Browsing by Subject "SOCIAL DETERMINANTS"

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  • Mackenbach, Johan P.; Valverde, Jose Rubio; Bopp, Matthias; Bronnum-Hansen, Henrik; Deboosere, Patrick; Kalediene, Ramune; Kovacs, Katalin; Leinsalu, Mall; Martikainen, Pekka; Menvielle, Gwenn; Regidor, Enrique; Nusselder, Wilma J. (2019)
    Background Socioeconomic inequalities in longevity have been found in all European countries. We aimed to assess which determinants make the largest contribution to these inequalities. Methods We did an international comparative study of inequalities in risk factors for shorter life expectancy in Europe. We collected register-based mortality data and survey-based risk factor data from 15 European countries. We calculated partial life expectancies between the ages of 35 years and 80 years by education and gender and determined the effect on mortality of changing the prevalence of eight risk factors-father with a manual occupation, low income, few social contacts, smoking, high alcohol consumption, high bodyweight, low physical exercise, and low fruit and vegetable consumption-among people with a low level of education to that among people with a high level of education (upward levelling scenario), using population attributable fractions. Findings In all countries, a substantial gap existed in partial life expectancy between people with low and high levels of education, of 2.3-8.2 years among men and 0.6-4.5 years among women. The risk factors contributing most to the gap in life expectancy were smoking (19.8% among men and 18.9% among women), low income (9.7% and 13.4%), and high bodyweight (7.7% and 11.7%), but large differences existed between countries in the contribution of risk factors. Sensitivity analyses using the prevalence of risk factors in the most favourable country (best practice scenario) showed that the potential for reducing the gap might be considerably smaller. The results were also sensitive to varying assumptions about the mortality risks associated with each risk factor. Interpretation Smoking, low income, and high bodyweight are quantitatively important entry points for policies to reduce educational inequalities in life expectancy in most European countries, but priorities differ between countries. A substantial reduction of inequalities in life expectancy requires policy actions on a broad range of health determinants. Copyright (C) 2019 The Author(s). Published by Elsevier Ltd.
  • Leinsalu, M.; Baburin, A.; Jasilionis, D.; Krumins, J.; Martikainen, P.; Stickley, A. (2020)
    We examined urban-rural differences in educational inequalities in mortality in the Baltic countries (Estonia, Latvia, Lithuania) and Finland in the context of macroeconomic changes. Educational inequalities among 30-74 year olds were examined in 2000-2003, 2004-2007, 2008-2011 and 2012-2015 using census-linked longitudinal mortality data. We estimated age-standardized mortality rates and the relative and slope index of inequality. Overall mortality rates were larger in rural areas except among Finnish women. Relative educational inequalities in mortality were often larger in urban areas among men but in rural areas among women. Absolute inequalities were mostly larger in rural areas excepting Finnish men. Between 2000-2003 and 2012-2015 relative inequalities increased in most countries while absolute inequalities decreased except in Lithuania. In the Baltic countries the changes in both relative and absolute inequalities tended to be more favorable in urban areas; in Finland they were more favorable in rural areas. The overall pattern changed during the reccessionary period from 2004-2007 to 2008-2011 when relative inequalities often diminished or the increase slowed, while the decrease in absolute inequalities accelerated with larger improvements observed in urban areas. Despite substantial progress in reducing overall mortality rates in both urban and rural areas in all countries, low educated men and women in rural areas in the Baltic countries are becoming increasingly disadvantaged in terms of mortality reduction.
  • Blukacz, Alice; Cabieses, Baltica; Markkula, Niina (2020)
    Mental health in a context of international migration is a particularly pressing issue, as migration is recognised as a social determinant of physical and mental health. As Chile is increasingly becoming a receiving country of South-South migration, immigrants face mental health inequities, with regards to outcomes and access to care. In order to identify and synthetize mental healthcare inequities faced by international migrants with regards to locals in Chile, a narrative review of the literature on national mental healthcare policies in Chile and a narrative review of the literature on migrants' mental healthcare in Chile were conducted, with a focus on describing mental health outcomes, policy environment and persisting gaps and barriers for both topics. The existing literature on mental healthcare in Chile, both for the general population and for international migrants, following the social determinant of health framework and categorised in terms of i) Inequities in mental health outcomes; ii) Description of the mental health policy environment and iii) Identification of the main barriers to access mental healthcare. Despite incremental policy efforts to improve the reach of mental healthcare in Chile, persisting inequities are identified for both locals and international migrants: lack of funding and low prioritisation, exacerbation of social vulnerability in the context of a mixed health insurance system, and inadequacy of mental healthcare services. International migrants may experience specific layers of vulnerability linked to migration as a social determinant of health, nested in a system that exacerbates social vulnerability. Based on the findings, the article discusses how mental health is a privilege for migrant populations as well as locals experiencing layers of social vulnerability in the Chilean context. International migrants' access to comprehensive and culturally relevant mental healthcare in Chile and other countries is an urgent need in order to contribute to reducing social vulnerability and fostering mechanisms of social inclusion. International migration, social determinants of mental health, mental health inequities, social vulnerability, review.
