Tim Huijts

Self-reported health assessments in the 2002 World Health Survey: how do they correlate with education?

OBJECTIVEnTo assess the value of self-rated health assessments by examining the association between education and self-rated poor health.nnnMETHODSnWe used the globally representative population-based sample from the 2002 World Health Survey, composed of 219,713 men and women aged 25 and over in 69 countries, to examine the association between education and self-rated poor health. In a binary regression model with a logit link function, we used self-rated poor health as the binary dependent variable, and age, sex and education as the independent variables.nnnFINDINGSnGlobally, there was an inverse association between years of schooling and self-rated poor health (odds ratio, OR: 0.929; 95% confidence interval, CI: 0.926-0.933). Compared with the individuals in the highest quintile of years of schooling, those in the lowest quintile were twice as likely to report poor health (OR: 2.292; 95% CI: 2.165-2.426). We found a dose-response relationship between quintiles of years of schooling and the ORs for reporting poor health. This association was consistent among men and women; low-, middle- and high-income countries; and regions.nnnCONCLUSIONnOur findings suggest that self-reports of health may be useful for epidemiological investigations within countries, even in low-income settings.

Income-related health inequalities in the Nordic countries: examining the role of education, occupational class, and age.

Numerous studies have concluded that peoples socioeconomic position is related to mortality and morbidity, but that the strength of this association varies considerably both within and between European regions. This has spurred several researchers to more closely examine educational and occupational gradients in health in the Nordic countries to clarify the causes of cross-national differences. However, comparable studies using income as an indicator of socioeconomic position are still lacking. This study uses recent and highly comparable data to fill this gap. The aim of this study is threefold. First, we ask to what extent there is an income gradient in health in the Nordic countries, and to what extent the association differs between these countries. Second and third, we examine whether differences in the attenuation of the income gradient by education and occupational class, and age-specific differences between countries, may act as explanations for differences in the income gradient between the Nordic countries. The data source are three waves of the European Social Survey (ESS, 2002/2004/2006), which included 17,801 people aged 25 and over from Denmark, Finland, Norway, and Sweden. Two subjective health measures (physical/mental self reported health and limiting longstanding illness) were analysed by means of logistic regression. The results show that, in all countries, people reported significantly better health and were less likely to suffer from longstanding illness as they had a higher income. This association is strongest in Norway and Finland and weakest in Denmark. The income gradient in health, but not country differences in this gradient, is partly explained by education and occupational class. Additionally, the strength of the income gradient in health varies between age groups. The relatively high health inequalities between income groups in Norway and Finland are already visible in the youngest age groups. The results imply that the socioeconomic gradient in health will arguably not be strongly reduced in the near future as a result of cohort replacement, as has been suggested in previous studies. Health policy interventions may be particularly important five to ten years prior to retirement and in early adulthood.

Causality, social selectivity or artefacts? Why socioeconomic inequalities in health are not smallest in the Nordic countries

The Nordic welfare states aim at providing equality of the highest standards for all their citizens. However, numerous studies have demonstrated that socioeconomic inequalities in morbidity and mortality are not among the smallest in these countries as compared with other European regions.1–7 Recently, this has spurred health researchers to evaluate the extent to which the Nordic welfare regime is capable of diminishing socioeconomic health inequalities.8,9 After all, the conclusion that the Nordic welfare regime does not succeed in reducing health inequalities would have serious implications for health policy world wide. In this commentary, we aim at evaluating why the Nordic welfare regime does not completely succeed in reducing socioeconomic inequalities in health, despite its egalitarian nature. Our presentation is divided into three types of explanations: causality, social selectivity and artefacts.nnScholars have generally argued that a distinction should be made between relative and absolute socioeconomic health inequalities. Moreover, the absolute health status of the weakest socioeconomic groups (e.g. manual workers) is considered to be most important as a marker of the ability of welfare regimes to reduce socioeconomic disparities in health. Using this distinction, it was concluded that whereas the Nordic countries perform only intermediately whenever relative inequalities are considered, they have lower absolute inequalities and a higher average absolute health status of the lowest socioeconomic groups as compared with other European societies (although this applies mostly to Sweden and Norway, and only to a lesser extent to Denmark and Finland). Since the authors argue that welfare regime performance should mainly be evaluated …

Religious Involvement, Religious Context, and Self-Assessed Health in Europe

In the present study, the authors examine the extent to which effects of individual religious involvement on self-assessed health are influenced by the religious context (i.e., religious involvement at the country level). The authors test their expectations using individual level data (N = 127,257) on 28 countries from the European Social Surveys (2002–2008). Results of multilevel analyses show that individual religious attendance is positively related to self-assessed health in Europe. Protestants appear to feel healthier than Catholics. Moreover, modeling cross-level interactions demonstrates that religious denominations at the national level are influential: The health advantage of Protestants as compared to Catholics is greater as the percentage of Protestants in a country is higher, yet smaller as countries have a higher percentage of Catholics. The association between religious attendance and self-assessed health does not depend on the national level of religious attendance.

