New insights into health care inequalities
Health care inequalities are associated with factors such as living conditions, psychosocial determinants, lifestyle and access to critical services such as health care. Tackling health care inequalities and understanding their determinants requires accounting for the actions of individuals, communities, private companies and governments. Currently, empirical evidence on ideal solutions are lacking as researchers have only recently begun developing and evaluating suitable interventions. Funded by the EU, the DEMETRIQ (Developing methodologies to reduce inequalities in the determinants of health) project explored natural policy experiments to effectively reduce health care inequalities in various European states. The project developed, evaluated and refined methodologies to identify policies that reduce health care inequalities among socioeconomic groups. Natural policy experiments were conducted to determine differential health effects by socioeconomic group. Factors taken into account include unemployment and poverty reduction, tobacco and alcohol control, and access to education and preventative health care. These results were used to engage stakeholders and promote knowledge exchange for enhanced policies and practices. Project members employed a mixed approach to better understand which policies work, and how and why they work. They selected natural policy experiments for review and produced guidance reports that evaluate their impacts on social inequalities in health. One work group processed data by socioeconomic group on risk factors and morbidity covering 27 countries, as well as mortality data from 22 countries. Interestingly, the project team found it easier to identify policy experiments that increased inequalities in different countries rather than those that bridged the gap. It also highlighted the difficulty in pinpointing the success of policies such as flexicurity, tobacco control efforts, increase in higher education, and primary care reform in central and eastern Europe. Nonetheless, the project team successfully identified different positive impacts of policies related to increasing employment for the underprivileged, financial security, breast cancer screening and health care funding. Although DEMETRIQ's results and recommendations can certainly support policy making to reduce inequalities in health care, the project team has called for additional research to support this drive. The expected positive impact on public health policy will ultimately translate to economic impact and reduced health care system losses arising from socioeconomic inequalities.
Keywords
Health care, inequalities, unemployment, poverty, tobacco, alcohol
