2. The five essential conditions underlying health inequities
2.7 Summary wheel profiles of inequities in underlying conditions
Inequities in income drive inequities in the conditions needed for a healthy life
•
Similar to the summary wheels in Section 1.3, Fig. 2.34 and Fig. 2.35 compare the differences in underlying conditions of health inequities for adults across the WHO European Region.21•
These summary assessments of inequities in indicators of Health Services, Living Conditions, Social and Human Capital, and Employment and Working Conditions across the Region show that there are socioeconomic gradients in every indicator in each of the conditions.•
Fig. 2.34 examines average differences between the highest and lowest income quintiles within all countries across the Region for which data were available. Some extremely pronounced inequities are observed, particularly in indicators of Living Conditions.Fig. 2.34. Average within-country inequities in conditions needed to live a healthy life (gap ratio between the lowest and highest incomes quintiles)
1.0
Unmet health care needs Low-quality health care
Burden of in
formal caregiving
No measles vaccination Low trust in others Inability to influence politics Social isolation
No one to ask
for help No pa
rticipation in
voluntee ring
Poor job quality score
Feeling unsa Lack of green space Severe housing dep
rivation Pollution/other environmental pro
Inequities in conditions needed to lead a healthy life
Unmet health care needs Low-quality health care Burden of informal caregiving No measles vaccination Low trust in others Inability to influence politics Social isolation
No one to ask for help No participation in volunteering Poor job quality score Feeling unsafe due to crime Lack of public transport Lack of green space Severe housing deprivation Housing overcrowding
Living environment dissatisfaction score Pollution/other environmental problems Food insecurity
Fuel insecurity
Note. These figures are not disaggregated for men and women as they include indicators for which data are collected only at the household (not individual) level.
Source: authors’ own compilation based on the Health Equity Dataset.
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2. The five essential conditions underlying health inequities
Key findings
•
Across the Region, there are pronounced inequities in the four conditions measured in the wheels.•
Compared to those in the highest income quintile, people in the lowest income quintile are:— almost eight times more likely to suffer from severe housing deprivation;
— five times more likely to suffer from food and fuel insecurity;
— more than twice as likely to live in overcrowded housing;
— more than twice as likely to have no one to turn to for help;
— more than twice as likely to be more at risk of unmet health care needs.
Substantial inequities in Living Conditions and Social and Human Capital
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People in the lowest income quintile are almost eight times more likely to suffer from severe housing deprivation compared to those in the highest income quintile.•
People in the lowest income quintile are five times more likely to suffer from food and fuel insecurity compared to those in the highest quintile.•
Those in the lowest income quintile are more than twice as likely to live in overcrowded housing and to have no-one to turn to for help.•
These gaps in Living Conditions and Social and Human Capital reflect inequities in safety, sense of belonging, peace and security associated with having decent housing and someone to turn to for help.Inequities in Health Services and other conditions
•
There are also strong inequities in unmet need for health care. People in the lowest income quintile are 2.5 times more at risk of unmet health care needs than those in the highest income quintile.•
There are clear inequities in all other indicators, showing that people in disadvantaged groups fare worse than those in advantaged groups, across the board and in all indicators.Key findings
•
Compared to people with higher education levels, those with lower education levels are:— more than twice as likely to have suffered from an accident at work;
— three times less likely to have participated in lifelong learning;
— 1.5 times more likely to have unmet health care needs, low levels of trust in others, inability to influence politics, lack of control over life, poor job quality, temporary insecure employment, lack of safety and lack of access to public transport.
Fig. 2.35. Average within-country inequities in conditions needed to live a healthy life (gap ratio between the lowest and highest education levels)
1.0 2.0 3.0 4.0 Gap ratio
Unmet health care needs Low-quality health care
Burden of in formal caregiving
Low trust in others Inability to influence politics Perceived political cor
ruption Social isolation No one to ask
for help Lack of control
over li fe No pa
rticipation in
voluntee No li ring
felong lea rning
Poor job quality score Accidents at
work Unempl
oyed Young people NEET In temporary employment
Feeling unsa Lack of green space
Living e
nvironment dissatis
faction score
Inequities in conditions needed to lead a healthy life
Unmet health care needs Low-quality health care Burden of informal caregiving Low trust in others Inability to influence politics Perceived political corruption Social isolation
No one to ask for help Lack of control over life No participation in volunteering No lifelong learning Poor job quality score Accidents at work Unemployed Young people NEET In temporary employment Feeling unsafe due to crime Lack of public transport Lack of green space
Living environment dissatisfaction score
Notes. The figures are not disaggregated for men and women as they include indicators for which data are collected only at the household (not individual) level. The large gap in participation in lifelong learning is partly an artefact of stratifying by years of education. NEET: not in education, employment or training.
Source: authors’ own compilation based on the Health Equity Dataset.
Inequities in education drive inequities in the conditions needed to live a healthy life
•
Fig. 2.35 shows the differences between people who have the lowest and highest number of years in education in the four conditions needed to lead a healthy life.•
For each condition measured, people with fewer years of education fare worse than those with more years of education.•
Those with most years of education are almost three times as likely to have participated in formal and informal education and training after the age of 25 years, compared to those with the fewest years of education.Substantial inequities in Health Services, Employment and Working Conditions, and Social and Human Capital
•
Across the WHO European Region people with the fewest years of education are more than twice as likely to have suffered from an accident at work compared to those with the most years of education.•
Unmet health care needs, low trust in others, inability to influence politics, lack of control over life, poor job quality, temporary insecure employment, lack of safety and lack of public transport are all around1.5 times more likely among people with the fewest years of education compared to those with the most years of education.
•
These factors contribute in particular to divisions across society in terms of the sense of security, belonging, and control over life for people across the Region, in ways that affect equity in mental and physical health.103
2. The five essential conditions underlying health inequities
22 The exceptions are the indicators of poor job quality and living environment dissatisfaction which form the basis of Fig. 2.35, whereby average scores are compared for the job quality score (as measured by Eurofound’s Skills and Discretion Index) and living environment satisfaction scores are compared between groups.
Methods behind the wheels
•
The gap ratios in the summary wheel figures are interpreted in the same way as described in Section 1.3. Each circular gridline indicates how many times more at risk those in the least advantaged group are in comparison to those in the most advantaged group for each indicator.22 These figures show the average size of the within-country gap for each indicator, considering all countries across the WHO European Region for which data were available.•
The figures draw on a wider set of disaggregated indicators in the Health Equity Dataset, some of which do not appear elsewhere in this report.For example, the Health Equity Dataset includes indicators on social isolation, public transport, and volunteering.