The question of how to reduce inequalities in mortality, which are caused by a range of risks factors, such as smoking or obesity, is one of the biggest challenges for European health policies.In particular it remains unclear which of these factors are the most important determinants of the observed inequalities and therefore should be addressed first by policy interventions. A recent study by Terje A Eikemo et al. tries to resolve this problem by quantifying the potential for reducing inequalities in mortality by looking at a number of key determinants in 21 European populations. It finds that, in general, upward levelling of inequalities in smoking, low income levels and economic inactivity hold the greatest potential for reducing inequalities in mortality.
Eikemo and his colleagues investigate the determinants of health and mortality inequalities among different socioeconomic groups in Europe. As differences in health and mortality continue to be considerable between European countries, they see significant room to reduce these disparities. For that reason, they analyse mortality from 2000-2005 and take into account six health risk factors based on educational level in 21 European populations. As key health determinants, they study the effect of several behavioural risks, such as smoking, obesity and lack of physical exercise and some socioeconomic factors like lack of social participation, low income level and economic activity. They find that trying to reduce smoking among men and improving women’s physical condition, together with increasing one’s income level and reducing economic inactivity differences for both sexes, are the most determining elements that could decrease mortality disparities across Europe.
Authors quantify the expected changes in mortality by altering the exposure to these six risk factors. Depending on the country, up to 10% of deaths among the lower-educated people could be avoided if their exposure to these risk factors decreased to the level of those with a higher education level.
Reducing overall socioeconomic differences
Reducing disparities among income levels and in economic inactivity are very important determinants in the reduction of mortality differences for both men and women. Policies in this direction could decrease mortality in more than 80 cases per 100,000 in one year. In some countries, like Hungary, this improvement could be very significant (avoiding 453 deaths per 100,000 per year among men and 113 deaths among women). Consequently, policies like improving income distribution and the labour market, and improved social policies could substantially reduce disparities in mortality among the European population.
Fewer men and more women in better shape
Another very effective way to reduce mortality rates within the male population throughout Europe, but especially among the Central/Eastern and Northern populations, is by reducing disparities in smoking between educational groups within a country. In only one year, this could reduce mortality rate differences among men by more than 80 deaths per 100,000.
Among women, however, policies should prioritise working towards improving their physical condition by reducing and eliminating differences in obesity and physical inactivity. These two aspects are especially important risk factors for women living in the South.
Results also suggest that country-based strategies are needed in order to continue improving mortality levels, since most of them could be an example or best practice case for the others depending on the target health risk. Thus, the authors encourage countries to increase and systematise exchange on experiences battling the determinants of health disparities.
This Population Digest has been published with financial support from the Progress Programme of the European Union in the framework of the project “Supporting a Partnership for Enhancing Europe’s Capacity to Tackle Demographic and Societal Change”.