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  • 1.
    Bergman, Lars R
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Lundberg, Olle
    Perspectives on determinants of social welfare.2006In: International Journal of Social Welfare, no 15, p. 1-52Article in journal (Refereed)
    Abstract [en]

    This special issue of International Journal of Social Welfare deals with sociological and psychological perspectives on determinants of social welfare to which invited leading researchers in psychology, sociology, social policy, and public health have contributed. In all articles the outcome variables are important factors related to social welfare and psychological or sociological factors are trated as explanatory variables. In the introduction, Lars Bergman and Olle Lundberg overview the issues and contents of the issue. The article by Johannes Siegrist deals with quality of work and health, partly from a sociological perspective. S.V. Subramanian and Ichiro Kawachi study the importance of income for health and they develop a typology of income-health relationships. Income is regarded at both the individual and community level and the importance of a multilevel framework is emphasized.The article by Daiva Daukantaite and Rita Zukauskiene deals with Swedish and Lithuanian women's subjective well-being and Alexander von Eye and Anne Bogat report on mental health in women experiencing intimate partner violence. Ulf Lundberg in his article describes the main physiological stress responses and analyze under which conditions these responses promote or damage health and he also discusses how objective and subjective health are related. Finally, Lars Bergman and Olle Lundberg provide a commentary on the issues raised by the articles.

  • 2.
    Bergqvist, Kersti
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Åberg Yngwe, Monica
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Lundberg, Olle
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Mid Sweden University, Sweden.
    Understanding the role of welfare state characteristics for health and inequalities - an analytical review2013In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 13, p. 1234-Article, review/survey (Refereed)
    Abstract [en]

    Background: The past decade has witnessed a growing body of research on welfare state characteristics and health inequalities but the picture is, despite this, inconsistent. We aim to review this research by focusing on theoretical and methodological differences between studies that at least in part may lead to these mixed findings. Methods: Three reviews and relevant bibliographies were manually explored in order to find studies for the review. Related articles were searched for in PubMed, Web of Science and Google Scholar. Database searches were done in PubMed and Web of Science. The search period was restricted to 2005-01-01 to 2013-02-28. Fifty-four studies met the inclusion criteria. Results: Three main approaches to comparative welfare state research are identified; the Regime approach, the Institutional approach, and the Expenditure approach. The Regime approach is the most common and regardless of the empirical regime theory employed and the amendments made to these, results are diverse and contradictory. When stratifying studies according to other features, not much added clarity is achieved. The Institutional approach shows more consistent results; generous policies and benefits seem to be associated with health in a positive way for all people in a population, not only those who are directly affected or targeted. The Expenditure approach finds that social and health spending is associated with increased levels of health and smaller health inequalities in one way or another but the studies are few in numbers making it somewhat difficult to get coherent results. Conclusions: Based on earlier reviews and our results we suggest that future research should focus less on welfare regimes and health inequalities and more on a multitude of different types of studies, including larger analyses of social spending and social rights in various policy areas and how these are linked to health in different social strata. But, we also need more detailed evaluation of specific programmes or interventions, as well as more qualitative analyses of the experiences of different types of policies among the people and families that need to draw on the collective resources.

  • 3. Eikemo, Terje A.
    et al.
    Hoffmann, Rasmus
    Kulik, Margarete C.
    Kulhanova, Ivana
    Toch-Marquardt, Marlen
    Menvielle, Gwenn
    Looman, Caspar
    Jasilionis, Domantas
    Martikainen, Pekka
    Lundberg, Olle
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Mackenbach, Johan P.
    How Can Inequalities in Mortality Be Reduced?: A Quantitative Analysis of 6 Risk Factors in 21 European Populations2014In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 9, no 11, p. e110952-Article in journal (Refereed)
    Abstract [en]

    Background: Socioeconomic inequalities in mortality are one of the greatest challenges for health policy in all European countries, but the potential for reducing these inequalities is unclear. We therefore quantified the impact of equalizing the distribution of six risk factors for mortality: smoking, overweight, lack of physical exercise, lack of social participation, low income, and economic inactivity. Methods: We collected and harmonized data on mortality and risk factors by educational level for 21 European populations in the early 2000s. The impact of the risk factors on mortality in each educational group was determined using Population Attributable Fractions. We estimated the impact on inequalities in mortality of two scenarios: a theoretical upward levelling scenario in which inequalities in the risk factor were completely eliminated, and a more realistic best practice scenario, in which inequalities in the risk factor were reduced to those seen in the country with the smallest inequalities for that risk factor. Findings: In general, upward levelling of inequalities in smoking, low income and economic inactivity hold the greatest potential for reducing inequalities in mortality. While the importance of low income is similar across Europe, smoking is more important in the North and East, and overweight in the South. On the basis of best practice scenarios the potential for reducing inequalities in mortality is often smaller, but still substantial in many countries for smoking and physical inactivity. Interpretation: Theoretically, there is a great potential for reducing inequalities in mortality in most European countries, for example by equity-oriented tobacco control policies, income redistribution and employment policies. Although it is necessary to achieve substantial degrees of upward levelling to make a notable difference for inequalities in mortality, the existence of best practice countries with more favourable distributions for some of these risk factors suggests that this is feasible.

  • 4. Ezendam, N. P. M.
    et al.
    Stirbu, I.
    Leinsalu, M.
    Lundberg, Olle
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Kalediene, R.
    Wojtyniak, B.
    Martikainen, P.
    Mackenbach, J.
    Kunst, A.
    Educational inequalities in cancer mortality differ greatly between countries around the Baltic Sea2008In: European Journal of Cancer, Vol. 44, no 3, p. 454-464Article in journal (Refereed)
  • 5.
    Fors, Stefan
    et al.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Lennartson, Carin
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Lundberg, Olle
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Childhood Living Conditions, Socioeconomic Position in Adulthood, and Cognition in Later Life: Exploring the Associations2009In: The journals of gerontology. Series B, Psychological sciences and social sciences, ISSN 1079-5014, E-ISSN 1758-5368, Vol. 64, no 6, p. 750-757Article in journal (Refereed)
    Abstract [en]

    Objectives This study examined the association between childhood living conditions, socioeconomic position in adulthood, and cognition in later life. Two questions were addressed: Is there an association between childhood living conditions and late-life cognition, and if so, is the association modified or mediated by adult socioeconomic position?

    Methods Nationally representative data of the Swedish population aged 77 years and older were obtained from the 1992 and 2002 Swedish Panel Study of Living Conditions of the Oldest Old (SWEOLD). Cognition was assessed with an abbreviated version of the Mini-Mental State Examination scale. Childhood living conditions were assessed by self-reports of childhood living conditions.

    Results The results showed independent associations between conflicts in the household during childhood, father's social class, education, own social class in adulthood, and cognition in later life. Exposure to conflicts during childhood, having a father classified as a manual worker, low education, and/or being classified as a manual worker in adulthood was associated with lower levels of cognition in old age. There seemed to be no modifying effect of adult socioeconomic position on the association between childhood conditions and cognition in later life.

