social determinants and health inequlities,...

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


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


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


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


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


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


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


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


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


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


Side 12


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


Mental illness

25,8

20,2

13,7

1

3,5

0

5

10

15

20

25

30


Side 14


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


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


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


• 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


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


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


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


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


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


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


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

Side 26


Thank you

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.

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