the seventh round of the European Social Survey. We examined CAM in terms of overall use and also dichotomized treatments into physical and consumable subgroups. Results At the individual level, we found CAM use to be associated with a range of socioeconomic, demographic and health indicators. At the country level, we found that countries’ health expenditures were positively related to the prevalence of overall and physical CAM treatments. Conclusions A common predictor for CAM use, both at the individual (in terms of education and financial strain) and country-level (in terms of health expenditures per capita), is greater resources

Subjective perceptions of unmet need for health care in Europe among social groups: Findings from the European social survey (2014) special module on the social determinants of health.

Background: Unmet need can be defined as the individually perceived subjective differences between services judged necessary to deal with health problems and the services actually received. This study examines what factors are associated with unmet need, as well as how reasons for unmet need are distributed across socioeconomic and demographic groups in Europe. Methods: Multilevel logistic regression models were employed using data from the 7th round of the European Social Survey, on people aged 25–75. Self-reported unmet need measured whether respondents had been unable to get medical consultation or treatment in the last 12 months. Reasons for unmet need were grouped into three categories: availability, accessibility and acceptability. Health status was measured by self-reported health, non-communicable diseases and depressive symptoms. Results: Two-thirds of all unmet need were due waiting lists and appointment availability. Females and young age groups reported more unmet need. We found no educational inequalities, while financial strain was found to be an important factor for all types of unmet need for health care in Europe. All types of health care use and poor health were associated with unmet need. Low physician density and high out-of-pocket payments were found to be associated with unmet need due to availability. Conclusion: Even though health care coverage is universal in many European welfare states, financial strain appeared as a major determinant for European citizens’ access to health care. This may suggest that higher income groups are able to bypass waiting lists. European welfare states should, therefore, intensify their efforts in reducing barriers for receiving care