    Discussion This suggests the importance of childhood living conditions in maintaining cognitive function even in late life.

  • 6.
    Fors, Stefan
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Social Work. Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Lennartson, Carin
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Lundberg, Olle
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Live long and prosper? Childhood living conditions, marital status, social class in adulthood and mortality during mid-life: A cohort study2011In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 39, no 2, p. 179-186Article in journal (Refereed)
    Abstract [en]

    Aims: The aim of the present study was to investigate the impact of childhood living conditions, marital status, and social class in adulthood on the risk of mortality during mid-life. Two questions were addressed: Is there an effect of childhood living conditions on mortality risk during mid-life and if so, is the effect mediated or modified by social class and/or marital status in adulthood? Methods: A nationally representative, Swedish, level of living survey from 1968 was used as baseline. The study included those aged 25—69 at baseline (n = 4082). Social conditions in childhood and adulthood were assessed using self-reports. These individuals were then followed for 39 years using registry data on mortality. Results: The results showed associations between childhood living conditions, marital status, social class in adulthood and mortality during mid life. Social class and familial conditions during childhood as well as marital status and social class in adulthood all contributed to the risk of mortality during mid-life. Individuals whose father’s were manual workers, who grew up in broken homes, who were unmarried, and/or were manual workers in adulthood had an increased risk of mortality during mid life. The effects of childhood conditions were, in part, both mediated and modified by social class in adulthood. Conclusions: The findings of this study suggest that there are structural, social conditions experienced at different stages of the life course that affect the risk of mortality during mid-life.

  • 7.
    Fors, Stefan
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Social Work. Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Lennartsson, Carin
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Lundberg, Olle
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Health inequalities among older adults in Sweden 1991–20022008In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 18, no 2, p. 138-143Article in journal (Refereed)
    Abstract [en]

    Current research has shown a decline in health amongolder adults in Sweden. This study examines health inequalitiesamong older adults in Sweden in 1991–1992 and 2000–2002and explores the development of these inequalities during thisperiod.

    Methods: A data set was constructed out of four levelsof living surveys, comprising 4085 individuals aged 55 and above.Multivariate logistic regressions were used to assess the associationbetween social class, sex, age and four different domains ofself-reported health: global self-rated health, impaired mobility,musculoskeletal pain and psychological distress. Adjustmentswere made for period of interview. Interaction terms were alsoused to assess change over time. Levin's attributable risk wasused to assess the magnitude of the health inequalities.

    Results:The results indicate an increase in reports of all specifichealth problems, but not in the global health measure duringthe period. Significant sex differences and a clear social gradientin health were discernible during both periods. Women were morelikely than men to report problems with impaired mobility, painand psychological distress. Manual workers were significantlymore likely than non-manuals to report problems in all fourdomains of health. However, both the sex differences and thesocial gradient seemed to remain constant during the period.

    Conclusion: Although it seems there are significant differencesin health depending on sex and social class among older adultsin Sweden, these inequalities appear to be unaffected by thegeneral increase in ill health that has been observed in thesegroups over the last decade.

  • 8. Glennerster, H.
    et al.
    Bradshaw, J.
    Lister, R.
    Lundberg, Olle
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Reducing the Risks to Health: The role of social protection. Report of the Social Protection Task Group for the Strategic Review of Health Inequalities in England Post 20102009Report (Other (popular science, discussion, etc.))
  • 9. Goldblatt, Peter
    et al.
    Siegrist, Johannes
    Lundberg, Olle
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Marinetti, Claudia
    Farrer, Linden
    Costongs, Caroline
    Improving health equity through action across the life course: summary of evidence and recommendations from the drivers project2015Report (Other academic)
  • 10. Herttua, Kimmo
    et al.
    Östergren, Olof
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Lundberg, Olle
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Martikainen, Pekka
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). University of Helsinki, Finland; The Max Planck Institute for Demographic Research, Germany.
    Influence of affordability of alcohol on educational disparities in alcohol-related mortality in Finland and Sweden: a time series analysis2017In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 71, no 12, p. 1168-1176Article in journal (Refereed)
    Abstract [en]

    Background: Prices of alcohol and income tend to influence how much people buy and consume alcohol. Price and income may be combined into one measure, affordability of alcohol. Research on the association between affordability of alcohol and alcohol-related harm is scarce. Furthermore, no research exists on how this association varies across different subpopulations. We estimated the effects of affordability of alcohol on alcohol-related mortality according to gender and education in Finland and Sweden.

    Methods: Vector-autoregressive time series modelling was applied to the quarter-annual aggregations of alcohol-related deaths and affordability of alcohol in Finland in 1988–2007 and in Sweden in 1991–2008. Alcohol-related mortality was defined using information on both underlying and contributory causes of death. We calculated affordability of alcohol index using information on personal taxable income and prices of various types of alcohol.

    Results: Among Finnish men with secondary education,an increase of 1% in the affordability of total alcohol was associated with an increase of 0.028% (95% CI 0.004 to 0.053) in alcohol-related mortality. Similar associations were also found for affordability for various types of alcohol and for beer only in the lowest education group. We found few other significant positive associations for other subpopulations in Finland or Sweden. However, reverse associations were found among secondary-educated Swedish women.

    Conclusions: Overall, the associations between affordability of alcohol and alcohol-related mortality were relatively weak. Increased affordability of total alcoholic beverages was associated with higher rates of alcohol-related mortality only among Finnish men with secondary education.

  • 11. Kulhánová, Ivana
    et al.
    Menvielle, Gwenn
    Hoffmann, Rasmus
    Eikemo, Terje A.
    Kulik, Margarete C.
    Toch-Marquardt, Marlen
    Deboosere, Patrick
    Leinsalu, Mall
    Lundberg, Olle
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Regidor, Enrique
    Looman, Caspar W. N.
    Mackenbach, Johan P.
    The role of three lifestyle risk factors in reducing educational differences in ischaemic heart disease mortality in Europe2017In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 27, no 2, p. 203-210Article in journal (Refereed)
    Abstract [en]

    Background: Ischaemic heart disease (IHD) is one of the leading causes of death worldwide with a higher risk of dying among people with a lower socioeconomic status. We investigated the potential for reducing educational differences in IHD mortality in 21 European populations based on two counterfactual scenarios—the upward levelling scenario and the more realistic best practice country scenario. Methods: We used a method based on the population attributable fraction to estimate the impact of a modified educational distribution of smoking, overweight/obesity, and physical inactivity on educational inequalities in IHD mortality among people aged 30–79. Risk factor prevalence was collected around the year 2000 and mortality data covered the early 2000s. Results: The potential reduction of educational inequalities in IHD mortality differed by country, sex, risk factor and scenario. Smoking was the most important risk factor among men in Nordic and eastern European populations, whereas overweight and obesity was the most important risk factor among women in the South of Europe. The effect of physical inactivity on the reduction of inequalities in IHD mortality was smaller compared with smoking and overweight/obesity. Although the reduction in inequalities in IHD mortality may seem modest, substantial reduction in IHD mortality among the least educated can be achieved under the scenarios investigated. Conclusion: Population wide strategies to reduce the prevalence of risk factors such as smoking, and overweight/obesity targeted at the lower socioeconomic groups are likely to substantially contribute to the reduction of IHD mortality and inequalities in IHD mortality in Europe.

