1. Work Package 2 Measurement and Indicators: EQUITY
Research Inventory of Child Health in Europe
Mapping current and future Child Public Health Research
Work Package 2 Measurement and Indicators: EQUITY
Coordinators:
Anders Hjern – Nordic School of Public Health, SE
Mitch Blair – Imperial College, London, UK
Equity:
Hein Raat – Erasmus MC Rotterdam

2. Inequity A. METHODS  we need a uniform approach
Indicators of social disadvantage, poverty, socio-economic status, migrant status, single parent family, neighbourhood status are social determinants of child health
Indicators of inequities in health are the outcomes
B. PUBLISHED RESULTS, since 2000
C. USE TO PROMOTE CHILD HEALTH
D. ELECTRONIC RECORDS

3. Time schedule
Time schedule: Indicators of equity
(ms 3-12)

4. Collaboration
INRICH sister initiative ‘unfunded’ on inequalities in childhood health
International Network for Research on Inequalities in Child Health

6. Collaboration  CHICOS EU sister project on child cohorts
CHICOS (Developing a Child Cohort Research Strategy for Europe)

8. Children, adults, life course
Who’s socio-economic status:
Unborn child: mother (and father)
Young child: the family (mother and father)
Adolescent: adolescent him/herself & family
Young adults: him/herself

9. Equity: what is it about?
Social disadvantage: general concept
Socio-economic status: Education, occupation, income, (status ?)
Poverty
Ethnicity
Neighbourhood status
Single-parent-family

10. SES: Education levels Type, ‘level’, number of years:
no education or primary education (up to approximately 6 years of education),
lower secondary education (9 years)
higher secondary education (11 years)
tertiary education (bachelor’s degree or higher)

11. SES: Job status Full-time paid job (~ hours per week)
Part-time paid job
Self-employed
Unemployed / seeking employment
Unemployed / disability benefit
Student
‘Housewife’ …

12. SES: Occupation: levels
“manual” (considered the lower level)
“nonmanual”
Or more refined

13. SES: Income: levels Household income Gross or net income (Euro’s)
Approximate quintiles of equivalent net household income
After-tax incomes of all household members, including benefits, were added, and the total was corrected for household size by dividing it by the total number of persons in the household to the power of 0.36.

14. Poverty Household income Income benefits
Indicators: other benefits (e.g. free school lunch)
Self-reported financial difficulties
Debts …

15. Ethnicity Self-assigned ethnicity (each parent; child)
Country of birth: Child, 2 parents, 4 grandparents, etc.
Ethnicity of mother, father, OR child
Migration history
(Level of) acculturation

16. Neighbourhood Aggregated indicators of disadvantage
Influence in addition to family-level
Geographical health-related characteristics

17. Single-parent family Associated with all social indicators
Associated with culture/ethnicity
Determinant of health, development and well-being independent of other indicators

18. Inequalities in health: The outcomes
Both relative and absolute measures of inequalities in health are important:
1. The relative index of inequality
2. The slope index of inequality
Mackenbach et al, N Engl J Med 2008;358:

19. 1. Relative index of inequality
The relative index of inequality is the ratio between the estimated mortality, morbidity, or riskfactor prevalence among persons at rank 1 (the lowest education, occupation, or income level) and rank 0 (the highest level).
(Poisson regression analysis)

20. 2. Absolute: slope index of inequality
The slope index of inequality measures absolute differences in rates (e.g., in deaths per 100,000 person-years) between the lowest and the highest ends of the socioeconomic scale.
Mackenbach et al, N Engl J Med 2008;358:

21. Sub-study WP2: Inequity
A. METHODS  we need a uniform approach
Indicators of social disadvantage
Indicators of inequities in health
B. PUBLISHED RESULTS, since 2000
C. USE TO PROMOTE CHILD HEALTH
D. ELECTRONIC RECORDS
Link to ‘INRICH’ and to ‘ CHICOS’