Angela Donkin

Socioeconomic inequalities in mortality among elderly people in 11 European populations

Study objective: To describe mortality inequalities related to education and housing tenure in 11 European populations and to describe the age pattern of relative and absolute socioeconomic inequalities in mortality in the elderly European population. Design and Methods: Data from mortality registries linked with population census data of 11 countries and regions of Europe were acquired for the beginning of the 1990s. Indicators of socioeconomic status were educational level and housing tenure. The study determined mortality rate ratios, relative indices of inequality (RII), and mortality rate differences. The age range was 30 to 90+ years. Analyses were performed on the pooled European data, including all populations, and on the data of populations separately. Data were included from Finland, Norway, Denmark, England and Wales, Belgium, France, Austria, Switzerland, Barcelona, Madrid, and Turin. Main results: In Europe (populations pooled) relative inequalities in mortality decreased with increasing age, but persisted. Absolute educational mortality differences increased until the ages 90+. In some of the populations, relative inequalities among older women were as large as those among middle aged women. The decline of relative educational inequalities was largest in Norway (men and women) and Austria (men). Relative educational inequalities did not decrease, or hardly decreased with age in England and Wales (men), Belgium, Switzerland, Austria, and Turin (women). Conclusions: Socioeconomic inequalities in mortality among older men and women were found to persist in each country, sometimes of similar magnitude as those among the middle aged. Mortality inequalities among older populations are an important public health problem in Europe.

A minimum income for healthy living

BACKGROUND Half a century of research has provided consensual evidence of major personal requisites of adult health in nutrition, physical activity and psychosocial relations. Their minimal money costs, together with those of a home and other basic necessities, indicate disposable income that is now essential for health. METHODS In a first application we identified such representative minimal costs for healthy, single, working men aged 18–30, in the UK. Costs were derived from ad hoc survey, relevant figures in the national Family Expenditure Survey, and by pragmatic decision for the few minor items where survey data were not available. RESULTS Minimum costs were assessed at £131.86 per week (UK April 1999 prices). Component costs, especially those of housing (which represents around 40% of this total), depend on region and on several assumptions. By varying these a range of totals from £106.47 to £163.86 per week was detailed. These figures compare, 1999, with the new UK national minimum wage, after statutory deductions, of £105.84 at 18–21 years and £121.12 at 22+ years for a 38 hour working week. Corresponding basic social security rates are £40.70–£51.40 per week. INTERPRETATION Accumulating science means that absolute standards of living, “poverty”, minimal official incomes and the like, can now be assessed by objective measurement of the personal capacity to meet the costs of major requisites of healthy living. A realistic assessment of these costs is presented as an impetus to public discussion. It is a historical role of public health as social medicine to lead in public advocacy of such a national agenda.

Mapping access to food at a local level

Access to food is currently on the political agenda. This paper presents a quantitative method for local level use to help identify the geographic location of areas with inadequate access to food. A census of retail outlets selling food of any kind was carried out in a deprived area within a 2km radius from a central point between two estates. Information on the price and availability of “healthy” food lists, acceptable to each of the four major ethnic groups in the area, was collected. The food lists were not mutually exclusive. Food shops were mapped in terms of food availability and price indices using Geographical Information System (GIS) software. Maps show, progressively: roads within/outside 500m of a postcode with any outlet selling food; any outlet selling more than 50 per cent of the food list, below the area mean price, acceptable to a Gujarati Hindu; the latter in relation to population density. Within the area analysed there appears to be reasonable walking access to the more reasonably priced shops within the area, however the cost of a healthy diet would still require more than 50 per cent of the income of someone in receipt of income support.

Educational Level and Stroke Mortality A Comparison of 10 European Populations During the 1990s

Background and Purpose— Variations between countries in occupational differences in stroke mortality were observed among men during the 1980s. This study estimates the magnitude of differences in stroke mortality by educational level among men and women aged ≥30 years in 10 European populations during the 1990s. Methods— Longitudinal data from mortality registries were obtained for 10 European populations, namely Finland, Norway, Denmark, England/Wales, Belgium, Switzerland, Austria, Turin (Italy), Barcelona (Spain), and Madrid (Spain). Rate ratios (RRs) were calculated to assess the association between educational level and stroke mortality. The life table method was used to estimate the impact of stroke mortality on educational differences in life expectancy. Results— Differences in stroke mortality according to educational level were of a similar magnitude in most populations. However, larger educational differences were observed in Austria. Overall, educational differences in stroke mortality were of similar size among men (RR, 1.27; 95% CI, 1.24 to 1.30) and women (RR, 1.29; 95% CI, 1.27 to 1.32). Educational differences in stroke mortality persisted at all ages in all populations, although they generally decreased with age. Eliminating these differences would on average reduce educational differences in life expectancy by 7% among men and 14% among women. Conclusions— Educational differences in stroke mortality were observed across Europe during the 1990s. Risk factors such as hypertension and smoking may explain part of these differences in several countries. Other factors, such as socioeconomic differences in healthcare utilization and childhood socioeconomic conditions, may have contributed to educational differences in stroke mortality across Europe.

Children′s Food Preferences: Television Advertising vs Nutritional Advice

Reports a survey of 507 parents of 7 to 11‐year‐old children in the Central Television district of the UK to ascertain what food products children requested and the effects of television advertising on children′s food preferences. The questionnaire found that 45 per cent of products requested had an extrinsic sugar content and 39 per cent of requests were for advertised foods. In addition a wide range of products were requested reflecting sophisticated tastes and, sometimes, healthy eating concern. Discusses the contradictory nature of messages about food that children receive and suggests that healthy eating campaigns should use specific food items as examples and advertisements should convey non‐misleading nutritional information.

Dietary supplement use in later life

Describes self‐reported dietary supplement use among elderly people in the UK and explores the association between supplement use and socioeconomic, physical and dietary factors. A three‐phase survey incorporating face‐to‐face interviews, self‐completed four‐day dietary diaries with a food frequency questionnaire and follow‐up face‐to‐face interviews took place in urban Nottingham and rural Nottinghamshire, Lincolnshire and Leicestershire. A total of 957 elderly people (aged over 65) were randomly selected from general practitioner lists. A total of 36 per cent of the urban respondents and 41 per cent of rural respondents were taking at least one dietary supplement. Respondents who did not smoke were of a higher social class and had more qualifications were the most likely to take supplements. Fish oil was the most commonly taken supplement, followed by multivitamins, garlic tablets and vitamin C. The mean dietary intake of all respondents was above the reference nutrient intakes (RNIs) for nutrients studied. The diets of supplement users, excluding nutrients derived from supplementation, contained more iron, vitamin C, fibre, folate and oily fish than non‐users. Dietary supplement usage is widespread among the UK elderly, although supplement users within this sample do not appear to have diets which warrant supplementation to meet RNIs in the nutrients studied. Many advantages are, however, reported of consuming fish oils, garlic and higher intakes of anti‐oxidants.

Healthy eating in primary schools: an educational perspective from a socially deprived area

The issue of access to cheap and healthy food for those living in poverty is now part of the social and health agenda in the United Kingdom. The pilot study described in this paper is investigating access to healthy food in a deprived area of London. The study has three interrelated elements: the local community, the school as part of the community and geographical mapping. The paper focuses on the work that has been undertaken with primary schools in the study area, identifying the strategies being used to collect data and outlining some preliminary findings.