  • 12. Lahelma, E.
    et al.
    Lundberg, Olle
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Health inequalities in European welfare states2009In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 19, no 5, p. 445-446Article in journal (Refereed)
  • 13.
    Lennartsson, Carin
    et al.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Agahi, Neda
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Hols-Salen, Linda
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Kelfve, Susanne
    Stockholm University, Faculty of Social Sciences, Department of Sociology. Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Kåreholt, Ingemar
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Jönkoping University, Sweden.
    Lundberg, Olle
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Parker, Marti G.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Thorslund, Mats
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Data Resource Profile: The Swedish Panel Study of Living Conditions of the Oldest Old (SWEOLD)2014In: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685, Vol. 43, no 3, p. 731-738Article in journal (Refereed)
    Abstract [en]

    As the number and proportion of very old people in the population increase, there is a need for improved knowledge about their health and living conditions. The SWEOLD interview surveys are based on random samples of the population aged 77+years. The low non-response rates, the inclusion of institutionalized persons and the use of proxy informants for people unable to be interviewed directly ensure a representative portrayal of this age group in Sweden. SWEOLD began in 1992 and has been repeated in 2002, 2004 and 2011. The survey is based on another national survey, the Swedish Level of Living Survey (LNU), started in 1968 with 10-year follow-up waves. This longitudinal design provides additional data collected when SWEOLD participants were in middle age and early old age. The SWEOLD interviews cover a wide range of areas including health and health behaviour, work history, family, leisure activities and use of health and social care services. Socio-economic factors include education, previous occupation and available cash margin. Health indicators include symptoms, diseases, mobility and activities of daily living (ADL). In addition to self-reported data, the interview includes objective tests of lung function, physical function, grip strength and cognition. The data have been linked to register data, for example for income and mortality follow-ups. Data are available to the scientific community on request. More information about the study, data access rules and how to apply for data are available at the website (www.sweold.se).

  • 14.
    Lindfors, Petra
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology. Centre for Health Equity Studies (CHESS).
    Lundberg, Olle
    Centre for Health Equity Studies (CHESS).
    Lundberg, Ulf
    Stockholm University, Faculty of Social Sciences, Department of Psychology. Centre for Health Equity Studies (CHESS).
    Allostatic load and clinical risk as related to sense of coherence in middle-aged women.2006In: Psychosomatic Medicine, ISSN 0033-3174, Vol. 68, no 5, p. 801-807Article in journal (Refereed)
    Abstract [en]

    Objective: To investigate how physiologic dysregulation, in terms of allostatic load and clinical risk, respectively, relates to sense of coherence (SOC) in women with no previously diagnosed pathology. Methods: At baseline, 200 43-year-old women took part in a standardized medical health examination and completed a 3-item measure of SOC, which they completed again 6 years later. According to data from the medical examination, two different measures of physiologic dysregulation were calculated: a) a measure of allostatic load based on empirically derived cut points and b) a measure of clinical risk based on clinically significant cut points. Results: In line with the initial hypotheses, allostatic load was found to predict future SOC, whereas clinical risk did not. In addition to baseline SOC and nicotine consumption, allostatic load was strongly associated with a weak SOC at the follow-up. Conclusions: The better predictive value of allostatic load to clinical risk indicates that focusing solely on clinical risk obscures patterns of physiologic dysregulation that influence future SOC.

  • 15.
    Lindfors, Petra
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology. Centre for Health Equity Studies (CHESS).
    Lundberg, Olle
    Lundberg, Ulf
    Stockholm University, Faculty of Social Sciences, Department of Psychology. Centre for Health Equity Studies (CHESS).
    Sense of Coherence and Biomarkers of Health in 43-Year-Old Women.2005In: International Journal of Behavioral Medicine, ISSN 1070-5503, Vol. 12, no 2, p. 98-102Article in journal (Refereed)
    Abstract [en]

    The aim of this cross-sectional study was to investigate how sense of coherence (SOC) relates to biomarkers of health in 43-year-old nonsmoking premenopausal women. Before taking part in a standardized medical health examination including assessment of blood pressure, blood lipids, and physical symptoms, participants completed a three-item measure of SOC. On the basis of their SOC scores, the 244 women with complete datasets were categorized into 1 of 3 groups with a weak, intermediate, or strong SOC. Results showed that women with a strong SOC had significantly lower levels of systolic blood pressure (p < .05) and total cholesterol (p < .05) than did women with a weak SOC. It is suggested that the lower levels of systolic blood pressure and total cholesterol found in women with a strong SOC may constitute a biological buffer against ill health and disease.

  • 16.
    Lundberg, Olle
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Commentary: A multi-factorial and dynamic approach to health inequalities–lessons from Marmot’s The Health Gap2017In: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685, Vol. 46, no 1, p. 1332-1333Article in journal (Refereed)
  • 17.
    Lundberg, Olle
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Commentary: Politics and public health - some conceptual considerations concerning welfare state characteristics and public health outcomes2008In: International Journal of Epidemiology, Vol. 37, no 5, p. 1105-1108Article in journal (Refereed)
  • 18.
    Lundberg, Olle
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    How do welfare policies contribute to reduction of health inequalities?2009In: Eurohealth, Vol. 15, no 3Article in journal (Refereed)
  • 19.
    Lundberg, Olle
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Kommissionen för jämlik hälsa – en kort rapport i halvtid2016In: Socialmedicinsk Tidskrift, ISSN 0037-833X, Vol. 93, no 5, p. 501-509Article in journal (Other academic)
    Abstract [sv]

    Den svenska regeringen har satt upp ett långsiktigt mål att sluta de påverkbara hälsoklyftorna inom en generation. Kommissionen för jämlik hälsa ska ge förslag på åtgärder som kan bidra till att målet kan nås. Utgångspunkten är de sociala bestämningsfaktorerna för hälsa, och huvudfokus ligger på skillnader i hälsa mellan socioekonomiska grupper samt mellan kvinnor och män. Mot bakgrund av tidigare initiativ och forskning har Kommissionen identifierat sju områden där skillnader i livsvillkor är avgörande för jämlik hälsa. Dessa är 1) Det tidiga livet; 2) Kunskaper, kompetenser och utbildning; 3) Arbete, arbetsförhållanden och arbetsmiljö; 4) Inkomst och försörjningsmöjligheter; 5) Boende och närmiljö; 6) Levnadsvanor; samt 7) Kontroll, inflytande och delaktighet. En mer jämlik hälsa kan i princip nås med insatser som direkt påverkar skillnader i livsvillkor och förutsättningar inom dessa områden. Sådana insatser kan handla om att stärka individers egna möjligheter att generera resurser liksom förbättringar av de resurser som välfärdssystemen kan bidra med. Därutöver kan en mer jämlik hälsa sannolikt även nås genom en mer strategisk styrning och uppföljning av välfärdsstatens befintliga institutioner och verksamheter.

