Social determinants and health inequalities- country report Denmark
Expert Group on Social Determinants and Health Inequalities 26-27 November 2007, Luxembourg
Tine Curtis, PhDResearch Programme Director
Health behaviour, life style and living conditions
University of Southern Denmark
Side 2
Inequalities in health – country report DenmarkUniversity of Southern Denmark
The policy situation regarding action to tackle health health inequalities
Side 3
Inequalities in health – country report DenmarkUniversity of Southern Denmark
0 1000 2000 3000 4000 5000 6000 7000 8000
Smoking
Short education
Physical inactivity
Alcohol abuse
Few fruits and vegatables
Too much fat
Passive smoking
Limited social network
Psykosocial work-stress
Overweight
Drug abuse
Trafic accidents
Number of deaths
Men
Women
Results of research creating concernRisk factors and public health in Denmark
Risk factors and mortality
Juel K, Sørensen J, Brønnum-Hansen H, 2006
Side 4
Inequalities in health – country report DenmarkUniversity of Southern Denmark
The Danish National Health Interview Surveys
Conducted in 1987, 1994, 2000 and 2005Representative on a national and regional level
Interview and self-administered questionnairesSelf-reported health, health behaviour, use of health care, living conditions, values, etc.
2005:Interviews N=14.566Self-administered questionnaires N=11.238
Re-interviews with participants from 1994Register-based follow-up
Side 5
Inequalities in health – country report DenmarkUniversity of Southern Denmark
Occupational level and rate of daily smokersDanish Health Interview Survey 2005
24,6
35,9
42,445,8
53,4
18,1
0
10
20
30
40
50
60
High level occupationMedium level occupationBasic level occupationOther employmentUnemployedSocial or illness pension
Side 6
Inequalities in health – country report DenmarkUniversity of Southern Denmark
Education and trend in daily smokingDanish Health Interview Surveys
47 484244 47
3441 41
2936 37
25
0
10
20
30
40
50
60
<10 år 10-12 år 13+ år
Combined year in school and further education
Proc
ent (
%)
1987 1994 2000 2005
A positive trend in a health determinant that go hand-in-hand with widening inequality in its social distribution
Side 7
Inequalities in health – country report DenmarkUniversity of Southern Denmark
Low self-rated health – smoking and physical inactivityDanish Health Interview Survey 2005
23,5
14,5
55,851,2
34,334,5
0
20
40
60
<=10 år 11-12 år 13+ år
Pro
cen
t (%
)
Total Both smoking & inactive
Side 8
Inequalities in health – country report DenmarkUniversity of Southern Denmark
Low self-rated health among low educated -low quality housing and inadequate social network The Danish Health Interview Survey 2005
50,254,0
35,0
0
10
20
30
40
50
60
Low level of education
Total - low eduationLow quality housingFew social relations
Side 9
Inequalities in health – country report DenmarkUniversity of Southern Denmark
Ethnicity and health behaviourDanish Health Interview Survey 2005
47,2
74,3
51,0
33,3
56,7
37,7
0
20
40
60
80
Seen familydoctor past 3
months
Measuredcholesterol
Believe in ownhealth
behaviour
Pro
cen
t (%
)
Danes
Non-Western immigrants
A question of differences in social position or culture?
Side 10
Inequalities in health – country report DenmarkUniversity of Southern Denmark
Long-standing illness
46,648,7
25
7,512,0
0
10
20
30
40
50
60
Alcohol abusersMentally vulnerableLow socio-economicsLow social networkNot socially marginalised
Analyses of the ‘worst off’ respondents of the Danish National Health Interview Survey 2005
Side 11
Inequalities in health – country report DenmarkUniversity of Southern Denmark
Contact with health care services,past 3 months
62,257,7
51,1
36,2
46,6
0
10
20
30
40
50
60
70
Alcohol abusersMentally vulnerableLow socio-economicsLow social networkNot socially marginalised
Side 12
Inequalities in health – country report DenmarkUniversity of Southern Denmark
Low or very low self-rated health
28,9
35,1
18,6
3,3
8,3
0
5
10
15
20
25
30
35
40
Alcohol abuserMentally vulnerableLow socio-economicsLow social relationsNot socially marginalised
Side 13
Inequalities in health – country report DenmarkUniversity of Southern Denmark
Mental illness
25,8
20,2
13,7
1
3,5
0
5
10
15
20
25
30
Alcohol abusersMentally vulnerableLow socio-economicsLow social networkNot socially marginalised
Side 14
Inequalities in health – country report DenmarkUniversity of Southern Denmark
No participation in organised leisure time activities
40,9
48,544,7
20,2
34,5
0
10
20
30
40
50
60
Alcohol abusersMentally vulnerableLow socio-economicsLow social networkNot socially excluded
Healthy eating habits among people with diabetes, – unpublished results from a Danish regional survey
111
22 23
29
36
14
05
10152025303540
High education
Mediumeducation
Low education
Side 16
Inequalities in health – country report DenmarkUniversity of Southern Denmark
