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Policy and research to reduce
health inequalities
The 10th Nordic Public Health Conference,
24-26 August 2011, Turku, Finland
Jurate KLUMBIENE
Lithuanian University of Health Sciences
HEALTH INEQUALITIES
can be defined as differences in health status or in the
distribution of health determinants between different
population groups.
World Health Organization
Socio-economic determinants
of health
• Level of education
• Place of residence
• Marital status
• Income
• Occupation
INEQUALITIES IN MORTALITY
Life expectancy of Lithuanian urban and rural
population in 2000 -2010
60
62
64
66
68
70
72
74
76
78
80
2000 2005 2006 2007 2008 2009 2010
Urban women
Urban men
Rural women
Rural men
Mortality from major causes of death among Lithuanian men
with university education and primary or no education
(mortality of the group with university education = 1)
**
** *
**
0
1
2
3
4
5
All causes Cardiovascular
diseases
Cancer External causes
1989 2001
* p<0.05 vs the group with university education Source - R.Kalediene, J.Petrauskiene,
Public Health (2005) 119
Mortality from major causes of death among Lithuanian
women with university education and primary or no education
(mortality of the group with university education = 1)
*
*
*
*
* *
*
0
1
2
3
4
5
6
7
All causes Cardiovascular
diseases
Cancer External causes
1989 2001
* p<0.05 vs the group with university education Source - R.Kalediene, J.Petrauskiene,
Public Health (2005) 119
INEQUALITIES IN SUBJECTIVE
HEALTH
(Finbalt Health Monitor project)
Proportion of men, who assessed their own health
status to be good or reasonable good by level of
education in 1994-2010
51
64
5242
31
25
3742
41
37
6658
4956
51
65
5659
0
10
20
30
40
50
60
70
1994 1996 1998 2000 2002 2004 2006 2008 2010
%
Secondary University
Proportion of women, who assessed their own health
status to be good or reasonable good by level of
education in 1994-2010
40
69
4034
2219
21
3435 38
6656
51
43
50
57
63
55
0
10
20
30
40
50
60
70
80
1994 1996 1998 2000 2002 2004 2006 2008 2010
%
Secondary University
Proportion of persons, who assessed their own health status to be good or reasonable good in 1994 and
2010 by place of residence
4246** 44*
56
31*
46**
35*
53
0
10
20
30
40
50
60
%
Rural Urban Rural Urban
1994
2010
MEN WOMEN
*p<0.05, compared to 2010
**p<0.05, compared to urban population in 2010
INEQUALITIES IN HEALTH
BEHAVIOUR (Finbalt Health Monitor project)
Proportion of daily smoking men in 1994 – 2010
by level of education
41
21
48
56
495047
53
40
48
2525
3235 35
31
2121
15
25
35
45
55
65
1994 1996 1998 2000 2002 2004 2006 2008 2010
%
Secondary University
Proportion of daily smoking women in 1994 – 2010
by level of education
20
12
1916
14
65
11
1820
9
13
8 9
6
1410
13
0
5
10
15
20
25
1994 1996 1998 2000 2002 2004 2006 2008 2010
%
Secondary University
Study year
MEN WOMEN
RII 95 % CI RII 95 % CI
1994
2.4 1.3-4.1 0.7 0.2-1.9
2010 4.1 2.3-7.3 2.7 1.5-4.9
Relative index of inequality (RII) in smoking
by education in 1994 and 2010
Education
level
MEN WOMEN
% OR 95 % CI % OR 95 % CI
University 14.4 1 18.6 1
Vocational 9.3 0.59 0.47-0.74 8.8 0.47 0.4-0.57
Secondary 7.4 0.47 0.37-0.59 4.5 0.25 0.2-0.31
Prevalence of regular wine consumption and
odds ratios (OR)* by sex and level of education
* - age, level of education, place of residence and marital status were included into the
model of logistic regression
Place of
residence
MEN WOMEN
% OR 95 % CI % OR 95 % CI
Cities 53.7 1 15.4 1
Towns 49.0 0.83 0.74-0.93 12.7 0.79 0.69-0.92
Villages 49.3 0.84 0.75-0.94 12.9 0.81 0.70-0.95
Prevalence of regular beer consumption and
odds ratios (OR)* by sex and place of residence
* - age, level of education, place of residence and marital status were included into the model
of logistic regression
Prevalence of daily consumption of fresh vegetables
during the last week among men by education
in 1996-2010
14
141212
3
12
15
20 23
14
3
10
22
2627
17
0
10
20
30
1996 1998 2000 2002 2004 2006 2008 2010
%
Secondary University
Prevalence of daily consumption of fresh vegetables
during the last week among women by education in
1996-2010
16
1719
15
5
1420
24
30
22
7
27
22
27
3332
0
5
10
15
20
25
30
35
1996 1998 2000 2002 2004 2006 2008 2010
%
Secondary University
Prevalence of daily consumption of fresh vegetables
during the last week by sex and place of residence
17.9
15.713.9*
25.3
20.9
18.3*
0
5
10
15
20
25
30
%
MEN WOMEN
Cities
Towns
Willages
* p<0.05 compared to cities
International research projects on health
inequalities in Lithuania
• WHO project “Health Inequalities” (1997)
– Report “Equity in health and health care in Lithuania. A
situation analysis” (1998)
• Tackling health inequalities in Europe. An
integrated approach - EUROTHINE (2004-2007)
The use of Finbalt Health Monitor data on social
differences in health behaviour in Lithuania
• The assessment of the implementation of Lithuanian Health programme
• The reports of National Health Board
• State Food and Nutrition Strategy and Action Plan for 2003-2010
• National alcohol and tobacco control programmes; the laws on tobacco and alcohol control
Health policy formulation addressing health
inequalities in Lithuania
• Lithuanian Health Programme for 1998 – 2010
– general objective on equity in health and health care
• New Lithuanian Health Programme for 2011-2020
– great emphasis on reduction of inequalities in health
Policy addressing socio-economic determinants of
health in Lithuania
• National programme on tackling poverty and
diminishing social gap in Lithuania (2000).
• The strategies and the plans of specific measures
were developed in 2002, 2004, 2006, 2008.
– Reduction of unemployment
– Improvement of access to high quality social service
– Strengthening support for families and children
– More attention to education of socially disadvantaged
groups
Summing-up
Finbalt Health Monitor study was an important
vehicle for evaluation of social differences and
trends in health behaviour. The data are useful to
guide policy making and to support the evaluation
of strategies to reduce health inequalities.
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