  • 20.
    Lundberg, Olle
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Politics and public health--some conceptual considerations concerning welfare state characteristics and public health outcomes2009In: Int J EpidemiolArticle in journal (Refereed)
  • 21.
    Lundberg, Olle
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Politics, public health and pessimism: should we take studies on welfare states and public health further? A commentary on Tapia Granados2010In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 71, no 5, p. 851-852Article in journal (Refereed)
  • 22.
    Lundberg, Olle
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Små välfärdsresurser ger sämre hälsa2011In: Tvärsnitt, no 3-4Article, review/survey (Other academic)
  • 23.
    Lundberg, Olle
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    The next step towards more equity in health in Sweden: how can we close the gap in a generation?2018In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 46, p. 19-27Article in journal (Refereed)
    Abstract [en]

    In 2015, a national Commission for Equity in Health was appointed by the Swedish Government. In this paper, some key lines of thought from the three reports published by the Commission are summarised. First, the theories and principles for the Commission's work are outlined, in particular regarding the views taken on how health inequalities arise. Second, the importance of process is discussed in relation to cross-sectorial efforts to reduce inequalities in health. More specifically, this brings up some of the proposals made for how to redesign the public health policy framework for cross-sectorial work. Third, the proposed content of cross-sectorial work for more equal health is presented in three steps, namely: (1) overarching recommendations, (2) more equal conditions and opportunities, and (3) general problems of governance. Regarding people's conditions and opportunities, the Commission submitted a number of proposals for the general direction of work that needs to be taken in order to reduce health inequalities, as well as some examples of more specific policy changes or reforms on the basis of each of these general directions, which are summarised here. Finally, some challenges and difficulties that may prevent Sweden from taking the next step towards more equity in health are discussed.

  • 24.
    Lundberg, Olle
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Albin, Maria
    Hartman, Laura
    Nilsson, Ingvar
    Sjögren, Anna
    Wieselgren, Ing-Marie
    Bergmark, Åke
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Kristenson, Margareta
    Nilsson, Per
    Vågerö, Denny
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Östergren, Per-Olof
    Det handlar om jämlik hälsa: utgångspunkter för Kommissionens vidare arbete2016Book (Other academic)
  • 25.
    Lundberg, Olle
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Dahl, E.
    Fritzell, Johan
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Palme, J.
    Sjöberg, O.
    Social Protection, Income and Health Inequalities: Final Report from TG4–GDP, Taxes, Income and Welfare to the Review of Social Determinants and the Health Divide in the WHO Euro Region. WHO2013Report (Other academic)
  • 26.
    Lundberg, Olle
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Fritzell, Johan
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Åberg Yngwe, Monica
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Kölegård, Maria L.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    The potential power of social policy programmes: income redistribution, economic resources and health2010In: International Journal of Social Welfare, ISSN 1369-6866, E-ISSN 1468-2397, Vol. 19, no s1, p. s2-s13Article in journal (Refereed)
    Abstract [en]

    This Supplement includes a number of articles dealing with the role of social policy schemes for public health across the life course. As a key social determinant of health, poverty and its consequences have historically been at the forefront of the public health discussion. But also in rich countries today, economic resources are likely to be important for health and survival, both on an individual and an aggregate level. This introductory article serves as a background for the more specific analyses that follow. The focus is on why income and income inequality could have an effect on individual and population health. We discuss relationships between the individual and population levels and between income and health, and some of the possible mechanisms involved. We also present arguments for why welfare state institutions may matter.

  • 27.
    Lundberg, Olle
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Toivanen, Susanna
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Sense of coherence and social structure2011In: Encyclopaedia of Environmental Health / [ed] Nriagu, J.O., Oxford: Elsevier , 2011Chapter in book (Other academic)
  • 28.
    Lundberg, Olle
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Yngwe Åberg, Monica
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Bergqvist, Kersti
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Sjöberg, Ola
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    The role of income and social protection for inequalities in health, evidence and policy implications.2014Report (Other academic)
  • 29.
    Lundberg, Olle
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Yngwe Åberg, Monika
    Kölegård Stjärne, Maria
    Vågerö, Denny
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Generös familjepolitik minskar spädbarnsdöd2007In: Dagens Nyheter debatt: (2007-10-18)Article in journal (Other (popular science, discussion, etc.))
  • 30.
    Lundberg, Olle
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). University of London, England.
    Åberg Yngwe, Monica
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Bergqvist, Kersti
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Sjöberg, Ola
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Stockholm University, Faculty of Social Sciences, The Swedish Institute for Social Research (SOFI).
    Welfare states and health inequalities2015In: Canadian public policy, ISSN 0317-0861, E-ISSN 1911-9917, Vol. 41, no Suppl. 2, p. S26-S33Article in journal (Refereed)
    Abstract [en]

    While much research points to the importance of a range of welfare state policies to reduce inequalities in health, the growing literature in this field is full of mixed and contradictory results. In this paper, we provide a brief discussion about the different conceptual and methodological approaches used in comparative research on the relationship between welfare policies and health. Against a theoretical discussion of possible linkages among one central welfare policy, unemployment benefit schemes, and health, we also provide examples of findings on how two central dimensions of such schemes—coverage and replacement rates—are linked to health and health inequalities across Europe. These examples indicate not only that welfare state programs can contribute to smaller health inequalities but also that their effectiveness in this respect depends on their institutional set-up.

  • 31.
    Lundberg, Olle
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Åberg Yngwe, Monica
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Fritzell, Johan
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Bacchus Hertzman, Jennie
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Bergqvist, Kersti
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Ferranini, Tommy
    Stockholm University, Faculty of Social Sciences, The Swedish Institute for Social Research (SOFI).
    Nelson, Kenneth
    Stockholm University, Faculty of Social Sciences, The Swedish Institute for Social Research (SOFI).
    Rehnberg, Johan
    Stockholm University, Faculty of Social Sciences, The Swedish Institute for Social Research (SOFI).
    Sjöberg, Ola
    Stockholm University, Faculty of Social Sciences, The Swedish Institute for Social Research (SOFI).
    The effect of social protection and income maintenance policies on health and health inequalities2013In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 23, no Suppl. 1Article in journal (Other academic)
    Abstract [en]

    Background

    As a starting point we review the existing evidence on welfare states, health and health inequalities, from 2005 onwards. Three different approaches emerge in these previous studies – the welfare regime approach, the welfare institutions approach and the social spending approach. While no clear picture emerges for the welfare regime approach, summarising findings regarding the institutional and expenditure approach suggest that a higher degree of generosity and social spending benefits public health. These are therefore approaches we follow to arrive at a better understanding of what type of policies are linked to smaller inequalities in health across the life-course.

    Methods

    A starting point in the analyses is the relation between income, poverty and mortality. The cross-national variation in poverty rates, both absolute (poverty threshold) and relative (60 per cent of median income) measure, and mortality rates in European 26 countries will be considered.

