Florence Jusot

Comparative appraisal of educational inequalities in overweight and obesity among adults in 19 European countries

BACKGROUND In Western societies, a lower educational level is often associated with a higher prevalence of overweight and obesity. However, there may be important international differences in the strength and direction of this relationship, perhaps in respect of differing levels of socio-economic development. We aimed to describe educational inequalities in overweight and obesity across Europe, and to explore the contribution of level of socio-economic development to cross-national differences in educational inequalities in overweight and obese adults in Europe. METHODS Cross-sectional data, based on self-reports, were derived from national health interview surveys from 19 European countries (N = 127 018; age range = 25-44 years). Height and weight data were used to calculate the body mass index (BMI). Multivariate regression analysis was employed to measure educational inequalities in overweight and obesity, based on BMI. Gross domestic product (GDP) per capita was used as a measure of level of socio-economic development. RESULTS Inverse educational gradients in overweight and obesity (i.e. higher education, less overweight and obesity) are a generalized phenomenon among European men and even more so among women. Baltic and eastern European men were the exceptions, with weak positive associations between education and overweight and obesity. Educational inequalities in overweight and obesity were largest in Mediterranean women. A 10 000-euro increase in GDP was related to a 3% increase in overweight and obesity for low-educated men, but a 4% decrease for high-educated men. No associations with GDP were observed for women. CONCLUSION In most European countries, people of lower educational attainment are now most likely to be overweight or obese. An increasing level of socio-economic development was associated with an emergence of inequalities among men, and a persistence of these inequalities among women.

Job loss from poor health, smoking and obesity: a national prospective survey in France

Background and objectives: Health selection into unemployment may be either direct or operate by reference to health-related behaviours rather than health per se (indirect selection). Panel data are desirable to investigate selection effects, and the two types of selection processes may be concurrent. We examine jointly the roles of health and health-related behaviours as precursors of unemployment, in order to disentangle direct from indirect selection processes. Design: The data of a multi-round nationally representative health survey in France were analysed longitudinally, based on three data collection rounds: 1992–5, 1996–8 and 2000–2. Following employees salaried in the private sector and aged 30–54 years at baseline, we explored through logistic regression the influence of non-optimal self-rated health, smoking and obesity on the risk of being found unemployed 4 years later. Results: After adjustment for self-rated health, obesity was found to be a significant precursor of unemployment in women, and heavy smoking had that role in men. After adjustment for smoking and obesity, poor health at baseline was found to be a significant precursor of unemployment in both genders. Conclusion: Those findings confirm the intrinsic role of poor health and of health-related behaviours as precursors of unemployment, with gender-specific patterns for the latter. Public policy prescriptions regarding employees’ protection from job insecurities should integrate appropriate accommodations of health limitations, and the personal factors underlying unfavourable work and health behaviours should be investigated, in order to thwart indirect selection phenomena.

Circumstances and efforts: how important is their correlation for the measurement of inequality of opportunity in health?

The way to treat the correlation between circumstances and effort is a central, yet largely neglected issue in the applied literature on inequality of opportunity. This paper adopts three alternative normative ways of treating this correlation championed by Roemer, Barry and Swift and assesses their empirical relevance using survey data. We combine regression analysis with the natural decomposition of the variance to compare the relative contributions of circumstances and efforts to overall health inequality according to the different normative principles. Our results suggest that, in practice, the normative principle on the way to treat the correlation between circumstances and effort makes little difference on the relative contributions of circumstances and efforts to explained health inequality.

Mediating role of education and lifestyles in the relationship between early-life conditions and health: evidence from the 1958 British cohort.

The paper focuses on the long-term effects of early-life conditions with comparison to lifestyles and current socioeconomic factors on health status in a cohort of British people born in 1958. Using the longitudinal follow-up data at age 23, 33, 42 and 46, we build a dynamic model to investigate the influence of each determinant on health and the mediating role of education and lifestyles in the relationship between early-life conditions and later health. Direct and indirect effects of early-life conditions on adult health are explored using auxiliary linear regressions of education and lifestyles and panel Probit specifications of self-assessed health with random effects addressing individual unexplained heterogeneity. Our study shows that early-life conditions are important parameters for adult health, their contribution to health disparities increases from 17.8% to 23% when mediating effects are identified. They also shape other health determinants: the contribution of lifestyles reduces from 28% down to 22% when indirect effects of early-life conditions are distinguished. Noticeably, the absence of father at the time of birth and experience of financial hardships represent the lead factors for direct effects on health. The absence of obesity at 16 influences health both directly and indirectly working through lifestyles.

Contribution of lifelong adverse experiences to social health inequalities: findings from a population survey in France

BACKGROUND Recent research shows that adverse experiences, such as economic hardships or exclusion, contribute to deterioration of health status. However, individuals currently experiencing adverse experiences are excluded from conventional health surveys, which, in addition, often focus on current social situation but rarely address past adverse experiences. This research explores the role of such experiences on health and related social inequalities based on a new set of ad hoc questions included in a regular health survey. METHODS In 2004, the National Health, Health Care and Insurance Survey included three questions on lifelong adverse experiences (LAE): financial difficulties, housing difficulties due to financial hardship, isolation. Logistic regressions were used to analyse associations between LAE, current socio-economic status (SES) (education, occupation, income) and health status (self-perceived health, activity limitation, chronic morbidity), on a sample of 4308 men and women aged ≥35 years. RESULTS LAE were reported by 20% of the sample. They were more frequent in low SES groups but concerned >10% of the highest income group. LAE increased the risk of poor self-perceived health, diseases and activity limitations, even after controlling for current SES [odds ratio (OR) > 2]. LAE experienced only during childhood are also linked to health. LAE account for up to 32% of the OR of activity limitations associated with the lowest quintile among women and 26% among men. CONCLUSIONS LAE contribute to the social health gradient and explain variability within social groups. It is useful to take lifetime social factors into account when monitoring health inequalities.

