Social inequalities in health and their determinants


Tim Huijts of the University of York was part of the team who developed the Round 7 rotating module on health. In this article, he explains why it was important to measure self-reported health as part of the European Social Survey.

In 2005 the World Health Organisation set up a 'Commission on the Social Determinants of Health' which systematically examined the contribution of the social determinants to health inequalities within and between countries. Since the publication of its final report in 2008, various national governments have commissioned similar reports (such as the Marmot Review of Health Inequalities in England), as has the European Union.

The social determinants of health and health inequalities have therefore become increasingly recognised as of significance to population health. However, there is little by way of comprehensive pan-European data on the social determinants of health, or on a range of health outcomes.

The core module of the ESS contains detailed data on a number of social determinant variables (e.g. unemployment, occupational classes, family structure, dimensions of social capital, income etc.), but less on health (apart from self-rated health and limiting long term illness) and non-existing on other key determinants (such as life styles). In general, social surveys lack rich information on health and life styles, and health surveys lack detailed information on the social structure of societies.

By including a rotating module on the social determinants of health in the ESS, we have addressed this problem. In addition to measures that were already present in the earlier waves of the ESS, this rotating module includes items on chronic conditions, BMI, healthcare use and access, risk behaviour, working conditions, housing, unpaid care and childhood conditions. We believe that the  ESS may now become a key source of health and health determinant data for both policy makers and researchers within comparative health research.

It has been increasingly recognised by European governments that those interventions which positively change the social determinants can improve health and reduce health inequalities. However, all the official reports have highlighted the lack of evidence to support how to intervene to improve health inequalities.

Of course, one way to do this is to commission more experimental evaluations of interventions. Another is to conduct more 'natural experiments' of existing policies and interventions, by comparing different countries. The rotating module on the social determinants of health and health inequalities will help in achieving this by creating and making publicly available a comprehensive and comparable pan-European data set on the social determinants of health, which includes a wide range of health outcomes.

The influence of different European policy arrangements (policy regimes) on health and health inequalities can then be compared. Additionally, as the proposed module includes a range of validated mental and physical health outcomes then such comparisons will be more extensive and specific than previous ones using ESS data.

In addition, the module helps researchers to examine and compare the influence of the social determinants of health, with the intention of testing the relative empirical contribution of the different theories of health and health inequalities (cultural-behavioural, material and psychosocial), and how this might vary by country and policy context.

It has not been possible to do this on a pan-European scale before. Establishing which of the models is most influential on various health outcomes across different European countries is important in terms of both theory-development and thinking about priorities for policy actions to improve population health and/or reduce health inequalities.

Our Topline Results publication on health provides a summary of the results from the rotating module.

You can analyse our Round 7 health data by using our Online Analysis Tool.