    The second step in the analysis focuses on the relationship between social rights and subjective health in Europe, with a focus on national variations and changes in social rights to levels and changes in subjective health outcomes across several countries. The data holds information regarding social rights and social expenditure, including individual data from EU-SILC.

    Results

    Preliminary results indicate that it is the totality of social protection that is important rather than individual policies. A sub-study regarding social rights and health among youth highlight also the importance of active and passive labour market policy in the 16 included countries.

    Conclusions

    In sum our diverse approach to analysing welfare state efforts and their links to health inequalities suggest that there is a clear relationship between more ambitious policies and smaller inequalities in health. These results are discussed in relation to previous findings.

  • 32.
    Lundberg, Olle
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Åberg Yngwe, Monica
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Kölegård Stjärne, Maria
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Björk, Lisa
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Fritzell, Johan
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    The Nordic Experience: Welfare States and Public Health (NEWS)2008Book (Other academic)
  • 33.
    Lundberg, Olle
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Åberg Yngwe, Monica
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Kölegård Stjärne, Maria
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Elstad, Jon Ivar
    Ferrarini, Tommy
    Stockholm University, Faculty of Social Sciences, The Swedish Institute for Social Research (SOFI).
    Kangas, Olli
    Norström, Thor
    Stockholm University, Faculty of Social Sciences, The Swedish Institute for Social Research (SOFI).
    Palme, Joakim
    Stockholm University, Faculty of Social Sciences, The Swedish Institute for Social Research (SOFI).
    Fritzell, Johan
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    The role of welfare state principles and generosity in social policy programmes for public health: an international comparative study2008In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 372, no 9650, p. 1633-1640Article in journal (Refereed)
    Abstract [en]

     Background Many important social determinants of health are also the focus for social policies. Welfare states contribute to the resources available for their citizens through cash transfer programmes and subsidised services. Although all rich nations have welfare programmes, there are clear cross-national differences with respect to their design and generosity These differences are evident in national variations in poverty rates, especially among children and elderly people. We investigated to what extent variations in family and pension policies are linked to infant mortality and old-age excess mortality. Methods Infant mortality rates and old-age excess mortality rates were analysed in relation to social policy characteristics and generosity. We did pooled cross-sectional time-series analyses of 18 OECD (Organisation for Economic Co-operation and Development) countries during the period 1970-2000 for family policies and 1950-2000 for pension policies. Findings Increased generosity in family policies that support dual-earner families is linked with lower infant mortality rates, whereas the generosity in family policies that support more traditional families with gainfully employed men and homemaking women is not. An increase by one percentage point in dual-earner support lowers infant mortality by 0.04 deaths per 1000 births. Generosity in basic security type of pensions is linked to lower old-age excess mortality, whereas the generosity of earnings-related income security pensions is not. An increase by one percentage point in basic security pensions is associated with a decrease in the old age excess mortality by 0.02 for men as well as for women. Interpretation The ways in which social policies are designed, as well as their generosity, are important for health because of the increase in resources that social policies entail. Hence, social policies are of major importance for how we can tackle the social determinants of health.

  • 34. Mackenbach, J. P.
    et al.
    Kulhánová, I.
    Artnik, B.
    Bopp, M.
    Borrell, C.
    Clemens, T.
    Costa, G.
    Dibben, C.
    Kalediene, R.
    Lundberg, Olle
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Mid Sweden University, Sweden.
    Martikainen, P.
    Menvielle, G.
    Östergren, Olof
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Prochorskas, R.
    Rodríguez-Sanz, M.
    Heine Strand, B.
    Looman, C. W. N.
    de Gelder, R.
    Changes in mortality inequalities over two decades: Register based study of European countries2016In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 353, no 1732Article in journal (Refereed)
    Abstract [en]

    Objective To determine whether government efforts in reducing inequalities in health in European countries have actually made a difference to mortality inequalities by socioeconomic group.

    Design Register based study.

    Data source Mortality data by level of education and occupational class in the period 1990-2010, usually collected in a census linked longitudinal study design. We compared changes in mortality between the lowest and highest socioeconomic groups, and calculated their effect on absolute and relative inequalities in mortality (measured as rate differences and rate ratios, respectively).

    Setting All European countries for which data on socioeconomic inequalities in mortality were available for the approximate period between years 1990 and 2010. These included Finland, Norway, Sweden, Scotland, England and Wales (data applied to both together), France, Switzerland, Spain (Barcelona), Italy (Turin), Slovenia, and Lithuania.

    Results Substantial mortality declines occurred in lower socioeconomic groups in most European countries covered by this study. Relative inequalities in mortality widened almost universally, because percentage declines were usually smaller in lower socioeconomic groups. However, as absolute declines were often smaller in higher socioeconomic groups, absolute inequalities narrowed by up to 35%, particularly among men. Narrowing was partly driven by ischaemic heart disease, smoking related causes, and causes amenable to medical intervention. Progress in reducing absolute inequalities was greatest in Spain (Barcelona), Scotland, England and Wales, and Italy (Turin), and absent in Finland and Norway. More detailed studies preferably using individual level data are necessary to identify the causes of these variations.

    Conclusions Over the past two decades, trends in inequalities in mortality have been more favourable in most European countries than is commonly assumed. Absolute inequalities have decreased in several countries, probably more as a side effect of population wide behavioural changes and improvements in prevention and treatment, than as an effect of policies explicitly aimed at reducing health inequalities.

  • 35. Mackenbach, J. P.
    et al.
    Kulhánová, I.
    Menvielle, G.
    Bopp, M.
    Borrell, C.
    Costa, G.
    Deboosere, P.
    Esnaola, S.
    Kalediene, R.
    Kovacs, K.
    Leinsalu, M.
    Martikainen, P.
    Regidor, E.
    Rodriguez-Sanz, M.
    Strand, B. H.
    Hoffmann, R.
    Eikemo, T. A.
    Östergren, Olof
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Lundberg, Olle
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Mid-Sweden University , Sweden.
    Trends in inequalities in premature mortality: a study of 3.2 million deaths in 13 European countries2015In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 69, no 3, p. 207-217Article in journal (Refereed)
    Abstract [en]

    Background Over the last decades of the 20th century, a widening of the gap in death rates between upper and lower socioeconomic groups has been reported for many European countries. For most countries, it is unknown whether this widening has continued into the first decade of the 21st century. Methods We collected and harmonised data on mortality by educational level among men and women aged 30-74 years in all countries with available data: Finland, Sweden, Norway, Denmark, England and Wales, Belgium, France, Switzerland, Spain, Italy, Hungary, Lithuania and Estonia. Results Relative inequalities in premature mortality increased in most populations in the North, West and East of Europe, but not in the South. This was mostly due to smaller proportional reductions in mortality among the lower than the higher educated, but in the case of Lithuania and Estonia, mortality rose among the lower and declined among the higher educated. Mortality among the lower educated rose in many countries for conditions linked to smoking (lung cancer, women only) and excessive alcohol consumption (liver cirrhosis and external causes). In absolute terms, however, reductions in premature mortality were larger among the lower educated in many countries, mainly due to larger absolute reductions in mortality from cardiovascular disease and cancer (men only). Despite rising levels of education, population-attributable fractions of lower education for mortality rose in many countries. Conclusions Relative inequalities in premature mortality have continued to rise in most European countries, and since the 1990s, the contrast between the South (with smaller inequalities) and the East (with larger inequalities) has become stronger. While the population impact of these inequalities has further increased, there are also some encouraging signs of larger absolute reductions in mortality among the lower educated in many countries. Reducing inequalities in mortality critically depends upon speeding up mortality declines among the lower educated, and countering mortality increases from conditions linked to smoking and excessive alcohol consumption such as lung cancer, liver cirrhosis and external causes.

