1. Health inequalities in adolescence Matthias Richter, Matthias Richter, Department of Prevention and Health Promotion School of Public health | WHO CC University of Bielefeld Germany from description to explanation beta v0.2

2. Socioeconomic inequalities in health have been observed in all industrialised countries. They are observable in most measures of health and longevity using different measures of SES. Socioeconomic inequalities in health (Overview_part 1)

3. Socioeconomic inequalities in health (Overview_part 2) Health and longevity tend to have a stepwise, not threshold, relationship with SES (social gradient). Inequalities in health are observable in childhood and adulthood

4. Do we find a similar pattern in adolescence?

5. Health inequalities in adolescence (Part 1) Compared to childhood and adulthood there is no consistent pattern of inequalities in health - esp. for early youth (11 to 16 year- olds). Where inequalities exist, they are less pronounced than in any other part of the life-course.

6. The pattern of inequalities in health might changes in adolescence. Health inequalities in adolescence (Part 2)

7. Health inequalities in adolescence (Part 3) There are a number of exceptions and variations (gender, age groups, countries and social indicators) The most important variation is across health outcomes.... but:

8. Theoretical models of the relationship between SES and health in childhood and adolescence Source: Chen et al. 2002

9. 1. The persistent model

10. low SES medium SES high SES for example: Mortality (due to accidents/injuries), severe asthma adolescencechildhood

11. 2. The childhood-limited model

12. for example: injuries, Infectious diseases adolescencechildhood low SES medium SES high SES

13. 3. The adolescent- emergent model

14. for example: passive smoking - smoking, physical activity adolescencechildhood low SES medium SES high SES

15. Two different patterns of inequalities in health in adolescence: 2. Changing inequalities in health 1. Persistent inequalities in health

16. What we need are two different explanatory models: 2. to explain changing/ equalising inequalities in health 1. to explain (persisting) inequalities in health

17. Explanations for persisting inequalities in health (Source: Macinytre 1997)

18. 1. Artefact Magnitude of observed class gradients will depend on the measurement of both class and health

19. 2. Social selection Health can contribute to achieved class position via social mobility and help to explain observed gradients Selection (Health influences SES)

20. 3. Behavioural factors Health damaging behaviours are differentially distributed across social classes and contribute to observed gradients Causation (SES influences health) (Part 1)

21. 4. Material/ structural factors Physical and psychosocial features associated with class structure influence health and contribute to observed gradients Causation (SES influences health) (Part 2)

22. Causation hypothesis (Source: Richter/Mielck 2000) Socio-economic status Behavioural factors e.g. Tobacco, Alcohol Structural factors e.g. working conditions, social support Health (social) unequal distribution of

23. Explanations for changing/ equalising inequalities in health in adolescence

24. 1. Latent differences Inequalities in health are already present, but not (yet) measurable with current outcome measures of health. The prelude is visible in the unequal distribution of different determinants (behavioural/ structural factors) of health among social groups.

25. 2. Buffer hypothesis Central elements of adolescence (school, peers, youth culture) and related mechanisms „break“ the traditional SES-barriers and form a buffer form young people against the health- damaging effect of SES. As children develop, other factors (may) play a more important role in determining adolescent health while the strength of (parent) SES decreases.

26. Conclusion Understanding those factors contributing to the existence or absence of socioeconomic differences in health can provide a better insight into the mechanisms which shape the health of youth.

27. Interested to learn more ?

28. Gecková, A. (2002). Inequality in health among Slovak adolescents.Groningen: Proefschrift Rijksuniversiteit Groningen. DownloadDownload Tuinstra, J. (1998). Health in adolescence: an empirical study of social inequality in health, health risk behaviour and decision making styles. Groningen: Proefschrift Rijksuniversiteit Groningen. DownloadDownload Recommended readings:

29. Socioeconomic Determinants of Health bmj.com collected resources and more collected resources on Socioeconomic Determinants of Health Recommended links: