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Special Issue "Inequalities in Health"

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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601).

Deadline for manuscript submissions: closed (31 May 2013)

Special Issue Editor

Guest Editor
Prof. Dr. Ulf-G. Gerdtham

Department of Clinical Sciences, Department of Economics, Lund University, P.O. Box 7082, S-220 07 Lund, Sweden
Website | E-Mail
Fax: +46 (0)46 222 41 18
Interests: health economics; health econometrics; inequalities in health; economics of health behaviour; international health expenditure; health system and organization

Special Issue Information

Dear Colleagues,

It has been suggested that health is determined by socioeconomic factors and that socioeconomic inequality has to be reduced in order to lessen socioeconomic inequalities in health. There are also income and education policies etc. which could impact on socioeconomic factors and thus socioeconomic health inequalities. Still, however, little is still known on exactly how such policies will impact on the socioeconomic health inequalities as the causal mechanisms underlying socioeconomic disparities in health are complex and controversial, and the causes may be different across population groups and over the lifecycle.  Policies aimed at reducing the socioeconomic inequalities in health may therefore easily be ineffective, inconsistent and even counterproductive. This issue welcomes new and innovative methods to measure, monitor and explain changes in socioeconomic health disparities over time including modeling effect of economic policies. Manuscripts which shed light on the causal effects of socioeconomic factors on health are particularly welcome.

Prof. Dr. Ulf-G. Gerdtham
Guest Editor

Submission

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Keywords

  • health inequalities
  • socioeconomic effects on health
  • causal effects of income on health
  • health related behavior
  • measurement of health inequalities

Published Papers (14 papers)

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Research

Jump to: Review

Open AccessArticle Access Disparity and Health Inequality of the Elderly: Unmet Needs and Delayed Healthcare
Int. J. Environ. Res. Public Health 2015, 12(2), 1745-1772; doi:10.3390/ijerph120201745
Received: 8 June 2014 / Revised: 29 October 2014 / Accepted: 21 January 2015 / Published: 3 February 2015
Cited by 1 | PDF Full-text (782 KB) | HTML Full-text | XML Full-text
Abstract
The purpose of this study is to investigate healthcare access disparity that will cause delayed and unmet healthcare needs for the elderly, and to examine health inequality and healthcare cost burden for the elderly. To produce clear policy applications, this study adapts a
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The purpose of this study is to investigate healthcare access disparity that will cause delayed and unmet healthcare needs for the elderly, and to examine health inequality and healthcare cost burden for the elderly. To produce clear policy applications, this study adapts a modified PRECEDE-PROCEED model for framing theoretical and experimental approaches. Data were collected from a large collection of the Community Tracking Study Household Survey 2003–2004 of the USA. Reliability and construct validity are examined for internal consistency and estimation of disparity and inequality are analyzed by using probit/ols regressions. The results show that predisposing factors (e.g., attitude, beliefs, and perception by socio-demographic differences) are negatively associated with delayed healthcare. A 10% increase in enabling factors (e.g., availability of health insurance coverage, and usual sources of healthcare providers) are significantly associated with a 1% increase in healthcare financing factors. In addition, information through a socio-economic network and support system has a 5% impact on an access disparity. Income, health status, and health inequality are exogenously determined. Designing and implementing easy healthcare accessibility (healthcare system) and healthcare financing methods, and developing a socio-economic support network (including public health information) are essential in reducing delayed healthcare and health inequality. Full article
(This article belongs to the Special Issue Inequalities in Health)
Open AccessArticle Spatial Relationship Quantification between Environmental, Socioeconomic and Health Data at Different Geographic Levels
Int. J. Environ. Res. Public Health 2014, 11(4), 3765-3786; doi:10.3390/ijerph110403765
Received: 31 October 2013 / Revised: 18 March 2014 / Accepted: 19 March 2014 / Published: 3 April 2014
Cited by 7 | PDF Full-text (1696 KB) | HTML Full-text | XML Full-text
Abstract
Spatial health inequalities have often been analyzed in terms of socioeconomic and environmental factors. The present study aimed to evaluate spatial relationships between spatial data collected at different spatial scales. The approach was illustrated using health outcomes (mortality attributable to cancer) initially aggregated
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Spatial health inequalities have often been analyzed in terms of socioeconomic and environmental factors. The present study aimed to evaluate spatial relationships between spatial data collected at different spatial scales. The approach was illustrated using health outcomes (mortality attributable to cancer) initially aggregated to the county level, district socioeconomic covariates, and exposure data modeled on a regular grid. Geographically weighted regression (GWR) was used to quantify spatial relationships. The strongest associations were found when low deprivation was associated with lower lip, oral cavity and pharynx cancer mortality and when low environmental pollution was associated with low pleural cancer mortality. However, applying this approach to other areas or to other causes of death or with other indicators requires continuous exploratory analysis to assess the role of the modifiable areal unit problem (MAUP) and downscaling the health data on the study of the relationship, which will allow decision-makers to develop interventions where they are most needed. Full article
(This article belongs to the Special Issue Inequalities in Health)
Open AccessArticle The Socioeconomic Determinants of Health: Economic Growth and Health in the OECD Countries during the Last Three Decades
Int. J. Environ. Res. Public Health 2014, 11(1), 815-829; doi:10.3390/ijerph110100815
Received: 25 October 2013 / Revised: 30 December 2013 / Accepted: 31 December 2013 / Published: 8 January 2014
Cited by 3 | PDF Full-text (202 KB) | HTML Full-text | XML Full-text | Supplementary Files
Abstract
In times of economic crisis, most countries face the dual challenge of fighting unemployment while restraining social expenditures and closing budget deficits. The spending cuts and lack of employment affect a large number of decisions that have a direct or indirect impact on
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In times of economic crisis, most countries face the dual challenge of fighting unemployment while restraining social expenditures and closing budget deficits. The spending cuts and lack of employment affect a large number of decisions that have a direct or indirect impact on health. This impact is likely to be unevenly distributed among different groups within the population, and therefore not only health levels may be at risk, but also their distribution. The main purpose of this paper is to explore links between unemployment, economic growth, inequality, and health. We regress a measure of health, the Health Human Development Index (HHDI), against a set of explanatory variables accounting for the countries’ economic performance (GDP growth, unemployment, and income inequality), and some institutional factors related to welfare spending and the nature of the health systems for the past three decades. In addition, we explore the causes for different results obtained using an inequality-adjusted HHDI, vs. the unadjusted HHDI. We describe a panel data model, estimated by random effects, for 32 countries from 1980–2010, in five-year intervals. Our conclusion is that the high economic growth observed in the last decades, together with an increase in the levels of income inequality and/or poverty, explain the observed changes of our index, particularly when this indicator is weighted by health inequality. The remaining institutional variables (the share of social spending, health care expenditure, and the type of health systems) show the expected sign but are not statistically significant. A comment on the methodological pitfalls of the approach completes the analysis. Full article
(This article belongs to the Special Issue Inequalities in Health)
Open AccessArticle Social Network Characteristics and Daily Smoking among Young Adults in Sweden
Int. J. Environ. Res. Public Health 2013, 10(12), 6517-6533; doi:10.3390/ijerph10126517
Received: 27 June 2013 / Revised: 10 November 2013 / Accepted: 12 November 2013 / Published: 29 November 2013
Cited by 6 | PDF Full-text (198 KB) | HTML Full-text | XML Full-text
Abstract
A large number of studies have shown that friends’ smoking behavior is strongly associated with an individual’s own risk for smoking. However, few studies have examined whether other features of social networks, independently or conjointly with friends’ smoking behavior, may influence the risk
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A large number of studies have shown that friends’ smoking behavior is strongly associated with an individual’s own risk for smoking. However, few studies have examined whether other features of social networks, independently or conjointly with friends’ smoking behavior, may influence the risk for smoking. Because it is characterized by the growing importance of friendship networks, the transition from adolescence to young adulthood may constitute a particularly relevant period on which to focus our investigation of network influences on smoking behavior. The aim of this study was therefore to examine the consequences of peer smoking as well as other network characteristics (friends’ other health behaviors, relationship content, and structural aspects of the network) on the risk for smoking among young adults. The data was based on a cross-sectional survey of Swedish 19-year-olds carried out in 2009 (n = 5,695) with a response rate of 51.6%. Logistic regression was the primary method of analysis. The results show that having a large percentage of smokers in one’s network was by far the most important risk factor for daily smoking. The risk of daily smoking was 21.20 (CI 14.24. 31.54) if 76%–100% of the network members smoked. Having a high percentage of physically active friends was inversely associated with daily smoking. The risk of smoking was 0.65 (CI 0.42. 1.00) if 76%–100% of the network members were physically active. No main associations between the other network characteristics (relationship content and structural aspects of the network) and smoking were found. However, there was an interaction between the percentage of smokers in the network and relationship content (i.e., trust, relationship quality and propensity to discuss problems): positive relationship content in combination with peer smoking may increase the risk of smoking. Women with a high percentage of smokers in their networks were also at higher risk of daily smoking than were men with many smoking friends. Hence, it is important to consider the interplay between peer smoking and other network characteristics on the risk of smoking, where features of networks which traditionally are seen as constructive may occasionally provide the impetus to smoke. Future studies should use longitudinal data to study whether these findings reflect peer selection or peer influence. Full article
(This article belongs to the Special Issue Inequalities in Health)
Open AccessCommunication Issues to Consider When Measuring and Applying Socioeconomic Position Quantitatively in Immigrant Health Research
Int. J. Environ. Res. Public Health 2013, 10(12), 6354-6365; doi:10.3390/ijerph10126354
Received: 18 September 2013 / Revised: 4 November 2013 / Accepted: 8 November 2013 / Published: 27 November 2013
Cited by 7 | PDF Full-text (178 KB) | HTML Full-text | XML Full-text
Abstract
The relationship between migration and health is complex, yet, immigrant-related inequalities in health are largely influenced by socioeconomic position. Drawing upon previous findings, this paper discusses issues to consider when measuring and applying socioeconomic position in quantitative immigrant health research. When measuring socioeconomic
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The relationship between migration and health is complex, yet, immigrant-related inequalities in health are largely influenced by socioeconomic position. Drawing upon previous findings, this paper discusses issues to consider when measuring and applying socioeconomic position in quantitative immigrant health research. When measuring socioeconomic position, it is important to be aware of four aspects: (1) there is a lack of clarity about how socioeconomic position should be measured; (2) different types of socioeconomic position may be relevant to immigrants compared with the native-born population; (3) choices of measures of socioeconomic position in quantitative analyses often rely on data availability; and (4) different measures of socioeconomic position have different effects in population groups. Therefore, caution should be used in the collection, presentation, analyses, and interpretation of data and researchers need to display their proposed conceptual models and data limitations as well as apply different approaches for analyses. Full article
(This article belongs to the Special Issue Inequalities in Health)
Open AccessArticle Longitudinal Influences of Neighbourhood Built and Social Environment on Children’s Weight Status
Int. J. Environ. Res. Public Health 2013, 10(10), 5083-5096; doi:10.3390/ijerph10105083
Received: 25 August 2013 / Revised: 1 October 2013 / Accepted: 7 October 2013 / Published: 15 October 2013
Cited by 8 | PDF Full-text (214 KB) | HTML Full-text | XML Full-text
Abstract
The objective was to examine longitudinal 4-year-relationships between neighbourhood social environment and children’s body mass index-standard deviation score (BMI-SDS) taking into account the built environment. Furthermore, we have analysed the influence of potential interactions between the social environment and family/social data on children’s
[...] Read more.
The objective was to examine longitudinal 4-year-relationships between neighbourhood social environment and children’s body mass index-standard deviation score (BMI-SDS) taking into account the built environment. Furthermore, we have analysed the influence of potential interactions between the social environment and family/social data on children’s BMI-SDS. Between 2006–2008 and 2010–2012, anthropometric measurements were conducted among 485 children (age at baseline: 6.1 (5.8–6.4)). Socio-demographic characteristics and perception of residential environment were reported by parents. Geographic Information Systems were used to examine street length, number of food outlets and distance to the nearest playground and park/green space within an 800 m Euclidian buffer of each participant address point. Additional data on neighbourhood characteristics (e.g., traffic density, walkability, crime rates) were obtained from the State Capital of Kiel, Germany. In a multivariate model, walkability, street type, socioeconomic status of the district and perceived frequency of passing trucks/busses were associated with BMI-SDS over 4 years, but only neighbourhood SES had an effect on change in BMI-SDS. However, familial/social factors rather than neighbourhood environment (especially social environment) had an impact on children’s BMI-SDS over 4 years. Thus, social inequalities in childhood overweight are only partially explained by social neighbourhood environment. Full article
(This article belongs to the Special Issue Inequalities in Health)
Open AccessArticle Relative Deprivation and Sickness Absence in Sweden
Int. J. Environ. Res. Public Health 2013, 10(9), 3930-3953; doi:10.3390/ijerph10093930
Received: 9 July 2013 / Revised: 14 August 2013 / Accepted: 16 August 2013 / Published: 29 August 2013
PDF Full-text (318 KB) | HTML Full-text | XML Full-text
Abstract
Background: A high prevalence of sickness absence in many countries, at a substantial societal cost, underlines the importance to understand its determining mechanisms. This study focuses on the link between relative deprivation and the probability of sickness absence. Methods: 184,000 men and women
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Background: A high prevalence of sickness absence in many countries, at a substantial societal cost, underlines the importance to understand its determining mechanisms. This study focuses on the link between relative deprivation and the probability of sickness absence. Methods: 184,000 men and women in Sweden were followed between 1982 and 2001. The sample consists of working individuals between the ages of 19 and 65. The outcome is defined as experiencing more than 14 days of sickness absence during a year. Based on the complete Swedish population, an individual’s degree of relative deprivation is measured through income compared to individuals of the same age, sex, educational level and type. In accounting for the possibility that sickness absence and socioeconomic status are determined by common factors, discrete-time duration models were estimated, accounting for unobserved heterogeneity through random effects. Results: The results confirm that the failure to account for the dynamics of the individual’s career biases the influence from socioeconomic characteristics. Results consistently suggest a major influence from relative deprivation, with a consistently lower risk of sickness absence among the highly educated. Conclusions: Altering individual’s health behavior through education appears more efficient in reducing the reliance on sickness absence, rather than redistributive policies. Full article
(This article belongs to the Special Issue Inequalities in Health)
Open AccessArticle Effects of Compulsory Schooling on Mortality: Evidence from Sweden
Int. J. Environ. Res. Public Health 2013, 10(8), 3596-3618; doi:10.3390/ijerph10083596
Received: 24 June 2013 / Accepted: 2 August 2013 / Published: 13 August 2013
Cited by 4 | PDF Full-text (347 KB) | HTML Full-text | XML Full-text
Abstract
Theoretically, there are several reasons to expect education to have a positive effect on health. Empirical research suggests that education can be an important health determinant. However, it has not yet been established whether education and health are indeed causally related, and the
[...] Read more.
Theoretically, there are several reasons to expect education to have a positive effect on health. Empirical research suggests that education can be an important health determinant. However, it has not yet been established whether education and health are indeed causally related, and the effects found in previous studies may be partially attributable to methodological weaknesses. Moreover, existing evidence on the education-health relationship generally uses information of fairly recent schooling reforms, implying that health outcomes are observed only over a limited time period. This paper examines the effect of education on mortality using information on a national roll-out of a reform leading to one extra year of compulsory schooling in Sweden. In 1936, the national government made a seventh school year compulsory; however, the implementation was decided at the school district level, and the reform was implemented over 12 years. Taking advantage of the variation in the timing of the implementation across school districts, by using county-level proportions of reformed districts, census data and administrative mortality data, we find that the extra compulsory school year reduced mortality. In fact, the mortality reduction is discernible already before the age of 30 and then grows in magnitude until the age of 55–60. Full article
(This article belongs to the Special Issue Inequalities in Health)
Open AccessArticle Healthier Lives for European Minority Groups: School and Health Care, Lessons from the Roma
