Decoding geographical health inequalities: a critical approach (original) (raw)
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SPATIAL AND REGIONAL HEALTH INEQUALITIES IN EUROPE
Purpose – We have studied the spatial interrelations of the regional health inequalities in Europe in view of the social selection hypothesis. The primary objective of our paper is to demonstrate the effect of health status on various socioeconomic development indicators. Design/methodology/approach – According to the social selection hypothesis, an individual's health status influences both his own socioeconomic status and the economy as a whole. Accordingly, we have operationalised the regional health status and socioeconomic development and analysed their correlations. For such purpose we have used correlation analysis and explanatory spatial data analysis (ESDA): spatial autocorrelation and regional regression models. Findings – According to our results, there are synergistic effects between the two phenomena, both in view of global and local statistics. Regions with better health status are characterised with better socioeconomic conditions. The spatial regression models have also justified and confirmed the use of the social selection hypothesis for the explanation of regional differences in economic development. Research limitations/implications – It is advisable to use panel databases for the future analysis of this topic. To give correct answer on social selection hypothesis on regional level, other examinations (Markov chain model) must be done. Practical implications – Furthermore, it is advisable to extend the range of health status indicators with variables such as noncommunicable chronic diseases or other causes of death associated with socioeconomic phenomena (e.g. TBC incidence indicates poverty). Originality/Value – As far as the social selection hypothesis is concerned, our paper presents new and innovative results whose approach (method for the exploration of regional data) has not been discussed so far in the international literature.
An assessment of the geographical approach to health inequality
Critical Public Health, 2011
New interest is being shown in the geographical approach to health inequality at both the research and the service provider level. The scientific and methodological basis of this approach does not take into consideration the social structure and the history of the locations/communities under investigation. The analysis of geographical differences must be verified and consideration given to possible variations in internal health inequalities between entities compared. Our approach to health inequalities is based on the theory that social health inequalities are essentially the final product of living conditions and lifestyle taking account of individual and collective history.
RESEARCH ARTICLE An assessment of the geographical approach to health inequality
2011
New interest is being shown in the geographical approach to health inequality at both the research and the service provider level. The scientific and methodological basis of this approach does not take into consideration the social structure and the history of the locations/communities under investigation. The analysis of geographical differences must be verified and consideration given to possible variations in internal health inequalities between entities compared. Our approach to health inequalities is based on the theory that social health inequalities are essentially the final product of living conditions and lifestyle taking account of individual and collective history.
Critical urban areas, deprived areas and neighbourhood effects on health in France
Health policy (Amsterdam, Netherlands), 2012
Since the 1980s, different French governments have formulated public policies aimed at taking into account the specific problems of deprived neighbourhoods. The aim of this paper is to determinate the existence of a neighbourhood effect on health and to discuss the implementation of a geographical index of deprived areas in France. Using the National Health Survey of 2002-2003 and 1999 French census data, we attempt to measure the individual and collective determinants of Self-Reported Health Status (SRH). By using a principal component analysis of aggregated census data, we obtain three synthetic factors: "economic and social condition", "residential stability" and "generational", and show that these contextual factors are correlated with individual SRH. Our research shows that health inequalities cannot be tackled by using only the Critical Urban Area criterion (the fact of living in a CUA or not) because some inequalities remain ignored and thus, hid...
Geographies of health and deprivation: relationship between them
C. Palagiano e G. de Santis (a cura di), …
A substantial body of evidence has shown a strong association between socioeconomic variables and health outcomes. Frequently, researches on health variations have established the relationships between ecological levels of deprivation and health. By using composite indices of area deprivation, like Carstairs or Townsend ones, several studies show higher levels of mortality and lower levels of health in deprived areas. In face of these results, we've tried to highlight the link between deprivation, or affluence, and health in a Portuguese urban area. We've created a score of multiple deprivation from the 2001 Census to apply in parishes and municipalities of Lisbon Metropolitan Area. Then, we've investigated the effects of deprivation, through the developed measure, in premature mortality. We've concluded that there is a strong relationship between our score of multiple deprivation and premature mortality.
Inequalities in Health: Methodological Approaches to Spatial Differentiation
International Journal of Environmental Research and Public Health, 2021
The prevalence of inequalities in the general health position of communities can be assessed by using selected determinants. The aims of this article are three-fold: (1) to apply a comprehensive approach to the assessment of inequalities in the general health position of communities, (2) to determine the spatial differentiation of determinants, and (3) to present selected assessment methods and their impact on the results. To present a quantitative assessment of these inequalities in health status in communities, a composite indicator (Health Index) was developed. This Health Index is composed of 8 areas of evaluation and 60 indicators which include, amongst others, determinants of health status and healthcare at district level (LAU 1) in the Czech Republic. The data are evaluated using multicriteria decision-making methods (the WSA and TOPSIS methods). Findings suggest that, when all eight domains are assigned the same weight of one, the spatial differentiation among the districts ...