MEDIATING ROLE OF EDUCATION AND LIFESTYLES IN THE RELATIONSHIP BETWEEN EARLY-LIFE CONDITIONS AND HEALTH: EVIDENCE FROM THE 1958 BRITISH COHORT: MEDIATING ROLE OF EDUCATION AND LIFESTYLES

The paper focuses on the long-term effects of early-life conditions with comparison to lifestyles and educational attainment on health status in a cohort of British people born in 1958. Using the longitudinal follow-up data at age 23, 33, 42 and 46, we build a dynamic model to investigate the influence of each determinant on health and the mediating role of education and lifestyles in the relationship between early-life conditions and later health. Direct and indirect effects of early-life conditions on adult health are explored using auxiliary linear regressions of education and lifestyles and panel Probit specifications of self-assessed health with random effects addressing individual unexplained heterogeneity. Our study shows that early-life conditions are important parameters for adult health accounting for almost 20% of explained health inequality when mediating effects are identified. The contribution of lifestyles reduces from 32% down to 25% when indirect effects of early-life conditions and education are distinguished. Noticeably, the absence of father at the time of birth and experience of financial hardships represent the lead factors for direct effects on health. The absence of obesity at 16 influences health both directly and indirectly working through lifestyles.

Social health inequalities among older Europeans: the contribution of social and family background

This analysis aims to get a step further in the understanding of the determining factors of social health inequalities, and to explore particularly the role played by parents’ social status and their vital status or age at death on the social health inequalities in adulthood among European older adults. The wealth-related health inequalities are measured using the popular concentration index. We then implement the decomposition method of the indices and evaluate the contribution of the various determinants of health introduced in interval regression models. Health is measured using self-assessed health and country-specific cut-points that correct observed differences in self-report due to cross-cultural differences in reporting styles. This paper uses data for ten European countries from the first wave of the 2004 SHARE. The study highlights significantly higher wealth-related health inequalities in the Netherlands, Denmark and Germany. These social inequalities of health in Europe are explained largely by individuals’ current social conditions, particularly wealth. Nevertheless, our analysis attests the existence of a long-term influence of initial conditions in childhood on health in middle-aged and beyond, independently of current social characteristics, which contribute to differences in health status across social groups. This article contributes to the identification of social determinants, which are important determinants of health and follows recommendations suggested to help ‘close the gap’ in various health inequities.

The role of time and risk preferences in smoking inequalities: a population-based study.

Heterogeneity in time and risk preferences has been proposed as one of the mechanisms involved in the educational gradient in smoking, but this mechanism has scarcely been explored empirically. Subjective scales were introduced in the 2008 French National Health, Health Care and Insurance Survey in order to elicit measures of time and risk preferences for a representative sample of 5188 men and 5684 women. Men and women were treated separately. First, logistic regressions were used to test the associations between preferences and education and between preferences and smoking. Second, nested logistic models were built to investigate the mediating role of preferences in the educational gradient in smoking, with an econometric treatment of the rescaling problem. Preference for the present and risk loving were found to be: inversely related to educational level; strongly related to each other, and; strongly associated to current smoking, even after adjustment for educational level. There was a weakening of the educational gradient after the control for preferences, which supports the role of these two preferences as partial mediators in the educational gradient in smoking. Among men, time preference was more strongly associated with smoking than risk aversion, while the reverse was found for women. We provide convincing evidence in favour of the mediating role of time preference and risk aversion in educational inequalities in smoking and highlight the connection between those two dimensions. Gender patterns are discussed and potential implications in terms of designing targeted anti-tobacco programmes are delineated.

The Shape of the Relationship Between Mortality and Income in France

Using a case-control study constructed with two fiscal databases, this paper investigates the shape of the relationship between income and the probability of death in France. The results show that the risk of mortality is strongly correlated with the level of income, independent from the occupational status. This relationship holds across the whole range of income distribution. Specifically the protective effect of highest incomes casts some doubt on the hypothesis of the concavity of the income-health relationship.

Access to psycho-social resources and health: exploratory findings from a survey of the French population

We study the psycho-social determinants of self-assessed health in order to explain social inequalities in health in France. We use a unique general population survey to assess the respective impact on self-assessed health status of subjective perceptions of social capital, social support, and sense of control, controlling for standard socio-demographic factors (SES, income, education, age, and gender). The survey is unique in that it provides a variety of measures of self-perceived psycho-social resources (trust and civic engagement, social support, sense of control, and self-esteem). We find empirical support for the link between the subjective perception of psycho-social resources and health. Sense of control at work is the most important correlate of health status after income. Other important ones are civic engagement and social support. To a lesser extent, sense of being lower in the social hierarchy is associated with poorer health status. On the contrary, relative deprivation does not affect health in our survey. Since access to psycho-social resources is not equally distributed in the population, these findings suggest that psycho-social factors can partially explain of social inequalities in health in France.