Int. J. Environ. Res. Public Health 2013, 10(8), 3089-3111; doi:10.3390/ijerph10083089
Received: 3 June 2013 / Revised: 12 July 2013 / Accepted: 16 July 2013 / Published: 24 July 2013
PDF Full-text (264 KB) | HTML Full-text | XML Full-text
Abstract
On average, the Roma in Europe can expect to die 10 years earlier than the rest of the population, given the health conditions they experience. EU-funded research has informed on successful actions (SA) that when implemented among the Roma provide them new forms
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On average, the Roma in Europe can expect to die 10 years earlier than the rest of the population, given the health conditions they experience. EU-funded research has informed on successful actions (SA) that when implemented among the Roma provide them new forms of educational participation which have a direct impact on improving their health status, regardless of their educational level. The findings from this research, unanimously endorsed by the European Parliament, have been included in several European Union recommendations and resolutions as part of the EU strategy on Roma inclusion. To analyze these SA, as well as the conditions that promote them and their impact on reducing health inequalities, communicative fieldwork has been conducted with Roma people from a deprived neighbourhood in the South of Spain, who are participating in the previously identified SA. The analysis reveals that these SA enable Roma people to reinforce and enrich specific strategies like improving family cohesion and strengthening their identity, which allow them to improve their overall health. These findings may inform public policies to improve the health condition of the Roma and other vulnerable groups, one goal of the Europe 2020 strategy for a healthier Europe. Full article
(This article belongs to the Special Issue Inequalities in Health)
Open AccessArticle Health Inequalities among Workers with a Foreign Background in Sweden: Do Working Conditions Matter?
Int. J. Environ. Res. Public Health 2013, 10(7), 2871-2887; doi:10.3390/ijerph10072871
Received: 3 June 2013 / Revised: 1 July 2013 / Accepted: 1 July 2013 / Published: 10 July 2013
Cited by 4 | PDF Full-text (243 KB) | HTML Full-text | XML Full-text
Abstract
Employment and working conditions are key social determinants of health, yet current information is lacking regarding relationships between foreign background status, working conditions and health among workers in Sweden. This study utilized cross-sectional data from the 2010 Swedish Level of Living Survey (LNU)
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Employment and working conditions are key social determinants of health, yet current information is lacking regarding relationships between foreign background status, working conditions and health among workers in Sweden. This study utilized cross-sectional data from the 2010 Swedish Level of Living Survey (LNU) and the Level of Living Survey for Foreign Born Persons and their Children (LNU-UFB) to assess whether or not health inequalities exist between native Swedish and foreign background workers and if exposure to adverse psychosocial and physical working conditions contributes to the risk for poor health among foreign background workers. A sub-sample of 4,021 employed individuals aged 18–65 was analyzed using logistic regression. Eastern European, Latin American and Other Non-Western workers had an increased risk of both poor self-rated health and mental distress compared to native Swedish workers. Exposure to adverse working conditions only minimally influenced the risk of poor health. Further research should examine workers who are less integrated or who have less secure labor market attachments and also investigate how additional working conditions may influence associations between health and foreign background status. Full article
(This article belongs to the Special Issue Inequalities in Health)
Open AccessArticle Influence of Maternal and Child Lifestyle-Related Characteristics on the Socioeconomic Inequality in Overweight and Obesity among 5-year-old Children; The “Be Active, Eat Right” Study
Int. J. Environ. Res. Public Health 2013, 10(6), 2336-2347; doi:10.3390/ijerph10062336
Received: 2 April 2013 / Revised: 21 May 2013 / Accepted: 27 May 2013 / Published: 6 June 2013
Cited by 7 | PDF Full-text (223 KB) | HTML Full-text | XML Full-text
Abstract
It is unclear whether the socioeconomic inequality in prevalence of overweight and obesity is already present among very young children. This study investigates the association between overweight and socioeconomic status (SES, with maternal educational level as an indicator of SES) among 5-year-old children.
[...] Read more.
It is unclear whether the socioeconomic inequality in prevalence of overweight and obesity is already present among very young children. This study investigates the association between overweight and socioeconomic status (SES, with maternal educational level as an indicator of SES) among 5-year-old children. This cross-sectional study uses baseline data from 5-year-olds of Dutch ethnicity (n = 5,582) and their mothers collected for the “Be active, eat right” study. Compared to children of mothers with the highest educational level, for children of mothers with the lowest educational level the odds ratio (adjusted for demographic characteristics) for having overweight was 2.10 (95% confidence interval: 1.57–2.82), and for having obesity was 4.18 (95% confidence interval: 2.32–7.55). Addition of maternal and child lifestyle-related characteristics decreased the odds ratios for overweight and obesity by 26.4% and 42.1%, respectively. The results show that an inverse SES-overweight/obesity association is already present at elementary school entry, and that watching TV by mother and child, the child consuming breakfast and, especially maternal weight status, are contributing factors in this association. These results should be taken into account when developing policies to reduce inequalities in (childhood) health. Full article
(This article belongs to the Special Issue Inequalities in Health)