Association between political ideology and health in Europe

Studies have largely examined the association between political ideology and health at the aggregate/ecological level. Using individual-level data from 29 European countries, we investigated whether self-reports of political ideology and health are associated. In adjusted models, we found an inverse association between political ideology and self-rated poor health; for a unit increase in the political ideology scale (towards right) the odds ratio (OR) for reporting poor health decreased (OR 0.95, 95% confidence interval 0.94-0.96). Although political ideology per se is unlikely to have a causal link to health, it could be a marker for health-promoting latent attitudes, values and beliefs.

Explaining health marginalisation of the lower educated: the role of cross-national variations in health expenditure and labour market conditions

Several studies have shown ample cross-national variation in the risk that lower educated people run to be in poor health. However, explanations for this cross-national variation are still scarce. In this article we aim at filling this lacuna by investigating to what extent cross-national variation in the health gap between the lower and higher educated in Europe is explained by governmental health expenditure, namely, how much governments contribute to a countrys total healthcare costs, and labour market conditions, that is, unemployment rates and modernisation of the labour market. We used information from the European Social Survey (ESS) 2002-2008 on more than 90,000 individuals in 32 European nations, and estimated hierarchical models with cross-level interactions to test our expectations. Our results show that the relative risk of being in poor health of lower educated individuals is smaller in countries where the government spends much on healthcare and with a highly modernised labour market.

Political regimes, political ideology, and self-rated health in Europe: A multilevel analysis

Background Studies on political ideology and health have found associations between individual ideology and health as well as between ecological measures of political ideology and health. Individual ideology and aggregate measures such as political regimes, however, were never examined simultaneously. Methodology/Principal Findings Using adjusted logistic multilevel models to analyze data on individuals from 29 European countries and Israel, we found that individual ideology and political regime are independently associated with self-rated health. Individuals with rightwing ideologies report better health than leftwing individuals. Respondents from Eastern Europe and former Soviet republics report poorer health than individuals from social democratic, liberal, Christian conservative, and former Mediterranean dictatorship countries. In contrast to individual ideology and political regimes, country level aggregations of individual ideology are not related to reporting poor health. Conclusions/Significance This study shows that although both individual political ideology and contextual political regime are independently associated with individuals self-rated health, individual political ideology appears to be more strongly associated with self-rated health than political regime.

Immigrants’ Health in Europe: A Cross-Classified Multilevel Approach to Examine Origin Country, Destination Country, and Community Effects

In this study, we examined origin, destination, and community effects on first- and second-generation immigrants’ health in Europe. We used information from the European Social Surveys (2002–2008) on 19,210 immigrants from 123 countries of origin, living in 31 European countries. Cross-classified multilevel regression analyses reveal that political suppression in the origin country and living in countries with large numbers of immigrant peers have a detrimental influence on immigrants’ health. Originating from predominantly Islamic countries and good average health among natives in the destination country appear to be beneficial. Additionally, the results point toward health selection mechanisms into migration.

RE: “ARE AMERICANS FEELING LESS HEALTHY? THE PUZZLE OF TRENDS IN SELF-RATED HEALTH”

Comparing aggregate levels of self-rated health in 4 national surveys conducted between 1971 and 2007 in theUnited States, Salomon et al. (1) conclude that self-rated health is unsuitable for monitoring changes in population health and health disparities over time. While the study raises important issues related to comparisons of self-rated health over time,we do not see their study as evidence against the use of self-rated health in population health research, for the following reasons. First, Salomon et al. (1) conclude that self-rated health levels were very different in the 4 surveys examined. Close

Intergenerationale overdracht van risicogedrag: Rookgedrag, alcoholgebruik en ongezonde eetgewoonten van ouders en hun volwassen kinderen

Employing information on more than 1200 individuals from the Family Survey Dutch Population 2000, we study to what extent risk behaviour (smoking, alcohol use, and unhealthy eating habits) is transmitted intergenerationally from parents to their adult children. Moreover, by building on theoretical notions on the socialization of risk behavior, we derive expectations on differential effects of parental risk behaviour for daughters and sons, and for low and high educated children. Our results show that risk behaviour of parents indeed has a stimulating effect on the smoking, drinking, and eating habits of their offspring. The transmission of abstinence and excessive alcohol use of mothers is stronger for daughters, whereas the transmission of excessive alcohol use of fathers is stronger for sons. Furthermore, higher educated children are less likely to be a smoker when they have a moderately smoking mother, and alcohol abstinence of the father leads to a lower risk of excessive alcohol use among higher educated children.