Educational health inequalities in former Yugoslavia: evidence from the South-East European Social Survey Project (original) (raw)
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Social determinants of health inequalities in Bosnia and Herzegovina
Public Health, 2007
Objective: To examine the social determinants of inequalities in health in Bosnia and Herzegovina in the post-conflict period, and to test if the relative effects vary across the two entities of the Federation of Bosnia and Herzegovina and the Republika Srpska. Study design: Cross-sectional data come from the first wave of the Bosnia and Herzegovina Household Panel Study conducted in 2001, which collected data from 7482 respondents aged 17 years and older based on over 3000 households. Methods: Distributions and odds ratios for physical limitations and poor mental well-being were calculated over a number of known social determinants. Multivariate logistic regression and t-tests were used to compare risks across entities within the state of Bosnia and Herzegovina. Results: The prevalence of poor mental well-being and physical limitations was significantly higher in the Republika Srpska. Significant differences in poor mental well-being and physical limitations were observed across most determinants within each entity, but only a few of these relative effects differed between entities. Conclusions: Efforts to tackle absolute differences in poor health between the entities within Bosnia and Herzegovina should be pursued, along with reducing social inequalities.
The Impovershing Effect of Ill Health: Evidence from the Western Balkans
SSRN Electronic Journal, 2000
This paper investigates the extent to which the health systems of the Western Balkans (Albania, Bosnia and Herzegovina, Montenegro, Serbia and Kosovo) have succeeded in providing financial protection against adverse health events. We examine disparities in health status, health care utilization and out-of-pocket payments for health care (including informal payments), and explore the impact of health care expenditures on household economic status and poverty. Data are drawn from LSMS surveys and methodologies include 'catastrophic-health' analysis, poverty incidence analysis adjusted for health payments, and multivariate regression analysis. On balance, we find that economic status is significantly associated with health care-seeking behavior in all transition economies and the cost of illness can increase the incidence and depth of poverty. The impoverishing effect of health expenditures is most severe in Albania and Kosovo, followed by Serbia, Bosnia and Herzegovina and Montenegro. Moreover, health care costs seem to place a heavier burden on the weakest strata of the population, such as children and people with chronic illness, with serious consequences for the breaking out of the illness-poverty vicious circle. 5 household economic status and poverty measures. Finally, in section 5 a set of country-specific probit regressions are used to model the relationship between health status, health care utilization and poverty. Section 6 concludes, suggesting implications for policy.
European Journal of Public Health, 2017
This introduction summarizes the main findings of the Supplement 'Social inequalities in health and their determinants' to the European Journal of Public Health. The 16 articles that constitute this supplement use the new ESS (2014) health module data to analyze the distribution of health across European populations. Three main themes run across these articles: documentation of cross-national variation in the magnitude and patterning of health inequalities; assessment of health determinants variation across populations and in their contribution to health inequalities; and the examination of the effects of health outcomes across social groups. Social inequalities in health are investigated from an intersectional stance providing ample evidence of inequalities based on socioeconomic status (occupation, education, income), gender, age, geographical location, migrant status and their interactions. Comparison of results across these articles, which employ a wide range of health outcomes, social determinants and social stratification measures, is facilitated by a shared theoretical and analytical approach developed by the authors in this supplement.
Comparison of Population Health Status in Six European Countries
Medical Care, 2009
Background: The EQ-5D questionnaire is an instrument for describing and valuing health states. Objectives: To compare general population health status measured by the EQ-5D in 6 European countries. Methods: In the European Study of the Epidemiology of Mental Disorders representative population samples in Belgium (n ϭ 2411), France (n ϭ 2892), Germany (n ϭ 3552), Italy (n ϭ 4709), the Netherlands (n ϭ 2367), and Spain (n ϭ 5473) completed the EQ-5D as part of personal computer-based home interviews in 2001 to 2003. Results: Of all respondents, 35.1% reported problems in one or more EQ-5D dimensions, most frequently pain/discomfort (28.5%), followed by mobility (13.6%), usual activities (10.5%), anxiety/ depression (8.0%), and self-care (3.6%). Proportions of respondents reporting any problems differed significantly between countries, ranging from 26.6% in Spain to 44.5% in France. Mean EQ VAS score was 77.1, ranging from 75.0 in Spain to 82.0 in the Netherlands. After adjusting for sociodemographic variables, the proportion of respondents reporting problems in any of the EQ-5D dimensions was significantly higher in France and lower in Spain and Italy than the grand mean. Even after controlling for reported EQ-5D health states, mean EQ VAS scores were significantly higher in the Netherlands and lower in Spain than the grand mean. Age, female gender, low educational level, lack of paid employment, and low income were associated with more problems in most of the EQ-5D dimensions and lower EQ VAS scores. Conclusions: Self-reported EQ-5D health status differed considerably between countries, calling for caution when making international comparisons of disease burden and health care effectiveness.
Journal of Epidemiology & Community Health, 1998
Study objective-To assess whether there are variations between 11 Western European countries with respect to the size of diVerences in self reported morbidity between people with high and low educational levels. Design and methods-National representative data on morbidity by educational level were obtained from health interview surveys, level of living surveys or other similar surveys carried out between 1985 and 1993. Four morbidity indicators were included and a considerable eVort was made to maximise the comparability of these indicators. A standardised scheme of educational levels was applied to each survey. The study included men and women aged 25 to 69 years. The size of morbidity diVerences was measured by means of the regression based Relative Index of Inequality. Main results-The size of inequalities in health was found to vary between countries. In general, there was a tendency for inequalities to be relatively large in Sweden, Norway, and Denmark and to be relatively small in Spain, Switzerland, and West Germany. Intermediate positions were observed for Finland, Great Britain, France, and Italy. The position of the Netherlands strongly varied according to sex: relatively large inequalities were found for men whereas relatively small inequalities were found for women. The relative position of some countries, for example, West Germany, varied according to the morbidity indicator. Conclusions-Because of a number of unresolved problems with the precision and the international comparability of the data, the margins of uncertainty for the inequality estimates are somewhat wide. However, these problems are unlikely to explain the overall pattern. It is remarkable that health inequalities are not necessarily smaller in countries with more egalitarian policies such as the Netherlands and the Scandinavian countries. Possible explanations are discussed.
