Policy and research to reduce

health inequalities

The 10th Nordic Public Health Conference,

24-26 August 2011, Turku, Finland

Jurate KLUMBIENE

Lithuanian University of Health Sciences

HEALTH INEQUALITIES

can be defined as differences in health status or in the

distribution of health determinants between different

population groups.

World Health Organization

Socio-economic determinants

of health

• Level of education

• Place of residence

• Marital status

• Income

• Occupation

INEQUALITIES IN MORTALITY

Life expectancy of Lithuanian urban and rural

population in 2000 -2010

60

62

64

66

68

70

72

74

76

78

80

2000 2005 2006 2007 2008 2009 2010

Urban women

Urban men

Rural women

Rural men

Mortality from major causes of death among Lithuanian men

with university education and primary or no education

(mortality of the group with university education = 1)

**

** *

**

0

1

2

3

4

5

All causes Cardiovascular

diseases

Cancer External causes

1989 2001

* p<0.05 vs the group with university education Source - R.Kalediene, J.Petrauskiene,

Public Health (2005) 119

Mortality from major causes of death among Lithuanian

women with university education and primary or no education

(mortality of the group with university education = 1)

*

*

*

*

* *

*

0

1

2

3

4

5

6

7

All causes Cardiovascular

diseases

Cancer External causes

1989 2001

* p<0.05 vs the group with university education Source - R.Kalediene, J.Petrauskiene,

Public Health (2005) 119

INEQUALITIES IN SUBJECTIVE

HEALTH

(Finbalt Health Monitor project)

Proportion of men, who assessed their own health

status to be good or reasonable good by level of

education in 1994-2010

51

64

5242

31

25

3742

41

37

6658

4956

51

65

5659

0

10

20

30

40

50

60

70

1994 1996 1998 2000 2002 2004 2006 2008 2010

%

Secondary University

Proportion of women, who assessed their own health

status to be good or reasonable good by level of

education in 1994-2010

40

69

4034

2219

21

3435 38

6656

51

43

50

57

63

55

0

10

20

30

40

50

60

70

80

1994 1996 1998 2000 2002 2004 2006 2008 2010

%

Secondary University

Proportion of persons, who assessed their own health status to be good or reasonable good in 1994 and

2010 by place of residence

4246** 44*

56

31*

46**

35*

53

0

10

20

30

40

50

60

%

Rural Urban Rural Urban

1994

2010

MEN WOMEN

*p<0.05, compared to 2010

**p<0.05, compared to urban population in 2010

INEQUALITIES IN HEALTH

BEHAVIOUR (Finbalt Health Monitor project)

Proportion of daily smoking men in 1994 – 2010

by level of education

41

21

48

56

495047

53

40

48

2525

3235 35

31

2121

15

25

35

45

55

65

1994 1996 1998 2000 2002 2004 2006 2008 2010

%

Secondary University

Proportion of daily smoking women in 1994 – 2010

by level of education

20

12

1916

14

65

11

1820

9

13

8 9

6

1410

13

0

5

10

15

20

25

1994 1996 1998 2000 2002 2004 2006 2008 2010

%

Secondary University

Study year

MEN WOMEN

RII 95 % CI RII 95 % CI

1994

2.4 1.3-4.1 0.7 0.2-1.9

2010 4.1 2.3-7.3 2.7 1.5-4.9

Relative index of inequality (RII) in smoking

by education in 1994 and 2010

Education

level

MEN WOMEN

% OR 95 % CI % OR 95 % CI

University 14.4 1 18.6 1

Vocational 9.3 0.59 0.47-0.74 8.8 0.47 0.4-0.57

Secondary 7.4 0.47 0.37-0.59 4.5 0.25 0.2-0.31

Prevalence of regular wine consumption and

odds ratios (OR)* by sex and level of education

* - age, level of education, place of residence and marital status were included into the

model of logistic regression

Place of

residence

MEN WOMEN

% OR 95 % CI % OR 95 % CI

Cities 53.7 1 15.4 1

Towns 49.0 0.83 0.74-0.93 12.7 0.79 0.69-0.92

Villages 49.3 0.84 0.75-0.94 12.9 0.81 0.70-0.95

Prevalence of regular beer consumption and

odds ratios (OR)* by sex and place of residence

* - age, level of education, place of residence and marital status were included into the model

of logistic regression

Prevalence of daily consumption of fresh vegetables

during the last week among men by education

in 1996-2010

14

141212

3

12

15

20 23

14

3

10

22

2627

17

0

10

20

30

1996 1998 2000 2002 2004 2006 2008 2010

%

Secondary University

Prevalence of daily consumption of fresh vegetables

during the last week among women by education in

1996-2010

16

1719

15

5

1420

24

30

22

7

27

22

27

3332

0

5

10

15

20

25

30

35

1996 1998 2000 2002 2004 2006 2008 2010

%

Secondary University

Prevalence of daily consumption of fresh vegetables

during the last week by sex and place of residence

17.9

15.713.9*

25.3

20.9

18.3*

0

5

10

15

20

25

30

%

MEN WOMEN

Cities

Towns

Willages

* p<0.05 compared to cities

International research projects on health

inequalities in Lithuania

• WHO project “Health Inequalities” (1997)

– Report “Equity in health and health care in Lithuania. A

situation analysis” (1998)

• Tackling health inequalities in Europe. An

integrated approach - EUROTHINE (2004-2007)

The use of Finbalt Health Monitor data on social

differences in health behaviour in Lithuania

• The assessment of the implementation of Lithuanian Health programme

• The reports of National Health Board

• State Food and Nutrition Strategy and Action Plan for 2003-2010

• National alcohol and tobacco control programmes; the laws on tobacco and alcohol control

Health policy formulation addressing health

inequalities in Lithuania

• Lithuanian Health Programme for 1998 – 2010

– general objective on equity in health and health care

• New Lithuanian Health Programme for 2011-2020

– great emphasis on reduction of inequalities in health

Policy addressing socio-economic determinants of

health in Lithuania

• National programme on tackling poverty and

diminishing social gap in Lithuania (2000).

• The strategies and the plans of specific measures

were developed in 2002, 2004, 2006, 2008.

– Reduction of unemployment

– Improvement of access to high quality social service

– Strengthening support for families and children

– More attention to education of socially disadvantaged

groups

Summing-up

Finbalt Health Monitor study was an important

vehicle for evaluation of social differences and

trends in health behaviour. The data are useful to

guide policy making and to support the evaluation

of strategies to reduce health inequalities.