  • 36. Mackenbach, JP
    et al.
    Kulhanova, I
    Bopp, M
    Deboosere, P
    Eikemo, TA
    Hoffmann, R
    Kulik, MC
    Leinsalu, M
    Martikainen, P
    Menvielle, G
    Regidor, E
    Wojtyniak, B
    Östergren, Olof
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Lundberg, Olle
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Mid-Sweden University, Sweden.
    Variations in the relation between education and cause-specific mortality in 19 European populations: A test of the “fundamental causes” theory of social inequalities in health2015In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 127, p. 51-62Article in journal (Refereed)
    Abstract [en]

    Link and Phelan have proposed to explain the persistence of health inequalities from the fact that socioeconomic status is a “fundamental cause” which embodies an array of resources that can be used to avoid disease risks no matter what mechanisms are relevant at any given time. To test this theory we compared the magnitude of inequalities in mortality between more and less preventable causes of death in 19 European populations, and assessed whether inequalities in mortality from preventable causes are larger in countries with larger resource inequalities.

    We collected and harmonized mortality data by educational level on 19 national and regional populations from 16 European countries in the first decade of the 21st century. We calculated age-adjusted Relative Risks of mortality among men and women aged 30–79 for 24 causes of death, which were classified into four groups: amenable to behavior change, amenable to medical intervention, amenable to injury prevention, and non-preventable.

    Although an overwhelming majority of Relative Risks indicate higher mortality risks among the lower educated, the strength of the education–mortality relation is highly variable between causes of death and populations. Inequalities in mortality are generally larger for causes amenable to behavior change, medical intervention and injury prevention than for non-preventable causes. The contrast between preventable and non-preventable causes is large for causes amenable to behavior change, but absent for causes amenable to injury prevention among women. The contrast between preventable and non-preventable causes is larger in Central & Eastern Europe, where resource inequalities are substantial, than in the Nordic countries and continental Europe, where resource inequalities are relatively small, but they are absent or small in Southern Europe, where resource inequalities are also large.

    In conclusion, our results provide some further support for the theory of “fundamental causes”. However, the absence of larger inequalities for preventable causes in Southern Europe and for injury mortality among women indicate that further empirical and theoretical analysis is necessary to understand when and why the additional resources that a higher socioeconomic status provides, do and do not protect against prevailing health risks.

  • 37. McHardy, Fiona
    et al.
    Lundberg, Olle
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Report on income and social protection for the EU Drivers project: synthesis of case study evidence compiled by European anti-poverty network.2015Report (Other academic)
  • 38. Menvielle, G.
    et al.
    Kunst, A.E.
    Stirbu, I.
    Strand, B.H.
    Borell, C.
    Regidor, E.
    Leclerc, A.
    Esnaola, S.
    Bopp, M.
    Lundberg, Olle
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Artnik, B.
    Costa, G.
    Deboosere, P.
    Martikainen, P.
    Mackenbach, J.P.
    Educational differences in cancer mortality among women and men: a gender pattern that differs across Europe2008In: Br J Cancer, Vol. 98, no 5, p. 1012-1019Article in journal (Refereed)
  • 39.
    Miething, Alexander
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Lundberg, Olle
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Geyer, Siegfried
    Income and health in different welfare contexts: A comparison of Sweden, East and West Germany2013In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 41, no 3, p. 260-268Article in journal (Refereed)
    Abstract [en]

    Background: The aim of the present study is to explore whether the association between income and self-rated health in Sweden is similar to that in Germany. Both countries represent relatively similar economic contexts, but also different welfare traditions and historic experiences. Thus, the study compares Sweden with East Germany and West Germany in order to incorporate the aftereffects of reunification in East Germany. Methods: The association between adjusted disposable household income and self-rated health is investigated by exploring cross-sectional survey data for the year 2000. In a sequence of logistic regression models, the risk for poor self-rated health across income quintiles is analysed, controlling for educational status and occupational position. Data sources are the Swedish Level-of-Living Survey and the German Socio-Economic Panel. Results: A relationship between income and health was observed for Sweden, East Germany and West Germany, before as well as after controlling for education and occupational position. The associations were somewhat stronger for women than for men. Similar magnitudes of income-related poor health were detected across the investigated subsamples, but patterns were distinct in the three regions. The highest estimates were not always found in groups with the lowest income position. Conclusions: Given the variation in the results, we found neither advantages nor disadvantages that can be linked to the effectiveness of the welfare contexts under study. We could also not identify an income threshold for poor health across the investigated countries and settings. Nevertheless, the association between income and health persists, although the patterns vary across regional contexts.

  • 40. Mäki, Netta E.
    et al.
    Martikainen, Pekka T.
    Eikemo, Terje
    Menvielle, Gwenn
    Lundberg, Olle
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Mid Sweden University, Sweden.
    Östergren, Olof
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Mackenbach, Johan P.
    The potential for reducing differences in life expectancy between educational groups in five European countries: the effects of obesity, physical inactivity and smoking2014In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 68, no 7, p. 653-640Article in journal (Refereed)
    Abstract [en]

    Introduction This study assesses the effects of obesity, physical inactivity and smoking on life expectancy (LE) differences between educational groups in five European countries in the early 2000s. Methods We estimate the contribution of risk factors on LE differences between educational groups using the observed risk factor distributions and under a hypothetically more optimal risk factor distribution. Data on risk factor prevalence were obtained from the Survey of Health, Ageing and Retirement in Europe study, and data on mortality from census-linked data sets for the age between 50 and 79 according to sex and education. Results Substantial differences in LE of up to 2.8 years emerged between men with a low and a high level of education in Denmark, Austria and France, and smaller differences among men in Italy and Spain. The educational differences in LE were not as large among women. The largest potential for reducing educational differences was in Denmark (25% among men and 41% among women) and Italy (14% among men). Conclusions The magnitude of the effect of unhealthy behaviours on educational differences in LE varied between countries. LE among those with a low or medium level of education could increase in some European countries if the behavioural risk factor distributions were similar to those observed among the highly educated.

