INEQUALITIES IN HEALTH
AND WELL-BEING
Week 3
Health status
• Health status includes physical, psychical and social
characteristics of quality of life.
• Evaluation of health status of the population is mainly
based on specific information systems, registers and
reports on activity of health establishments.
• Basic information on heath status is reported by primary
health care providers.
Global health
• Social epidemiology is the study of the causes and
distribution of diseases.
• It can reveal how social problems are connected to
the health within different populations.
How does health differ around the world?
Health and its measurement
• Where? - in social and medical sciences
• „Hard“ and „soft“ indicators
• Sociology – „soft“ – concept of health (self-rated health)
Subjective measurement of health –
historical overview
• Up to the 90s XX century – objective indicators.
• Subjective measurement of health appears in
connection with research focused on quality of life
and/or subjective well-being.
Concept of health
Multidimensional:
1. Objective or biological health
2. Subjective or lived health (SRH)
Different ways to measure SRH
2 ways:
• the individual evaluates his own health
• the health status is assessed by another, "third" person.
In social research - self-rated health - SRH.
Conceptualization of SRH
• Two basic categories according to the number of
internal dimensions:
1. one-dimensional concepts
2. multi-dimensional concepts
Operacionalization in survey
• question: "Would you say that your health is…?"
For evaluation:
• most often similar to the so-called Likert scale: “very good;
good; average; poorly; very bad"
• an interval scale ranging from 1 to 100.
• Less often - pictograms or using a "Visual Analogue Scales"
Measuring SRH by use of different scales in CR
Limits of SRH
1. Different wording of questions, number of
answers/options offered and the role of translation
2. Heterogeneity in reporting
3. Health optimism and pessimism
Health in high-income countries
Obesity, which is on the rise in high-income nations.
• Improvements in technology and reduced family size have
led to a reduction of work to be done in household
production.
• Unhealthy market goods are replacing home-produced
goods.
• Leisure activities are growing more sedentary.
• More workers are shifting from active work (agriculture and
manufacturing) to service industries.
• Increased access to passive transportation has led to more
driving and less walking.
Health in low-income countries
• Problems such as infectious disease, high infant mortality
rates, scarce medical personnel, and inadequate water and
sewer systems.
• The most frequent causes of death for children under five
were pneumonia and diarrheal diseases.
• The availability of doctors and nurses in low-income
countries is one-tenth that of nations with a high income.
Health and income
Within societiesBetween (rich) societies
Source: Wilkinson & Pickett, The Spirit Level (2009)
70
71
72
73
74
75
76
77
78
79
80
Least
deprived
Electoral wards in England & Wales ranked by deprivation score
Most
deprived
www.equalitytrust.org.uk
• Predominantly female-bias:
1) cultural norms
2) legal codes
Developing countries ⇨ more vulnerable to suffering from
health problems, less able to have access and control
over healthcare resources.
• Disparities against males:
1) armed conflicts
2) drug cartels
3) alcohol consumption and psychological stress
Health status and women
• Women live longer than men, but they tend to be
“sicker” than men (Waldron, 1994, 2002).
• When social discrimination decreases, women’s life
expectancy increases (Waldron, 1983, 2001)
• Women show healthier behaviors than men do across
a wide range of activities ⇨ For example????
Health status and men
• Behavioral factors are fundamental causes in the etiology
of gender differences in health and illness ⇨ Macho’s self-
concept
• In general, men tend to engage in more health-risk
behaviors than women ⇨ For example????
• Fewer men than women engage in positive or preventive
health behaviors.
• Men have more toxic/death occupational exposure.
Index of:
• Life expectancy
• Math & Literacy
• Infant mortality
• Homicides
• Imprisonment
• Teenage births
• Trust
• Obesity
• Mental illness – incl.
drug & alcohol
addiction
• Social mobility
Healthand social problems are worsein more unequal countries
Source: Wilkinson & Pickett, The Spirit Level (2009) www.equalitytrust.org.uk
It doesn’t matter how you get to more income equality:
Japan: incomes are not that far apart before taxes – small welfare state.
Sweden: incomes differ widely, taxes are used to redistribute the income - large welfare state.
Healthand social problems are not relatedto average income in rich countries
Index of:
• Life expectancy
• Math & Literacy
• Infant mortality
• Homicides
• Imprisonment
• Teenage births
• Trust
• Obesity
• Mental illness – incl.
drug & alcohol
addiction
• Social mobility
Source: Wilkinson & Pickett, The Spirit Level (2009) www.equalitytrust.org.uk
Well-being
• An increasing interest in quality of life and life satisfaction.
• Subjective wellbeing (SWB) ⇨ a person’s evaluation of
his or her life, including both cognitive judgments of life
satisfaction and affective evaluations of moods.
Well-being in an aggregate perspective – 1.
• Well-being = Gross Domestic Product (GDP)
• Is is a valid measurement tool?
WHY???
• GDP reflects the economic dimension only.
• Determinants that cannot be traded on market.
Well-being in an aggregate perspective – 2.
• Well-being = a multidimensional phenomenon
• Quantification by aggregation = weighting scheme
• No clear consensus can be found in existing literature on
the issue of weighting.
Well-being in an aggregate perspective – 3.
• Human Development Index (HDI) = first synthetic well-being
metrics designed to overcome the GDP-related issues.
• Three dimensions:
1. “Long and healthy life”
2. “Education”
3. “Decent standard of living”
• A new well-being measure = Inequality-adjusted HDI (IHDI).
Well-being in an aggregate perspective – 4.
Subjective measurement of well-being:
“All things considered, how satisfied are you with your life as a
whole these days?”
Well-being in an aggregate perspective – 5.
• OECD within Better Life Initiative.
• It builds upon three pillars: material living conditions,
quality of life, and sustainability.
• Each of the domains is measured by several indicators.
• Your Better Life index - a composite indicator combined
from these eleven dimensions:
http://www.oecdbetterlifeindex.org/
Well-being in an aggregate perspective – 6.
• Happy Planet Index
https://neweconomics.org/2006/07/happy-planet-index/
Life satisfaction x Life expectancy at birth
HPI =----------------------------------------------------------
Ecological footprint
• Sustainable Society Index
https://ssi.wi.th-koeln.de/
Components of SWB (subjective well-being)
• Cognitive component of SWB: satisfaction.
• Affective component of SWB: happiness.
• Most widely used measure of SWB: life satisfaction.
• Satisfaction and happiness are often used interchangeably in
the literature It can complicate interpretation of findings and
comparability between countries.
• https://personal.eur.nl/veenhoven/
• Relatively high positive levels of SWB consistently found
even in developing countries.
„Happiness“ – Subjective well-being in Czechia
7
11
15
18
0
5
10
15
20
25
30
35
1991 1999 2008 2017
Very happy
Question: All things together, would you say you are…
Very
happy
Happy
Not too
happy
Very
unhappy
%
1991 7 71 19 2 100 %
1999 11 75 13 1 100 %
2008 15 71 13 2 100 %
2017 18 72 10 1 100 %
78
86
86
90
„Happiness“ – Subjective well-being
Life satisfaction in Czechia- answer (%): satisfied
44
47
53
59
0
10
20
30
40
50
60
70
80
1991 1999 2008 2017
Satisfied
All things together, how satisfied are you with your own life?
Child well-being is better in more equal rich countries
Source: Wilkinson & Pickett, The Spirit Level (2009) www.equalitytrust.org.uk
Child-wellbeing is unrelated to average incomes in rich countries
Source: Wilkinson & Pickett, The Spirit Level (2009) www.equalitytrust.org.uk