  • Kemppainen, Teemu Tapio; Elovainio, Marko Juhani; Kortteinen, Matti Mikael; Vaattovaara, Mari Kaarina (2020)
    Involuntary staying, or a desire to move without the possibility to do so, is an under-studied topic. In this study, we examine involuntary staying among the residents of post-Second World War Finnish housing estates; we study its frequency, association with self-rated health and role in the relationship between neighbourhood disadvantage and self-rated health. Involuntary staying and poor health are expected to be associated through long-term stress related to housing and health-based selection in inconvenient housing outcomes. Furthermore, we address the self-perceived reasons for involuntary staying and the interaction between involuntary staying and household income. Two types of involuntary staying are distinguished, depending on whether a resident wants to move within or away from the current neighbourhood. The survey data (n = 7369) from a stratified cluster sample of the residents of 70 Finnish housing estate neighbourhoods are combined with the corresponding geo-referenced register data on these neighbourhoods’ sociodemographic characteristics. Of the residents, 35% are found to be involuntary stayers, and over half of the involuntary stayers want to move away from their current neighbourhoods. Financial concern is the most common self-perceived reason for involuntary staying. Both types of involuntary staying are associated with low self-rated health after adjusting for potential confounders. Being trapped in the current neighbourhood partially mediates the adjusted association between neighbourhood disadvantage and self-rated health. The association between self-rated health and involuntary staying is not modified by household income. In conclusion, involuntary staying is common in the study population and furthers the understanding about neighbourhood inequalities in health.
  • Paljarvi, Tapio; Martikainen, Pekka; Pensola, Tiina; Leinonen, Taina; Herttua, Kimmo; Makela, Pia (2015)
    Background Long-term employment trajectories of young problem drinkers are poorly understood. Methods We constructed retrospective labour market participation histories at ages 18-34 of 64 342 persons born in 1969-1982. Beginning from the year of each subject's 18th birthday, we extracted information from the records of Statistics Finland on educational attainment, main type of economic activity, months in employment, and months in unemployment for a minimum of seven years (range 7-16 years). We used information on the timing of alcohol-related hospitalizations and deaths in the same period to define problem drinkers with early onset limited course, early onset persistent course, and late onset problem drinking. Results Early onset limited course problem drinkers improved their employment considerably by age, whereas early onset persistent problem drinkers experienced a constant decline in their employment by age. From the age of 18 to 34, early onset persistent problem drinkers were in employment merely 12% of the time, in comparison with 39% among the early onset limited course problem drinkers, and 58% among the general population. Conclusions These results indicate that young adults who were retrospectively defined as having early onset persistent course problem drinking were extensively marginalized from the labour market early on during their life course, and that their employment trajectory was significantly worse compared to other problem drinkers.
  • Berg, Noora; Kiviruusu, Olli; Karvonen, Sakari; Rahkonen, Ossi; Huurre, Taina (2017)
    Poor childhood family conditions have a long-term effect on adult mental health, but the mechanisms behind this association are unclear. Our aim was to study the pathways from problematic family relationships in adolescence to midlife psychological distress via disadvantages in early adulthood. Participants of a Finnish cohort study at the age of 16 years old in 1983 were followed up at ages 22, 32 and 42 years old (N = 1334). Problems in family relationships were measured with poor relationship with mother and father, lack of parental support in adolescent's individuation process and poor home atmosphere, and mental health was assessed using Kessler's Psychological Distress Scale (K10). We analyzed the indirect effects of adolescent family relations on mental health at age 42 years old via various disadvantages (somatic and psychological symptoms, relationship/marital status, low education/unemployment and heavy drinking) at ages 22 and 32 years old. Problematic adolescent family relationships were associated with midlife psychological distress in women (0.19; 95% CI 0.11, 0.26) and men (0.13; 95% CI 0.04, 0.21). However, after adjustment for adolescent psychological symptoms, the association was only significant for women (0.12; 95% CI 0.04, 0.20). Poor family relationships were associated with various disadvantages in early adulthood. The association from poor family relationships (16 years old) to psychological distress (42 years old) was in part mediated via psychological symptoms in women (0.03; 95% CI 0.01, 0.04) and men (0.02; 95% CI 0.00, 0.04) and in women also via heavy drinking in early adulthood (0.02; 95% CI 0.00, 0.03). Adolescent family relationships have a role in determining adult mental health. Targeted support addressing psychological well-being and hazardous drinking for adolescents with problematic family relationships might prevent disadvantages in early adulthood, and further prevent poor midlife mental health.