Social determinants and health inequalities - country report Denmark Expert Group on Social Determinants and Health Inequalities 26-27 November 07, Luxembourg Tine Curtis, PhD Research Programme Director Health behaviour, life style and living conditions
The policy situation regarding action to tackle health health inequalities Side 2
Results of research creating concern Risk factors and public health in Denmark Risk factors and mortality Smoking Short education Physical inactivity Alcohol abuse Few fruits and vegatables Too much fat Passive smoking Limited social network Psykosocial work-stress Overweight Drug abuse Trafic accidents Men Women 0 1000 00 3000 4000 5000 6000 7000 8000 Number of deaths Juel K, Sørensen J, Brønnum-Hansen H, 06 Side 3
The Danish National Health Interview Surveys Conducted in 1987, 1994, 00 and 05 Representative on a national and regional level Interview and self-administered questionnaires Self-reported health, health behaviour, use of health care, living conditions, values, etc. 05: Interviews N=14.566 Self-administered questionnaires N=11.238 Re-interviews with participants from 1994 Register-based follow-up Side 4
Occupational level and rate of daily smokers Danish Health Interview Survey 05 60 53,4 50 40 30 18,1 24,6 35,9 42,4 45,8 High level occupation Medium level occupation Basic level occupation Other employment Unemployed Social or illness pension 10 0 Side 5
Education and trend in daily smoking Danish Health Interview Surveys 1987 1994 00 05 Procent (%) 60 50 40 30 47 48 47 44 41 41 36 37 42 34 29 25 10 0 <10 år 10-12 år 13+ år Combined year in school and further education A positive trend in a health determinant that go hand-in-hand with widening inequality in its social distribution Side 6
Low self-rated health smoking and physical inactivity Danish Health Interview Survey 05 60 55,8 51,2 Procent (%) 40 34,5 23,5 14,5 34,3 0 <=10 år 11-12 år 13+ år Total Both smoking & inactive Side 7
Low self-rated health among low educated - low quality housing and inadequate social network The Danish Health Interview Survey 05 60 50 50,2 54,0 40 30 10 0 35,0 Low level of education Total - low eduation Low quality housing Few social relations Side 8
Ethnicity and health behaviour Danish Health Interview Survey 05 80 74,3 Procent (%) 60 40 37,7 51,0 47,2 33,3 56,7 Danes Non-Western immigrants 0 Seen family doctor past 3 months Measured cholesterol Believe in own health behaviour A question of differences in social position or culture? Side 9
Analyses of the worst off respondents of the Danish National Health Interview Survey 05 Long-standing illness 60 50 46,6 48,7 40 30 25 Alcohol abusers Mentally vulnerable Low socio-economics Low social network Not socially marginalised 10 12,0 7,5 0 Side 10
Contact with health care services, past 3 months 70 60 62,2 57,7 50 40 30 46,6 51,1 36,2 Alcohol abusers Mentally vulnerable Low socio-economics Low social network Not socially marginalised 10 0 Side 11
Low or very low self-rated health 40 35,1 35 30 28,9 25 15 18,6 Alcohol abuser Mentally vulnerable Low socio-economics Low social relations Not socially marginalised 10 8,3 5 3,3 0 Side 12
Mental illness 30 25 25,8 15 10,2 13,7 Alcohol abusers Mentally vulnerable Low socio-economics Low social network Not socially marginalised 5 0 3,5 1 Side 13
No participation in organised leisure time activities 60 50 40 30 34,5 40,9 48,5 44,7,2 Alcohol abusers Mentally vulnerable Low socio-economics Low social network Not socially excluded 10 0 Side 14
Healthy eating habits among people with diabetes, unpublished results from a Danish regional survey 40 35 30 25 15 10 5 0 36 22 23 High education 1 29 Medium education 11 Low education 14
KRAM a Danish HIS/HES 13 municipalities 07 and 08 Internet based questionnaire exp. 100.000 responses Health examination exp..000 participants Local health promotion activities and campaigns Side 16
Motivation to become more physically active among those who are not already active, by years of education 70 60 50 % 40 30 10 0 39 55 60 67 <10 years 10-12 years 13-14 years 15+ years KRAM, results from 1 municipality (N=17.000) Side 17
Among those who are motivated but are not already active, respondents with longer education Are motivated because they want to be fit, look good and as relaxation (lower education: being together and having fun with others) Have more suggestions as to what the municipality can do to help them become more active Would like more activities with high levels of action, outdoors and family-oriented (lower education: low-impact, ill-health oriented) Side 18
People we don t reach with existing surveys The socially most disadvantaged; the 1-10 % worst off People without an address the homeless, many prostitutes People who can t manage visitors (interviewers) or read and respond to self-administered questionnaires the mentally ill, severe alcoholics, drug abusers Side 19
Health survey of the socially disadvantaged (Danish name: SUSY UDSAT) Cooperation between the Council for Socially Marginalised People and the National Institute of Public Health Questionnaire survey self-administered or with help Distributed through shelters, counselling centres, nurses on wheels and various organisations Respondents who are socially marginalised and either homeless, drug abusers, prostitutes, mentally ill or alcoholics Side
Status Nov 07 Received app. 1.300 questionnaires Personal Identification Number from 80% Report with survey results April 08 Qualitative studies spring 08 Registry-based analyses autumn 08 Final report end of 08 Side 21
National health inequalities policies National public health programmes aim at reducing social inequalities in health, but without specific, quantitative targets Two waves of focus on social inequality in health 1990 ies: the gradient, illustrating disparities in determinants of health 05- : marginalisation, supporting (local) projects on social exclusion 07: New government New ministry of Health and health promotion Health promotion commission Focus on health inequalities as the most disadvantaged groups and marginalisation A shift from tackling inequalities in social position to tackling the most negative consequences on people s health of the (existing) inequalities? Side 22
New structure for health care and health promotion in Denmark From January 1 st 07 Health care hospitals and primary care is the responsibility of 5 regions Health promotion and prevention outside hospitals is the responsibility of 98 municipalities Knowledge-gap on health promotion interventions and best practices at the local level Effectiveness Implementation Organisation Etc. Side 23
Municipal health policies Numer of municipalities (N=98) 70 60 50 24 24 40 30 14 14 37 39 33 10 22 24 0 28 40 Gennemarbejdet/godt i gang Vedtaget 13 11 9 22 30 9 Samarbejdsparter Evidens Side 24 Sundhedskonsekvens Bredt sundhedsbegreb Livskvalitet Lighed i sundhed Kommunen skaber rammer
Health inequalities projects The National Board of Health is supporting local model projects: Healthy lifestyle among socially vulnerable groups Life style and health care services targeted the socially disadvantaged (drug and alcohol addicts and homeless) Danish participation in EU-project: Determine http://www.health-inequalities.eu Side 25
Thank you Side 26
This paper was produced for a meeting organized by Health & Consumer Protection DG and represents the views of its author on the subject. These views have not been adopted or in any way approved by the Commission and should not be relied upon as a statement of the Commission's or Health & Consumer Protection DG's views. The European Commission does not guarantee the accuracy of the data included in this paper, nor does it accept responsibility for any use made thereof.