Socioeconomic inequalities in health are reported in all European countries, but with substantial variations in their magnitude. Reducing these inequalities should be a priority not only because such inequalities are unfair but also because their burden has huge economic consequences. The association between education and health has been demonstrated for different health outcomes. This thesis aimed at exploring the educational inequalities in all-cause and cause-specific mortality in Europe in a comparative perspective. Based on mortality and morbidity data from a large number of European populations, we first investigated the quality of cause-specific mortality data by assessing educational differences in the proportion of ill-defined causes of death. Then, the magnitude of educational inequalities in mortality was estimated and the trends in these inequalities between the 1990s and the 2000s were analysed. Finally, the thesis focused on quantifying the potential health gains and inequality reductions due to different policies and interventions using the Population Attributable Fraction (PAF) methodology. The PAF methodology was used in two different ways. First, the impact of on-going improvements in the educational structure of the population on mortality was assessed. Second, the potential reduction in educational inequalities in mortality was estimated by modifying the educational distribution of selected lifestyle risk factors. Based on the findings of this thesis, policy makers should invest and improve education for the whole population. However, the full beneficial effect of education will be achieved only if there are enough employment opportunities and if the achieved education meets the occupational needs. There is also a need for policies and interventions that reduce educational inequalities in mortality through risk factor modifications. The heterogeneity of the findings across European countries highlights the fact that there is no single common strategy in Europe that would effectively decrease educational inequalities in mortality.

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J.P. Mackenbach (Johan)
Erasmus University Rotterdam
The studies presented in this thesis were funded by the Directorate General for Health and Consumer Protection (DG SANCO) of the European Commission (grant numbers 2003125 and 20081309), and by the Netherlands Organization for Health Research and Development (ZonMw, project number 121020026). This thesis was printed with financial support of the Department of Public Health, Erasmus Medical Center and of the Erasmus University Rotterdam.
Erasmus MC: University Medical Center Rotterdam

Kulhánová, I. (2015, January 27). Exploring Educational Inequalities in Mortality in Europe. Erasmus University Rotterdam. Retrieved from http://hdl.handle.net/1765/77480