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clinmed/1999120021v1 (December 29, 1999)
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THE WIDENING SOCIAL CLASS GAP OF PREVENTIVE HEALTH BEHAVIOURS IN SPAIN

Carlos Alvarez-Dardet, Cristina Montahud and Maria Teresa Ruiz

Department of Public Health, University of Alicante, Spain

Word count (excluding figure and references 607)
Conflict of interest: none

Corresponding author: Carlos Alvarez-Dardet, Departamento de Salud Publica, Edificio de Ciencias Sociales, Campus de San Vicente, Universidad de Alicante, Apdo Correos 99, 03080, Alicante Spain
tel 34 96 5903918
fax 34 96 5903964
carlos.alvarez{at}ua.es

Professional and political debates on health inequalities usually remain at a rhetorical level (1,2). Policies and practices in the health sector worldwide are little affected by the growing scientific evidence on inequalities. One of the putative reasons for this, apart from ideological resistance, is the time lag that tends to occur when measuring the effect of social inequalities in health. Trends of inequalities in health are mainly measured using mortality and less often morbidity; therefore at least 10 to 20 years are needed to show empirical evidence of the positive or negative effect of changes in policies or professional practices. The effect of this time lag is a reduction in the political and professional accountability.

One simple way to reduce this time lag is by measuring not only the outcome of the process but also its origin in the distribution and trends of health related behaviours by social class. In a particular society , preventive health behaviours and the resultant trends by social class at a given time can be considered a clear reflection of the inequalities in health, disease burden and mortality in the future.

The better known life style choices that affect health - smoking, alcohol consumption, physical exercise and obesity - can be summarised by using a single index, the Health Practices Index (HPI). Not surprisingly as health behaviours are social class mediated, HPI exhibits an excellent correlation with measures of social class, as was shown by Pill et al in 1995 using cross sectional UK data (3).

In this paper we show the trends of preventive health behaviours in Spain in the last 10 years by social class using data from the national health surveys.

MATERIAL, METHODS AND RESULTS

The Spanish national health surveys covered samples of non-institutionalised adult population of 17,118 people in 1987, 14,536 in 1993, 4969 in 1995 and 5124 in 1997.

The HPI was built, following methods described elsewhere (3) that were slightly modified by using five of the HPI variables contained in the four Spanish surveys: smoking and alcohol consumption, physical exercise, sleep hours and Quetelet index. HPI could thus range from 0 to 5, the highest values of the index being given those lifestyle choices that promote better health. Social class was measured using the classification of the Spanish Epidemiological Society (4), which is comparable to the one of the British Registrar General. The mean of the HPI in each of the five social class categories and its confidence intervals were calculated and are shown for the study period in figure I

DISCUSSION

Our data show a differentiated response based on social class to the available scientific knowledge and public health efforts on behaviour and health in Spain. In the last ten years the disadvantaged population of Spain obtained no benefits, nor has it opted for healthier behavioural choices; on the contrary the figures have worsen during the study period. Conversely, groups III, II and I exhibit a net gain in its average HPI. An increase in the existing gap of health inequalities in Spain (5), in terms of morbidity and mortality, can be forecasted for the near future.

Health behaviours could be easily monitored by social class using data routinely collected in the majority of the health surveys in developed countries. A replication of this study in other developed countries could produce valuable information on the future trends in different cultural, social and economic milieus. This approach, adding preventive health behaviour to the usual morbidity and mortality measures, could reduce as well, the needed time to measure the lag between exposition to a given intervention and its eventual impact in reducing inequalities in morbidity and mortality.

References

1.- Davey-Smith G, Morris JN, Shaw M The independent inquiry into inequalities in health is welcome, but its recommendations are too cautious and vague. BMJ 1998;317:1465-6

2.-Ashton J Inequalities in health. Independent inquiry gives detailed recommendations. BMJ 1998 ;317:1659

3.-Pill R, Peters TJ, Robling MR Social Class and preventive health behaviour. J Epidemiol Comm Health 1995;49:28-32

4.- Álvarez-Dardet C, Alonso J, Domingo A, Regidor E. La medición de la

clase social en ciencias de la salud. Informe de un grupo de trabajo de la

Sociedad Española de Epidemiología. SG Editores, Sociedad Española de

Epidemiología, Barcelona 1995.

5.- Benach J, Yasui Y Geographical patterns of excess mortality in Spain explained by two indices of deprivation.J Epidemiol Community Health 1999 ;53:423-31

 





This Article
Right arrow Abstract Freely available
Services
Right arrow Similar articles in this netprints
Right arrow Download to citation manager
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Alvarez-Dardet, C.
Right arrow Articles by Ruiz, M. T.
Right arrow Search for Related Content
PubMed
Right arrow Articles by Alvarez-Dardet, C.
Right arrow Articles by Ruiz, M. T.
Related Collections
Right arrow Epidemiology:
Socioeconomic Determinants of Health

Right arrow Other Epidemiology
Right arrow Health Policy:
International health


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