Using the ESEC to describe health inequalities in Europe

Anton Kunst

Department of Public Health

a.kunst@erasmusmc.nl

Why look at occupational class in relation to health?

Large socioeconomic inequalities in health are observed in all European countries

We need measures that can help to accurately identify social groups with most health problems

Educational level and income level are often used in European research

Occupational class is much less often used

Potential advantages of the ESEC

Theoretical basis

“Employment relationships” complementary to education

and income

Internationally applicable and comparable

In most countries, the population is evenly distributed across

many classes

Questions

Is the ESEC practically applicable in the area of health? For example, would excluding people with “unknown” ESEC bias the observed patterns?

How does health differ according to ESEC class? Does this class pattern differ between men and women, or between countries?

Can these class differences in health be explained by class differences in education and income? Or has “class” an independent effect?

Material and methods

The European Community Household Panel, covering > 10 countries

in the northern and southern part

Health is analysed using data from wave 1 (1994)

“How rate do you rate your general health: very good, good, fair,

poor, to very poor”

Smoking and overweight data were analyzed using data from wave 8

(year 2000)

Results (1) Proportion of respondents with “poor” health according to ESEC Class. Men, all countries.

0

0.2

0.4

0.6

0.8

1

1.2

1.4

ESEC Class

Re

lati

ve

Ra

te (

na

tio

na

l =

1)

1 2 3 6 7 8 9 4 5

Results (2) Prevalence of “poor” health by ESEC Class. Northern compared to southern countries. Men.

0

0.2

0.4

0.6

0.8

1

1.2

1.4

Northern countries Southern countries

Rela

tive R

ate

(n

ati

on

al =

1)

1 2 3 6 7 8 9 4 5

Results (3)Prevalence of “poor” health by ESEC Class. Women compared to men. All countries.

0

0.2

0.4

0.6

0.8

1

1.2

1.4

Women Men

Rel

ativ

e R

ate

(nat

ion

al =

1)

1 2 3 6 7 8 9 4 5

Results (4)Prevalence of “poor” health by ESEC Class. Women: household vs. individual assignment

0

0.2

0.4

0.6

0.8

1

1.2

1.4

Household Individual

Rela

tive R

ate

(n

ati

on

al =

1)

1 2 3 7 8 9 4 5

Health outcomes

Educational level

Occupational class

Income, wealth

From description to explanation

Results (5)Prevalence of “poor” health compared to ESEC Class I. The role of education and income. Men.

1

1,1

1,2

1,3

1,4

1,5

1,6

1,7

1,8

Before control After control

Relat

ive Ra

te (cl

ass I

= 1)

2 3 7 6 8 9 4 5

Results (7)The prevalence of obesity (BMI>30) compared to class I. The role of education and income. Women.

1

1,2

1,4

1,6

1,8

2

2,2

2,4

Before control After control

Relat

ive Ra

te (cl

ass I

= 1)

2 3 7 6 8 9 4 5

Results (8)The prevalence of smoking compared to class I. Control for education, income and wealth/deprivation.

0,8

0,9

1

1,1

1,2

1,3

1,4

Before control after control

Relat

ive Ra

te (cl

ass I

= 1)

2 3 7 6 8 9 4 5

The relative importance of class compared to other socio-economic indicators in predicting smoking

Northern Europe - Explained variance (%) by SES indicators

0,0

2,0

4,0

6,0

8,0

10,0

12,0

14,0

All 25-60 yrs

Male 25-39 yrs

Male 40-60 yrs

Female25-39 yrs

Female40-60 yrs

Housing tenure

Wealth

Income

Occupational class

Employment status

Education

Summary of results

We observed health differences along the entire occupational hierarchy,

from the most to the least advantaged classes

The health differences were generalised, i.e. found among both men and

women, within different age groups, and within different countries

The health differences could in part, but not entirely, be attributed to

differences between ESEC classes in education and income level

ESEC class had independent effects as well on overweight and smoking

Evaluation of the ESEC as a tool to describe health inequalities

In each country, the ESEC enables a detailed description of class

variations in health and health-related behaviours

The ESEC enables international overviews and cross-national

comparisons with regards to these class differences

Further development and refinement of the ESEC is needed

The ESEC cannot account for all relevant differences between countries.

This should be taken into account when interpreting results

Using the ESEC for explaining health inequalities

Occupational class adds to the explanation of health inequalities,

independent from educational level and income

The ESEC emphasises the role of “employment relationships” or,

more generally, factors intrinsic to the work of people

While ESEC provides a starting point, true understanding of

health inequalities should come from multivariate or qualitative

research

End

Thank you