Contextualizing Disparities: The Case for Comparative Research on Social Inequalities in Health

Diminished Returns in Europe: Socioeconomic Status and Ethno-Racial Health Disparities Across 30 Countries in the European Social Survey

Ethnic and racial minorities in many countries experience worse relative health outcomes and earlier mortality compared to national averages or outcomes of the majority population. Although socioeconomic status often contributes to a portion of ethno-racial health disparities, there are many unanswered questions about the relationship between socioeconomic status and ethno-racial health disparities across contexts. Recent scholarship in the USA has found support for a "diminished returns" effect in which the socioeconomic health gradient is systematically smaller for marginalized groups, yet it is unclear whether this pattern exists in other national contexts. This study tests the interaction between socioeconomic status and ethno-racial minority status in 30 countries across six waves of the European Social Survey. The results include evidence of the diminished returns pattern, particularly for populations with origins in Sub-Saharan Africa and the Middle East. Multilevel mixed-effects models find variation across countries in the interaction between socioeconomic status and ethno-racial minority status. The findings suggest racism and socioeconomic status interact to affect health and health disparities in multiple contexts and highlight the importance of cross-national comparison to further understand variation across countries.

The positive impact of a care-physical activity initiative for people with a low socioeconomic status on health, quality of life and societal participation: a mixed-methods study

Background

Overweight and obesity rates are increasing worldwide, particularly among people with a low socioeconomic status (SES). Care–physical activity (care–PA) initiatives may improve participants’ lifestyles and thereby lower overweight and obesity rates. A two-year care–PA initiative specifically developed for citizens with a low SES, X-Fittt 2.0, was offered free of charge to participants, and included 12 weeks of intensive guidance and sports sessions, and 21 months of aftercare. Here, we study the impact of X-Fittt 2.0 on health, quality of life (QoL) and societal participation using a mixed-methods design.

Methods

Questionnaires and body measurements were taken from 208 participants at the start of X-Fittt 2.0 (t₀) and after 12 weeks (t₁), one year (t₂) and two to three years (t₃). We also held 17 group discussions (t₁, n = 71) and 68 semi-structured interviews (t₂ and t₃). Continuous variables were analysed using a linear mixed-model analysis (corrected for gender, age at t₀, height, education level and employment status at the different time points), while we used descriptive statistics for the categorical variables. Qualitative data were analysed using a thematic analysis.

Results

Body weight was significantly lower at all three post-initiative time points compared with the baseline, with a maximum of 3.8 kg difference at t₂. Body Mass Index, waist circumference, blood pressure and self-perceived health only significantly improved during the first 12 weeks. A positive trend regarding paid work was observed, while social visits decreased. The latter might be explained by the COVID-19 pandemic, as lockdowns limited social life. Furthermore, participants reported increased PA (including sports) and a few stopped smoking or drinking alcohol. Participants mentioned feeling healthier, fitter and more energetic. Additionally, participants’ self-esteem and stress levels improved, stimulating them to become more socially active. However, the participants also mentioned barriers to being physically active, such as a lack of money or time, or physical or mental health problems.

Conclusions

X-Fittt 2.0 improved the health, QoL and societal participation of the participants. Future initiatives should take into account the aforementioned barriers, and consider a longer intervention period for more sustainable results. More complete data are needed to confirm the findings.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-13936-w.

Can physical activity compensate for low socioeconomic status with regard to poor self-rated health and low quality-of-life?

Background

Both high socioeconomic status (SES) and high physical activity (PA) are associated with better self-rated health (SRH) and higher quality-of-life (QoL).

Aim

To investigate whether high levels of PA may compensate for the association between low SES and subjective health outcomes in terms of poorer SRH and lower QoL.

Method

Data from a cross-sectional, population-based study (n = 5326) was utilized. Multiple logistic regression models were used to estimate odds ratios (OR) and 95% confidence intervals (95% CI) for the associations between indicators of SES (economic situation and educational level), SRH and QoL, as well as between the combination of SES and PA in relation to SRH and QoL.

Result

Participants with high PA and economic problems had approximately the same OR for good SRH as those with low PA and without economic problems (OR 1.75 [95% CI 1.20–2.54] and 1.81 [1.25–2.63] respectively). Participants with high PA and low education had higher odds for good SRH (OR 3.34 [2.96–5.34] compared to those with low PA and high education (OR 1.46 [0.89–2.39]).Those with high PA and economic problems had an OR of 2.09 [1.42–3.08], for high QoL, while the corresponding OR for those with low PA and without economic problems was 4.38 [2.89–6.63].

Conclusion

Physically active people with low SES, had the same or even better odds to report good SRH compared to those with low PA and high SES. For QoL the result was not as consistent. The findings highlight the potential for promotion of PA to reduce SES-based inequalities in SRH.

Electronic supplementary material

The online version of this article (10.1186/s12955-019-1102-4) contains supplementary material, which is available to authorized users.

Institutions, Incorporation, and Inequality: The Case of Minority Health Inequalities in Europe

Scholars interested in the relationship between social context and health have recently turned attention further "upstream" to understand how political, social, and economic institutions shape the distribution of life chances across contexts. We compare minority health inequalities across 22 European countries ( N = 199,981) to investigate how two such arrangements-welfare state effort and immigrant incorporation policies-influence the distribution of health and health inequalities. We examine two measures of health from seven waves of the European Social Survey. Results from a series of multilevel mixed-effects models show that minority health inequalities vary across contexts and persist after accounting for socioeconomic differences. Cross-level interaction results show that welfare state effort is associated with better health for all groups but is unrelated to levels of inequality between groups. In contrast, policies aimed at protecting minorities from discrimination correlate with smaller relative health inequalities.

Educational inequalities in self-rated health across US states and European countries

OBJECTIVES

The US shows a distinct health disadvantage when compared to other high-income nations. A potential lever to reduce this disadvantage is to improve the health situation of lower socioeconomic groups. Our objective is to explore how the considerable within-US variation in health inequalities compares to the health inequalities across other Western countries.

METHODS

Representative survey data from 44 European countries and the US federal states were obtained from the fourth wave of the European Values Study (EVS) and the 2008 wave of the Behavioral Risk Factor Surveillance System. Using binary logistic regression, we analyze different forms of educational inequalities in self-rated health (SRH), adjusted for age and sex.

RESULTS

The extent of educational inequalities in SRH varies considerably over European countries and US states; with US states in general showing greater inequality, however, differences between US states and European countries are less clear than commonly assumed.

CONCLUSIONS

The US has considerable differences in educational inequalities in SRH across geographic locations. To understand the reasons for the US health disadvantage, comparative research has to take into account the vast variation in health inequalities within the US.