  • 41. Mäki, Netta
    et al.
    Martikainen, Pekka
    Eikemo, Terje
    Menvielle, Gwenn
    Lundberg, Olle
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Östergren, Olof
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Jasilionis, Domantas
    Mackenbach, Johan P.
    Educational differences in disability-free life expectancy: a comparative study of long-standing activity limitation in eight European countries2013In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 94, p. 1-8Article in journal (Refereed)
    Abstract [en]

    Healthy life expectancy is a composite measure of length and quality of life and an important indicator of health in aging populations. There are few cross-country comparisons of socioeconomic differences in healthy life expectancy. Most of the existing comparisons focus on Western Europe and the United States, often relying on older data. To address these deficiencies, we estimated educational differences in disability-free life expectancy for eight countries from all parts of Europe in the early 2000s. Long-standing severe disability was measured as a Global Activity Limitation Indicator (GALI) derived from the European Union Statistics on Income and Living Conditions (EU-SILC) survey. Census-linked mortality data were collected by a recent project comparing health inequalities between European countries (the EURO-GBD-SE project). We calculated sex-specific educational differences in disability-free life expectancy between the ages of 30 and 79 years using the Sullivan method. The lowest disability-free life expectancy was found among Lithuanian men and women (33.1 and 39.1 years, respectively) and the highest among Italian men and women (42.8 and 44.4 years, respectively). Life expectancy and disability-free life expectancy were directly related to the level of education, but the educational differences were much greater in the latter in all countries. The difference in the disability-free life expectancy between those with a primary or lower secondary education and those with a tertiary education was over 10 years for males in Lithuania and approximately 7 years for males in Austria, Finland and France, as well as for females in Lithuania. The difference was smallest in Italy (4 and 2 years among men and women, respectively). Highly educated Europeans can expect to live longer and spend more years in better health than those with lower education. The size of the educational difference in disability-free life expectancy varies significantly between countries. The smallest and largest differences appear to be in Southern Europe and in Eastern and Northern Europe, respectively.

  • 42. Parker, M. G.
    et al.
    Thorslund, M.
    Lundberg, Olle
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Support and care for frail old persons in Sweden2004In: Welfare Policy and Labour Markets: Transformations of the Japanese and Swedish Models for the 21st Century / [ed] N. Maruo, A. Björklund, C. le Grand, Stockholm: Almqvist & Wiksell International , 2004Chapter in book (Other academic)
  • 43. Pega, Frank
    et al.
    Carter, Kristie
    Kawachi, Ichiro
    Davis, Peter
    Gunasekara, Fiona Imlach
    Lundberg, Olle
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institutet.
    Blakely, Tony
    The impact of in-work tax credit for families on self-rated health in adults: a cohort study of 6900 New Zealanders2013In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 67, no 8, p. 682-688Article in journal (Refereed)
    Abstract [en]

    Background In-work tax credit (IWTC) for families, a welfare-to-work policy intervention, may impact health status by improving income and employment. Most studies estimate that IWTCs in the USA and the UK have no effect on self-rated health (SRH) and several other health outcomes, but these estimates may be biased by confounding. The current study estimates the impact of one such IWTC intervention (called In-Work Tax Credit) on SRH in adults in New Zealand, controlling more fully for confounding. Methods We used data from seven waves (2002-2009) of the Survey of Family, Income and Employment, restricted to a balanced panel of adults in families. The exposures, eligibility for IWTC and the amount of IWTC a family was eligible for, were derived for each wave by applying government eligibility and entitlement criteria. The outcome, SRH, was collected annually. We used fixed effects regression analyses to eliminate time-invariant confounding and adjusted for measured time-varying confounders. Results Becoming eligible for IWTC was associated with no detectable change in SRH over the past year (=0.001, 95% CI -0.022 to 0.023). A $1000 increase in the IWTC amount a family was eligible for increased SRH by 0.003 units (95% CI -0.005 to 0.011). Conclusions This study found that becoming eligible for IWTC or a substantial increase in the IWTC amount was not associated with any detectable difference in SRH over the short term. Future research should investigate the impact of IWTC on health over the longer term.

  • 44. Pega, Frank
    et al.
    Kawachi, Ichiro
    Rasanathan, Kumanan
    Lundberg, Olle
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Mid Sweden University, Sweden.
    Politics, policies and population health: A commentary on Mackenbach, Hu and Looman (2013)2013In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 93, p. 176-179Article in journal (Refereed)
  • 45. Plug, Iris
    et al.
    Hoffmann, Rasmus
    Artnik, Barbara
    Bopp, Matthias
    Borrell, Carme
    Costa, Giuseppe
    Deboosere, Patrick
    Esnaola, Santi
    Kalediene, Ramune
    Leinsalu, Mall
    Lundberg, Olle
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Martikainen, Pekka
    Regidor, Enrique
    Rychtarikova, Jitka
    Heine Strand, Björn
    Wojtyniak, Bogdan
    Mackenbach, Johan P.
    Socioeconomic inequalities in mortality from conditions amenable to medical interventions: do they reflect inequalities in access or quality of health care?2012In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 12, article id 346Article in journal (Refereed)
    Abstract [en]

    Background

    Previous studies have reported large socioeconomic inequalities in mortality from conditions amenable to medical intervention, but it is unclear whether these can be attributed to inequalities in access or quality of health care, or to confounding influences such as inequalities in background risk of diseases. We therefore studied whether inequalities in mortality from conditions amenable to medical intervention vary between countries in patterns which differ from those observed for other (non-amenable) causes of death. More specifically, we hypothesized that, as compared to non-amenable causes, inequalities in mortality from amenable causes are more strongly associated with inequalities in health care use and less strongly with inequalities in common risk factors for disease such as smoking.

    Methods

    Cause-specific mortality data for people aged 30–74 years were obtained for 14 countries, and were analysed by calculating age-standardized mortality rates and relative risks comparing a lower with a higher educational group. Survey data on health care use and behavioural risk factors for people aged 30–74 years were obtained for 12 countries, and were analysed by calculating age-and sex-adjusted odds ratios comparing a low with a higher educational group. Patterns of association were explored by calculating correlation coefficients.

    Results

    In most countries and for most amenable causes of death substantial inequalities in mortality were observed, but inequalities in mortality from amenable causes did not vary between countries in patterns that are different from those seen for inequalities in non-amenable mortality. As compared to non-amenable causes, inequalities in mortality from amenable causes are not more strongly associated with inequalities in health care use. Inequalities in mortality from amenable causes are also not less strongly associated with common risk factors such as smoking.

    Conclusions

    We did not find evidence that inequalities in mortality from amenable conditions are related to inequalities in access or quality of health care. Further research is needed to find the causes of socio-economic inequalities in mortality from amenable conditions, and caution should be exercised in interpreting these inequalities as indicating health care deficiencies.

