Trend in inequalities

More generous spending on health care helps reduce absolute inequalities in mortality, at least in the European context. This is what emerged from a study conducted by LIFEPATH researchers, who examined trends in inequalities in mortality in seventeen European countries, over the course of twenty years.

“Looking at this trends is extremely useful to understand whether progresses in health technologies managed to reduce inequalities in mortality”, explains Giuseppe Costa, epidemiologist at the University of Turin and member of the research team. “Also, we wanted to investigate the relationship between higher investment in health care and socioeconomic conditions”.

LIFEPATH researchers used level of education as an indicator of socioeconomic condition, and selected all European countries for which comparable data on mortality by level of education and on educational inequalities in mortality were available from 1980 to 2010. Such countries were Denmark, Finland, Norway, Sweden, Austria, Belgium, England (including Wales), France, Switzerland, Italy, Spain, the Czech Republic, Estonia, Hungary, Lithuania, Poland, and Slovenia.

The authors of the study were particularly interested in the effect of changes in health care financing schemes and expenditure levels on mortality due to avoidable causes, such as infectious or cardiovascular diseases, cancer, or other conditions like asthma. Their study, published on Health Affairs, is the first one to compare trends in mortality from amenable conditions in different countries by socioeconomic status.

Health inequalities between different socioeconomic groups represent a major threat for public health. Reducing the health gap between people who occupy different positions on the social and economic ladder is thus a main goal for public health institutions and national governments. Although the causes of these health inequalities lie mostly outside of the health care system, ensuring equal access to health care is often seen as one of the main pillars of the strategies used to reach this goal.

However, in order to do that it is crucial to understand whether – and if so, to what extent – the increase of investments in the health care sector may reduce health inequalities. And this is where the LIFEPATH study comes into play.

The researchers of the European consortium found that the effect of health care expenditure on amenable mortality was equally strong, in relative terms, among people with low levels of education and those with high levels.

“Starting levels of avoidable mortality are higher among people with low education than among those with high education”, explains Costa. “However, the fact that both these categories were equally affected by higher health care spending imply larger absolute effects for people with low education”.

This is why avoidable mortality remarkably declined over the study period among the low educated group. Which, in turns, seems to suggest that more generous spending on health care helps reduce absolute inequalities in mortality, at least in the European context, in which most countries have national health systems or social health care insurance schemes that, to some degree, guarantee equality of access to health care.

More detailed studies will be required to provide further evidence for specific policy recommendations, but the demonstration of a link between more health care funding and smaller health inequalities, shown by the LIFEPATH study, clearly indicate that enhancing the health care system can be an effective way to reduce health inequalities.

Publication date: 
Wednesday, September 20, 2017