KRAM – a Danish HIS/HES• 13 municipalities 2007 and 2008• Internet based questionnaire – exp. 100.000 responses• Health examination – exp. 20.000 participants• Local health promotion activities and campaigns
Side 17
Inequalities in health – country report DenmarkUniversity of Southern Denmark
Motivation to become more physically active among those who are not already active, by years of education
39 55 60 670
10
20
30
40
50
60
70
<10 years 10-12 years 13-14 years 15+ years
%
KRAM, results from 1 municipality (N=17.000)
Side 18
Inequalities in health – country report DenmarkUniversity of Southern Denmark
• Are motivated because they want to be fit, look good and as relaxation (lower education: being together and having fun with others)
• Have more suggestions as to what the municipality can do to help them become more active
• Would like more activities with high levels of ’action’, out-doors and family-oriented (lower education: low-impact, ill-health oriented)
Among those who are motivated but are not already active, respondents with longer education …
Side 19
Inequalities in health – country report DenmarkUniversity of Southern Denmark
People we don’t reach with existing surveys
• The socially most disadvantaged; the 1-10 % worst off
• People without an address – the homeless, many prostitutes
• People who can’t manage visitors (interviewers) or read and respond to self-administered questionnaires – the mentally ill, severe alcoholics, drug abusers
Side 20
Inequalities in health – country report DenmarkUniversity of Southern Denmark
Health survey of the socially disadvantaged (Danish name: SUSY UDSAT)
• Cooperation between the Council for Socially Marginalised Peopleand the National Institute of Public Health
• Questionnaire survey – self-administered or with help
• Distributed through shelters, counselling centres, nurses on wheels and various organisations
• Respondents who are socially marginalised and either homeless, drug abusers, prostitutes, mentally ill or alcoholics
Side 21
Inequalities in health – country report DenmarkUniversity of Southern Denmark
Status Nov 2007
• Report with survey results April 2008
• Qualitative studies spring 2008
• Registry-based analyses autumn 2008
• Final report end of 2008
Received app. 1.300 questionnairesPersonal Identification Number from 80%
Side 22
Inequalities in health – country report DenmarkUniversity of Southern Denmark
National health inequalities policies
• National public health programmes aim at reducing social inequalities in health, but without specific, quantitative targets
• Two waves of focus on social inequality in health1990’ies: the gradient, illustrating disparities in determinants of health2005- : marginalisation, supporting (local) projects on social exclusion
• 2007: ’New’ government• New ministry of ’Health and health promotion’• Health promotion commission• Focus on health inequalities – as the most disadvantaged groups and marginalisation
A shift from tackling inequalities in social position to tackling the most negative consequences on people’s health of the (existing) inequalities?
Side 23
Inequalities in health – country report DenmarkUniversity of Southern Denmark
New structure for health care and health promotion in Denmark
• From January 1st 2007• Health care – hospitals and primary care – is the responsibility
of 5 regions• Health promotion and prevention outside hospitals is the
responsibility of 98 municipalities
• Knowledge-gap on health promotion interventions and best practices at the local level
• Effectiveness• Implementation• Organisation• Etc.
Side 24
Inequalities in health – country report DenmarkUniversity of Southern Denmark
Municipal health policiesNumer of municipalities (N=98)
37
22
3339
24
40
9
2230
24
14
2420
14
28
9
11
13
0
10
20
30
40
50
60
70
Bredt s
undhed
sbeg
reb
Livskva
litet
Lighed i s
undh
ed
Kommunen
skab
er ra
mmer
Sundh
edsk
onsek
vens
Samarb
ejdsp
arter
Evidens
Gennemarbejdet/godt i gang
Vedtaget
Side 25
Inequalities in health – country report DenmarkUniversity of Southern Denmark
Health inequalities projects
The National Board of Health is supporting local model projects:
• Healthy lifestyle among socially vulnerable groups• Life style and health care services targeted the socially
disadvantaged (drug and alcohol addicts and homeless)
Danish participation in EU-project: Determinehttp://www.health-inequalities.eu
This paper was produced for a meeting organized by Health & Consumer Protection DG and represents the views of its author on thesubject. These views have not been adopted or in any way approved by the Commission and should not be relied upon as a statement of the Commission's or Health & Consumer Protection DG's views. The European Commission does not guarantee the accuracy of the dataincluded in this paper, nor does it accept responsibility for any use made thereof.