Review

Jump to: Research

Open AccessReview What Causes Environmental Inequalities and Related Health Effects? An Analysis of Evolving Concepts
Int. J. Environ. Res. Public Health 2014, 11(6), 5807-5827; doi:10.3390/ijerph110605807
Received: 4 July 2013 / Revised: 30 April 2014 / Accepted: 20 May 2014 / Published: 30 May 2014
Cited by 5 | PDF Full-text (323 KB) | HTML Full-text | XML Full-text
Abstract
Early environmental justice studies were exposure-oriented, lacked an integrated approach, and did not address the health impact of environmental inequalities. A coherent conceptual framework, needed to understand and tackle environmental inequalities and the related health effects, was lacking. We analyzed the more recent
[...] Read more.
Early environmental justice studies were exposure-oriented, lacked an integrated approach, and did not address the health impact of environmental inequalities. A coherent conceptual framework, needed to understand and tackle environmental inequalities and the related health effects, was lacking. We analyzed the more recent environmental justice literature to find out how conceptual insights have evolved. The conceptual framework of the WHO Commission on Social Determinants of Health (CSDH) was analyzed for additional explanations for environmental inequalities and the related health effects. This paper points out that recent environmental justice studies have broadened their scope by incorporating a broader set of physical and social environmental indicators, and by focusing on different geographic levels and on health impacts of environmental inequalities. The CSDH framework provided additional elements such as the role of structural determinants, the role of health-related behavior in relation to the physical and social environment, access to health care, as well as the life course perspective. Incorporating elements of the CSDH framework into existing environmental justice concepts, and performing more empirical research on the interactions between the different determinants at different geographical levels would further improve our understanding of environmental inequalities and their health effects and offer new opportunities for policy action. Full article
(This article belongs to the Special Issue Inequalities in Health)
Open AccessReview Simulation Models for Socioeconomic Inequalities in Health: A Systematic Review
Int. J. Environ. Res. Public Health 2013, 10(11), 5750-5780; doi:10.3390/ijerph10115750
Received: 5 September 2013 / Revised: 14 October 2013 / Accepted: 16 October 2013 / Published: 4 November 2013
Cited by 2 | PDF Full-text (485 KB) | HTML Full-text | XML Full-text
Abstract
Background: The emergence and evolution of socioeconomic inequalities in health involves multiple factors interacting with each other at different levels. Simulation models are suitable for studying such complex and dynamic systems and have the ability to test the impact of policy interventions
[...] Read more.
Background: The emergence and evolution of socioeconomic inequalities in health involves multiple factors interacting with each other at different levels. Simulation models are suitable for studying such complex and dynamic systems and have the ability to test the impact of policy interventions in silico. Objective: To explore how simulation models were used in the field of socioeconomic inequalities in health. Methods: An electronic search of studies assessing socioeconomic inequalities in health using a simulation model was conducted. Characteristics of the simulation models were extracted and distinct simulation approaches were identified. As an illustration, a simple agent-based model of the emergence of socioeconomic differences in alcohol abuse was developed. Results: We found 61 studies published between 1989 and 2013. Ten different simulation approaches were identified. The agent-based model illustration showed that multilevel, reciprocal and indirect effects of social determinants on health can be modeled flexibly. Discussion and Conclusions: Based on the review, we discuss the utility of using simulation models for studying health inequalities, and refer to good modeling practices for developing such models. The review and the simulation model example suggest that the use of simulation models may enhance the understanding and debate about existing and new socioeconomic inequalities of health frameworks. Full article
(This article belongs to the Special Issue Inequalities in Health)
Open AccessReview Using Inequality Measures to Incorporate Environmental Justice into Regulatory Analyses
Int. J. Environ. Res. Public Health 2013, 10(9), 4039-4059; doi:10.3390/ijerph10094039
Received: 6 June 2013 / Revised: 1 August 2013 / Accepted: 19 August 2013 / Published: 30 August 2013
Cited by 3 | PDF Full-text (272 KB) | HTML Full-text | XML Full-text
Abstract
Formally evaluating how specific policy measures influence environmental justice is challenging, especially in the context of regulatory analyses in which quantitative comparisons are the norm. However, there is a large literature on developing and applying quantitative measures of health inequality in other settings,
[...] Read more.
Formally evaluating how specific policy measures influence environmental justice is challenging, especially in the context of regulatory analyses in which quantitative comparisons are the norm. However, there is a large literature on developing and applying quantitative measures of health inequality in other settings, and these measures may be applicable to environmental regulatory analyses. In this paper, we provide information to assist policy decision makers in determining the viability of using measures of health inequality in the context of environmental regulatory analyses. We conclude that quantification of the distribution of inequalities in health outcomes across social groups of concern, considering both within-group and between-group comparisons, would be consistent with both the structure of regulatory analysis and the core definition of environmental justice. Appropriate application of inequality indicators requires thorough characterization of the baseline distribution of exposures and risks, leveraging data generally available within regulatory analyses. Multiple inequality indicators may be applicable to regulatory analyses, and the choice among indicators should be based on explicit value judgments regarding the dimensions of environmental justice of greatest interest. Full article
(This article belongs to the Special Issue Inequalities in Health)

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