Slovenian Journal of Public Health, 2013
Background: This article explores gender trends in self-rated health in Slovenia over the period of thirty years. The main research goals are to examine the associations between gender, social class and health, establish the extent that the patterns of subjective health converge with those in other countries and identify the most vulnerable health groups. Methods: The study is based on six waves of the Slovenian Public Opinion survey carried out between 1981 and 2012 on representative samples of the adult Slovenian population. The main dependent variables are the respondent’s self-assessed health and three indicators of psychosomatic health - experiences of insomnia, irregular heartbeat and anxiety. The main independent variables are gender and socio-economic status. The relationship between them was examined using Chi-square tests. Results: The 30 year trend is consistent with prior studies, which found that women report poorer self-assessed health than men. In Slovenia, this gende...
Background/Aim. A consistent association between socioeconomic determinants and health related variables has been found in many European countries. The aims of this study were: to analyze the association of socioeconomic factors with self-perceived health and utilization of health services as well as to suggest some interventions to overcome the existing problems. Methods. Hybrid study was pefrormed. The two cross-sectional studies were conducted on quota samples (1999 and 2015) in Kruševac Municipality. The questionnaire was used as the investigation instrument for 196 interviewees in 1999 and 226 interviewees in 2015. Results. In the reporting period, there were the following results: a significant increase in people who did not have a steady income (χ 2 = 22.800; df = 4; р < 0.01), a decrease in the number of people who perceived their own health as "well" and "very well", a significant increase (6.1%) in people who did not visit anyone when disease occurred, a decrease of 13.2% in number of people who, at least once, visited the general practitioner and an increase in the number of people who visited private health care sector. The findings revealed inequalities in self-perceived health depending on socioeconomic position, in particular educational and employment status (χ 2 = 11.293; df = 4; p < 0.05). There are two major ways in which unemployment affects health: lack of income and ability to meet daily needs and emotional stress related to the meaning of the work, uncertain future, loss of self-esteem, and identity. Conclusion. Equality is a key value in the assessment of the effects on health. It is necessary to conduct effective interventions for overcoming the consequences in society that would be focused on a specific target group in one territory.
The Oslo Health Study: The impact of self-selection in a large, population-based survey
International Journal for Equity in Health, 2004
Background Research on health equity which mainly utilises population-based surveys, may be hampered by serious selection bias due to a considerable number of invitees declining to participate. Sufficient information from all the non-responders is rarely available to quantify this bias. Predictors of attendance, magnitude and direction of non-response bias in prevalence estimates and association measures, are investigated based on information from all 40 888 invitees to the Oslo Health Study. Methods The analyses were based on linkage between public registers in Statistics Norway and the Oslo Health Study, a population-based survey conducted in 2000/2001 inviting all citizens aged 30, 40, 45, 59–60 and 75–76 years. Attendance was 46%. Weighted analyses, logistic regression and sensitivity analyses are performed to evaluate possible selection bias. Results The response rate was positively associated with age, educational attendance, total income, female gender, married, born in a Western county, living in the outer city residential regions and not receiving disability benefit. However, self-rated health, smoking, BMI and mental health (HCSL) in the attendees differed only slightly from estimated prevalence values in the target population when weighted by the inverse of the probability of attendance. Observed values differed only moderately provided that the non-attending individuals differed from those attending by no more than 50%. Even though persons receiving disability benefit had lower attendance, the associations between disability and education, residential region and marital status were found to be unbiased. The association between country of birth and disability benefit was somewhat more evident among attendees. Conclusions Self-selection according to sociodemographic variables had little impact on prevalence estimates. As indicated by disability benefit, unhealthy persons attended to a lesser degree than healthy individuals, but social inequality in health by different sociodemographic variables seemed unbiased. If anything we would expect an overestimation of the odds ratio of chronic disease among persons born in non-western countries.
Central European Journal of Public Health
Objectives: Determinants of health in Central and Eastern Europe (CEE) have been discussed primarily in relation to the transition of the 1990's and early 2000's, citing lifestyles as the main culprit. This paper tries to draw a bigger picture of the health determinants in CEE in the first decade of the 21st century. To do so, the two main analytical approaches to health are united in one setting. One of them is based on the definition of health as a personal commodity relying mostly on micro-level subjective data. The other views health as a public commodity analysing objective societal characteristics and health care interventions with often a macro-level perspective. The current study incorporates these different approaches (subjective and objective) in a multi-level setting in CEE. Methods: The analysis concentrates on health care, social, political, and economic factors as determinants of self-rated health. Multilevel analysis is carried out on a dataset of Life in Transition Survey (LiTS), conducted in 2006 and 2010, pooled cross-sectional data on 46,546 individuals in 27 CEE states. They are accompanied by macro-level data. Results: The findings demonstrate that a complex mix of determinants influences subjective health in CEE. There are clear differences in the way objective and subjective indicators influence self-rated health. While societal economic prosperity does not influence health, there are strong country-specific differences in the effect of individual prosperity on health. Conclusions: The study adds to the recent literature on health in CEE by introducing an encompassing systematic approach to analysing health, as no leading cause for self-rated health variation was found. This paper also contributes to research on the determinants of health by fusing objective and subjective determinants in a hierarchical setting. Both subjective and objective determinants matter for health.