Documents Van Oyen, Herman 4 results

"Background Socioeconomic differences in health are a major challenge for public health. However, realistic estimates to what extent they are modifiable are scarce. This problem can be met through the systematic application of the population attributable fraction (PAF) to socioeconomic health inequalities. Methods The authors used cause-specific mortality data by educational level from Belgium, Norway and Czech Republic and data on the prevalence of smoking, alcohol, lack of physical activity and high body mass index from national health surveys. Information on the impact of these risk factors on mortality comes from the epidemiological literature. The authors calculated PAFs to quantify the impact on socioeconomic health inequalities of a social redistribution of risk factors. The authors developed an Excel tool covering a wide range of possible scenarios and the authors compare the results of the PAF approach with a conventional regression. Results In a scenario where the whole population gets the risk factor prevalence currently seen among the highly educated inequalities in mortality can be reduced substantially. According to the illustrative results, the reduction of inequality for all risk factors combined varies between 26% among Czech men and 94% among Norwegian men. Smoking has the highest impact for both genders, and physical activity has more impact among women. Conclusions After discussing the underlying assumptions of the PAF, the authors concluded that the approach is promising for estimating the extent to which health inequalities can be potentially reduced by interventions on specific risk factors. This reduction is likely to differ substantially between countries, risk factors and genders."

"Background Life expectancy gaps between Eastern and Western Europe are well reported with even larger variations in healthy life years (HLY).Aims To compare European countries with respect to a wide range of health expectancies based on more specific measures that cover the disablement process in order to better understand previous inequalities.Methods Health expectancies at age 50 by gender and country using Sullivan's method were calculated from the Survey of Health and Retirement in Europe Wave 2, conducted in 2006 in 13 countries, including two from Eastern Europe (Poland, the Czech Republic). Health measures included co-morbidity, physical functional limitations (PFL), activity restriction, difficulty with instrumental and basic activities of daily living (ADL), and self-perceived health. Cluster analysis was performed to compare countries with respect to life expectancy at age 50 (LE50) and health expectancies at age 50 for men and women.Results In 2006 the gaps in LE50 between countries were 6.1 years for men and 4.1 years for women. Poland consistently had the lowest health expectancies, however measured, and Switzerland the greatest. Polish women aged 50 could expect 7.4 years fewer free of PFL, 6.2 years fewer HLY, 5.5 years less without ADL restriction and 9.5 years less in good self-perceived health than the main group of countries (Austria, Belgium, Denmark, France, Germany, Italy, the Netherlands, Spain, Sweden).Conclusions Substantial inequalities between countries were evident on all health expectancies. However, these differed across the disablement process which could indicate environmental, technological, healthcare or other factors that may delay progression from disease to disability."

"En 2001, un homme de 25 ans disposant d'un diplôme de l'enseignement supérieur pouvait espérer vivre presque 7 années de plus qu'un homme sans qualification. En 1991, cette différence s'élevait à 5 années. Cela signifie que les inégalités sociales dans les espérances de vie ont augmenté en Belgique au courant de la dernière décennie. Voilà un des constats de cet ouvrage qui rassemble une série d'études visant à développer une meilleure compréhension des inégalités sociales de santé en Belgique et à proposer des recommandations politiques efficaces pour y faire face. Réduire ces inégalités, en améliorant la santé de ceux qui sont situés au bas de l'échelle hiérarchique, pourrait générer des améliorations substantielles dans la santé de la population belge.

Les auteurs concluent que la solution appropriée n'est pas d'investir davantage dans le système de santé mais de s'attaquer à la source de ces inégalités et de mener des actions bien ciblées pour éviter que ces inégalités ne s'aggravent. Dès lors, ils en appellent à une volonté politique ferme et à de stratégies durables qui impliquent, non seulement le secteur de la santé, mais aussi d'autres secteurs de la gestion publique, comme le secteur social, le milieu de vie et l'enseignement."