Inequalities in health have attracted much epidemiological interest Usually, differences in rates of ill-health between the sexes, among socio-economic groups, geographical regions, etc., are quantified separately, so that it remains undear which variables are associated with the largest degree of variation. We analyzed variations in perceived general health, prevalence of chronic conditions, and mortality associated with six sociodemographic characteristics: age, gender, marital status, level of education, degree of urbanization and region. Nationally representative data from the Netherlands were used. The Index of Dissimilarity (the proportion of the number of cases of ill-health in the whole population which has to be redistributed to achieve complete equality) was used to summarize the degree of variation in these health measures. Age was associated with the highest degree of variation in all three health measures. The rank order of the other background characteristics differed slightiy among health measures, but on the whole gender, marital status and level of education appeared to be of equal importance. Degree of urbanization and region were less important, although not negligible. Improvements in the health status of groups having high rates of health problems could contribute substantially to further reduction of the burden of ill-health in the population as a whole. The results of this analysis suggest that such interventions should not be limited to one dimension of inequality only, and that, at least in the Netherlands, inequalities by gender, marital status and level of education deserve equal attention from health policy makers. Examples of specific factors and mechanisms involved in these inequalities are given, and possible strategies for reduction of these inequalities are discussed.

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European Journal of Public Health
Erasmus MC: University Medical Center Rotterdam

Mackenbach, J.P. (1993). Inequalities in health in the Netherlands according to age, gender, marital status, level of education, degree of urbanization, and region. European Journal of Public Health, 3(2), 112–118. doi:10.1093/eurpub/3.2.112