1. The ESEC and inequalities in health Anton E. Kunst Tanja Houweling Johan P. Mackenbach

2. Structure of this presentation Background Experiences from previous comparative research The work package (general aim, data source, hypotheses)

3. Background (1)  Why look at ESEC in relation to health?  from perspective of ESEC: health as a comprehensive measure of life chances  from perspective of health: ESEC as an improved instrument to study social determinants

4. Background (2)  Food Today No 45, October 2004 “Educational level and income determine food choices and behaviours that ultimately lead to diet-related diseases”

5. Background (3)  Why is occupational class often ignored in public health?  measurement too complex for epidemiological studies  difficult or impossible to apply to women and elderly people  other reasons, e.g. not strictly hierarchical

6. Background (4) Education Behaviour Social networks Living conditions Occupation Labour market Health Survival Income

7. Previous research (1)  Comparative projects on inequalities in health -1991-1993: Netherlands compared to elsewhere -1993-1998: general European overview -1999-2001: trends over time -2000-2004: elderly people -2002-2007: smoking -2004-2007: cancer -2004-2008: “Eurothine” (policies, new member states)

8. Previous research (2)  Mortality rate according to EGP class men 30-59 years, 1980s Sweden and England/ Wales

9. Previous research (3)  Mortality rate according to educational level men, 1990s 11 countries combined

10. Previous research (4)  % smokers according to educational level women, 1985 and 2000 7 countries combined

11. The work package (1)  Objectives  general: to test (and thus demonstrate?) the usefulness of the ESEC scheme for describing health inequalities in European countries  specific: to describe health differences according to ESEC class, and to generate evidence on possible explanations (‘causal narratives’)

12. The work package (2)  Data sources  International surveys covering several countries  More sources might be used if data with individuals assigned to ESEC classes are readily available  Inactive must be classified according to their last main occupation, or the class of the main income earner

13. The work package (3)  ECHP  5 broad ESEC classes  health, smoking, overweight  analyses per country (old member states)  ESS  detailed ESEC classification  health and well being  analyses per region (e.g. north, south, east)

14. The work package (4)  Hypotheses for descriptive research  there are substantial inequalities in health according to ESEC class  these inequalities are observed for each country or region  these inequalities are observed for each age group, and for both men and women

15. The work package (5)  Hypotheses for explanatory research  there is a graded association of health with the “service contract” versus “labour contract” continuum  this association persists to some extent after control for education level and current income  “irregular” patterns in health (e.g. service workers have poorest health) can be related to the social conditions of particular groups