Health status, Neighbourhood effects and Public choice: Evidence from France
Working Papers, 2008
Observation of socioeconomic statistics between different neighbourhoods highlights significant differences for economic indicators, social indicators and health indicators. The issue faced here is determining the origins of health inequalities: individual effects and neighbourhood effects. Using National Health Survey and French census data from the period 2002-2003, we attempt to measure the individual and collective determinants of Self-Reported Health Status (SRH). By using a principal component analysis of aggregated census data, we obtain three synthetic factors called: "economic and social condition", "mobility" and "generational" and show that these contextual factors are correlated with individual SRHs.
The European Journal of Public Health, 2005
Background: The study objective was to investigate the association between health outcomes and several small-area-based socioeconomic measures and also with individual socioeconomic measures as a check on external validity. Methods: Cross-sectional design based on the analysis of the Barcelona Health Interview Survey of 1992. A representative stratified sample of the non-institutionalised population resident in Barcelona city (Spain) was obtained. The present study refers to the 4171 respondents aged over 14. We studied perceived health status, presence of chronic conditions and smoking as health outcomes. Area socioeconomic measures (1991 census) were generated at census tract level and individual socioeconomic measures were educational level and social class obtained through the survey. Results: With individual socioeconomic measures we observed that the lower the educational level or social class, the higher the probability of reporting a perceived health status of fair, poor or very poor and of presenting some chronic condition. With regard to smoking, among men this trend was similar [odds ratio (OR) ¼ 1.5; 95% confidence interval (CI) ¼ 1.2À1.9 in social classes IV-V with respect to social classes I-II], while among women it was reversed (OR ¼ 0.7; 95% CI ¼ 0.5À0.9). With the different areabased socioeconomic indicators differences were also observed in this sense, with the exception of smoking in women for which these indicators do not show any differences by socioeconomic level. Conclusions: With several census area-based socioeconomic measures similar effects on inequalities in health have been observed. In general, these inequalities were in the same sense as those obtained with individual-based measures. Small-area-based socioeconomic measures from the Spanish census could greatly enhance analysis of social inequalities in health, overcoming the absence of socioeconomic data in public health registries and in medical records.
European Journal of Ageing, 2020
The objectives were to estimate disability-free life expectancy (DFLE) and life expectancy with disability (DLE) by gender for the 100 French départements (administrative geographical subdivisions) and to investigate associations with socioeconomic factors, supply of healthcare and services for older persons. DFLE and DLE at age 60 are estimated using the Sullivan method and based on the GALI indicator provided by the French cross-sectional survey Vie Quotidienne et Santé 2014. In 2014, DFLE for men and women aged 60 was 14.3 years and 15.6 years, respectively. Variations across départements were considerable (5.4 years for men, 6.7 years for women). Multivariate random effects meta-regression models indicated a negative association for men between DFLE and some of the socioeconomic contextual indicators (ratio of manual workers to higher-level occupations and unemployment rate); the level of in-home nursing services (HNS) was negatively associated with DFLE and density of nurses positively associated with DLE. Among women, ratio of manual workers to higher-level occupations, unemployment rate, proportion of the population living in large urban areas, density of nurses, and level of HNS were negatively associated with DFLE; density of physiotherapy supply was associated positively with DFLE and negatively with DLE. Our results suggest that geographical inequalities in health expectancies are significantly correlated with socioeconomic status and with healthcare supply, support for older persons, and urban environments, particularly among women. These results underline the importance of monitoring these indicators and disparities at infra-national-level, and of investigating their relations with local context, particularly the supply of healthcare and services.Electronic supplementary materialThe online version of this article (10.1007/s10433-020-00589-0) contains supplementary material, which is available to authorized users.
2019
In our paper we analysed the regional health inequalities of Europe with the aim of highlighting the role of country and country-group effects. Our hypothesis, which states that the processes at the above levels also have an effect on territorial mortality, proved to be true. Based on the analyses, country and country group effects can be clearly demonstrated in the development of Europe's regional (NUTS3 level) health inequalities. It is important to emphasize that, for both macro-regional and national analyses, regional economic prosperity is an independent predictor of regression analysis. Published in: Jakab G. - Csengeri E. (2019): 21th Century Water Management in the Intersection of Sciences. Conference Papers. Szarvas, Hungary, Szent Istvan University, Faculty of Agricultural and Economic Studies, pp. 264-272.