  • 46. Stickley, Andrew
    et al.
    Leinsalu, Mall
    Kunst, Anton E.
    Bopp, Matthias
    Heine Strand, Bjørn
    Martikainen, Pekka
    Lundberg, Olle
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Kovács, Katalin
    Artnik, Barbara
    Kalediene, Ramune
    Rychtaříková, Jitka
    Wojtyniak, Bogdan
    Mackenbach, Johan P.
    Socioeconomic inequalities in homicide mortality: a population-based comparative study of 12 European countries2012In: European Journal of Epidemiology, ISSN 0393-2990, E-ISSN 1573-7284, Vol. 27, no 11, p. 877-884Article in journal (Refereed)
    Abstract [en]

    Recent research has suggested that violent mortality may be socially patterned and a potentially important source of health inequalities within and between countries. Against this background the current study assessed socioeconomic inequalities in homicide mortality across Europe. To do this, longitudinal and cross-sectional data were obtained from mortality registers and population censuses in 12 European countries. Educational level was used to indicate socioeconomic position. Age-standardized mortality rates were calculated for post, upper and lower secondary or less educational groups. The magnitude of inequalities was assessed using the relative and slope index of inequality. The analysis focused on the 35–64 age group. Educational inequalities in homicide mortality were present in all countries. Absolute inequalities in homicide mortality were larger in the eastern part of Europe and in Finland, consistent with their higher overall homicide rates. They contributed 2.5 % at most (in Estonia) to the inequalities in total mortality. Relative inequalities were high in the northern and eastern part of Europe, but were low in Belgium, Switzerland and Slovenia. Patterns were less consistent among women. Socioeconomic inequalities in homicide are thus a universal phenomenon in Europe. Wide-ranging social and inter-sectoral health policies are now needed to address the risk of violent victimization that target both potential offenders and victims.

  • 47. Toch-Marquardt, Marlen
    et al.
    Menvielle, Gwenn
    Eikemo, Terje A.
    Kulhánová, Ivana
    Kulik, Margarete C.
    Bopp, Matthias
    Esnaola, Santiago
    Jasilionis, Domantas
    Mäki, Netta
    Martikainen, Pekka
    Regidor, Enrique
    Lundberg, Olle
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Mackenbach, Johan P.
    Occupational class inequalities in all-cause and cause-specific mortality among middle-aged men in 14 European populations during the early 2000s2014In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 9, no 9, p. e108072-Article in journal (Refereed)
    Abstract [en]

    This study analyses occupational class inequalities in all-cause mortality and four specific causes of death among men, in Europe in the early 2000s, and is the most extensive comparative analysis of occupational class inequalities in mortality in Europe so far. Longitudinal data, obtained from population censuses and mortality registries in 14 European populations, from around the period 2000-2005, were used. Analyses concerned men aged 30-59 years and included all-cause mortality and mortality from all cancers, all cardiovascular diseases (CVD), all external, and all other causes. Occupational class was analysed according to five categories: upper and lower non-manual workers, skilled and unskilled manual workers, and farmers and self-employed combined. Inequalities were quantified with mortality rate ratios, rate differences, and population attributable fractions (PAF). Relative and absolute inequalities in all-cause mortality were more pronounced in Finland, Denmark, France, and Lithuania than in other populations, and the same countries (except France) also had the highest PAF values for all-cause mortality. The main contributing causes to these larger inequalities differed strongly between countries (e. g., cancer in France, all other causes in Denmark). Relative and absolute inequalities in CVD mortality were markedly lower in Southern European populations. We conclude that relative and absolute occupational class differences in all-cause and cause specific mortality have persisted into the early 2000's, although the magnitude differs strongly between populations. Comparisons with previous studies suggest that the relative gap in mortality between occupational classes has further widened in some Northern and Western European populations.

  • 48. van der Wel, Kjetil A.
    et al.
    Östergren, Olof
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Lundberg, Olle
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Korhonen, Kaarina
    Martikainen, Pekka
    Nybo Andersen, Anne-Marie
    Kjaer Urhoj, Stine
    A gold mine, but still no Klondike: Nordic register data in health inequalities research2019In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905Article in journal (Refereed)
    Abstract [en]

    Aims: Future research on health inequality relies on data that cover life-course exposure, different birth cohorts and variation in policy contexts. Nordic register data have long been celebrated as a 'gold mine' for research, and fulfil many of these criteria. However, access to and use of such data are hampered by a number of hurdles and bottlenecks. We present and discuss the experiences of an ongoing Nordic consortium from the process of acquiring register data on socio-economic conditions and health in Denmark, Finland, Norway and Sweden. Methods: We compare experiences of data-acquisition processes from a researcher's perspective in the four countries and discuss the comparability of register data and the modes of collaboration available to researchers, given the prevailing ethical and legal restrictions. Results: The application processes we experienced were time-consuming, and decision structures were often fragmented. We found substantial variation between the countries in terms of processing times, costs and the administrative burden of the researcher. Concerned agencies differed in policy and practice which influenced both how and when data were delivered. These discrepancies present a challenge to comparative research. Conclusions: We conclude that there are few signs of harmonisation, as called for by previous policy documents and research papers. Ethical vetting needs to be centralised both within and between countries in order to improve data access. Institutional factors that seem to facilitate access to register data at the national level include single storage environments for health and social data, simplified ethical vetting and user guidance.

  • 49. van Hedel, Karen
    et al.
    Avendano, Mauricio
    Berkman, Lisa F
    Bopp, Matthias
    Deboosere, Patrick
    Lundberg, Olle
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Martikainen, Pekka
    Menvielle, Gwenn
    van Lenthe, Frank J
    Mackenbach, Johan P
    The contribution of national disparities to international differences in mortality between the United States and 7 European countries.2015In: American Journal of Public Health, ISSN 0090-0036, E-ISSN 1541-0048, Vol. 105, no 4, p. e112-e119Article in journal (Refereed)
  • 50. van Raalte, A.
    et al.
    Kunst, A. E.
    Deboosere, P.
    Leinsalu, M.
    Lundberg, Olle
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Martikainen, P.
    Strand, P. H.
    Artnik, B.
    Wojtyniak, B.
    Mackenbach, J. P.
    More variation in lifespan in lower educated groups: evidence from 10 European countries2011In: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685, Vol. 40, no 6, p. 1703-1714Article in journal (Refereed)
    Abstract [en]

    Background Whereas it is well established that people with a lower socio-economic position have a shorter average lifespan, it is less clear what the variability surrounding these averages is. We set out to examine whether lower educated groups face greater variation in lifespans in addition to having a shorter life expectancy, in order to identify entry points for policies to reduce the impact of socio-economic position on mortality.

    Methods We used harmonized, census-based mortality data from 10 European countries to construct life tables by sex and educational level (low, medium, high). Variation in lifespan was measured by the standard deviation conditional upon survival to age 35 years. We also decomposed differences between educational groups in lifespan variation by age and cause of death.

    Results Lifespan variation was higher among the lower educated in every country, but more so among men and in Eastern Europe. Although there was an inverse relationship between average life expectancy and its standard deviation, the first did not completely predict the latter. Greater lifespan variation in lower educated groups was largely driven by conditions causing death at younger ages, such as injuries and neoplasms.

    Conclusions Lower educated individuals not only have shorter life expectancies, but also face greater uncertainty about the age at which they will die. More priority should be given to efforts to reduce the risk of an early death among the lower educated, e.g. by strengthening protective policies within and outside the health-care system.

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