1. Socioeconomic inequalities and health Ozren Polašek Department of Public Health

2. Basics  Equality – ethically and logcally neutral term denoting the same (value or worth)  Equity – morally defined term, denoting judgement made by the individuals, societies or international public

3. SIE  Differential health-related status and outcomes among people with different socioeconomic status (SES)

4. Health determinants The Acheson Report (1998)

5. Main SES determinants  Education  Employment  Marital status  Material status (objective vs. subjective)  Social networks …

6. Racial / ethnical status

7. SEI are natural…  Postoje oduvijek

9. Social stratification in UK I professionals – physicians, lawyers, etc. II intermediate – managers, nurses, teachers III N skilled non-manual – clerks, administrators III M skilled manual – drivers, butchers, miners IV partly skilled – agricultural, postmen, controllors V unskilled – cleaners, harbour workers Townsend and Davidson 1982

10. Principal reseacrh sources  The Black Report (1980)  The Health Divide (1987)  Working Together for a Healthier Scotland (1998)  The Acheson Report (1998)

11. The Black Report (1980)

14. Comparability? ©www.fiberlitetech.com©http://www.tombullock.com

16. Theoretical background  Material / neomaterial  Social / Social network  Educational  Life-long theory

17. SEI today  Nearly systematic indication of worse health status and outcomes among people with poor SES

18. Smoking of children, depending on SES of the father HBSC Survey, 2001

19. Not static Life expectancy

20. Growing inequalities

22. Izvor: Državni zavod za statistiku

25. … istraživanja nikad dosta…

26. Screening use Polasek O, Voncina L, Kolcic I, Strnad M, Vuletic S, Kern J. Social disparities related to breast, colon and prostate cancer screening in the adult population of Croatia – Does rural origin matter? Rural and Remote Health 2007:7(3);749.

27. Polašek O et al. Rural Remote Health 2007;7;e749

28. Rural origin and student outcomes Polašek O. et al. Rural Remote Health. 2006;6(2):e530.

29. Gender-related differences Smoljanovic A, et al. Croatian Medical Journal. 2007;48(5):734-40. SES; 16 items: WC, wooden floors, 2 TVs, art collection, second flat, boat, ….

30. Spousal diferences  Men reported nearly 10% better SES than their corresponding spouses Kolcic I, et al. Journal of Epidemiology and Community Health. 2009;63(2):175-6.

31. Subjective assessment, men Polasek O, et al. Collegium Antropologicum. 2009;33 (Suppl 1):171-6.

32. Subjective assessment, women Polasek O, et al. Collegium Antropologicum. 2009;33 (Suppl 1):171-6.

33. Survey participation, M Kolčić I and Polašek O. Do public health surveys provide representative data? Comparison of three different sampling approaches in the adult population of Croatia? Collegium Antropologicum, In Press 2009.

34. Survey participation, W Kolčić I and Polašek O. Do public health surveys provide representative data? Comparison of three different sampling approaches in the adult population of Croatia? Collegium Antropologicum, In Press 2009.

35. SEI reduction?  Social policy measures: increase in salaries, reduction of unemployment, improvement of housing, …  Healthy living measures: healthier lifestyles promotion  Improvement of the health care system through better health services

36. Accessability of health care Polašek O et al. Rural Remote Health 2007;7;e749

37. Targeted interventions  A simple intervention across the entire population often promote disparities  Why?  These need to be investigated, thinked through and then a designed approach needs to be undertaken in order for a successfull result  Measures towards poor and wealthy can’t be the same

38. Basic research is still needed  Local specifics  Croatia especially  Comparisons questionable  Time-dependent

39. Lastly  SEI can’t be removed, but we have to act to reduce their effects on health  Equality can’t be achieved, but equity within health MUST be achieved