Introduction

Socioeconomic inequalities in health are an important challenge for public health in Europe. Such inequalities are substantial in all countries for which data exist and they concern inequalities in mortality, life expectancy and morbidity.

In the 1980s, socioeconomic inequalities in mortality and morbidity were found in many Western European countries. In countries in Northern Europe, such as Norway, Sweden and Finland, health inequalities were not smaller than in other Western European countries, despite long-term political commitment to reduce socioeconomic inequalities in these Northern countries (Mackenbach et al., 1997).

Here we present the findings of the Eurothine project, the most recent (1990s and early 2000s) European project on the magnitude of socioeconomic inequalities in mortality and morbidity in a large number of countries of both Western and Eastern Europe (Mackenbach et al., 2007a).

Inequalities in all cause mortality

In 16 European countries, all cause mortality was higher in the lower as compared to the higher socioeconomic groups. See Relative inequalities in total mortality by level of education. However, the magnitude of inequalities in total mortality by educational level varies substantially between countries. For both men and women, inequalities are smallest in the Basque Country and the largest in the Czech Republic (for men) and Lithuania (for women). In the Southern European populations, educational inequalities in mortality were smaller than average, while most countries in the East and Baltic regions have larger-than-average educational inequalities in mortality (Mackenbach et al., 2007b).

Inequalities in morbidity

Throughout the European continent, the same pattern is observed: worse self-assessed health is lower as compared to higher socioeconomic groups. In Italy and Spain, educational inequalities in self-assessed health are smaller than the European average. In the Baltic region, educational inequalities in self-assessed health are larger than average (see Relative inequalities in self-assessed health by level of education).

The association between alcohol consumption and mortality is complex: there are potential benefical effects of moderate alcohol consumption, while excessive use may cause substantial health problems and mortality.

Alcohol related mortality includes deaths from a great number of underlying causes, which can be divided into two large groups:

• mortality from alcohol related disease (natural causes);
• mortality from alcohol related injuries or adverse effects (external causes).

It is important to note that only part of the specific causes of death related to alcohol, such as alcoholic cirrhosis, can be wholly attributed to alcohol. For many other diseases, alcohol is only one of the potential causes.

A few earlier studies reported on higher alcohol-related mortality among lower socioeconomic groups within some European populations (Harrison & Gardiner, 1999; Mäkelä et al., 1997; Mäkelä et al., 2003). From the Eurothine study it appears that alcohol related mortality is higher among lower educated men and women in all countries. Educational differences in alcohol related mortality are especially large in some countries; for example in Hungary and the Czech Republic for men and in the East and Baltic region for women (Van Oyen et al., 2007).

See Relative indices of inequality for all cause mortality and alcohol related mortality in men in selected countries by age, and Relative indices of inequality for all cause mortality and alcohol related mortality in women in selected countries by age.

See also EUphact details Alcohol use.

Socioeconomic inequalities in health may partly be caused by inequalities in access to and quality of health services. Avoidable mortality stands for mortality from conditions amenable to medical interventions.

Some studies revealed higher levels of avoidable mortality among people with a low socioeconomic status or among people from disadvantaged ethnic groups (Tobias & Jackson, 2001; Poikolainen & Eskola, 1995; Wood et al., 1999; Stirbu et al., 2006; Westerling et al., 1996; Schwarz, 2007.

In the Eurothine study, avoidable mortality refers to mortality from conditions that are amenable to treatment, including those subject to early detection programs (Stirbu et al., 2007).

Inequalities in all avoidable mortality

Inequalities in all avoidable mortality are present in all included European populations. Smaller inequalities in all avoidable mortality are observed in Southern European populations and larger inequalities are found in Central-Eastern European countries and Baltic countries (Stirbu et al., 2007).

See Relative index of inequality (RII) for all avoidable mortality in selected countries.

Inequalities in mortality from infectious diseases

Large inequalities are observed in the group infectious diseases. For all infectious diseases combined, inequalities are larger in CEE and Baltic countries, while among western European countries large inequalities are found in Denmark and the Basque region (Stirbu et al., 2007).

See Relative index of inequality (RII) for diseases of infectious origin in selected countries.

Inequalities in mortality from all avoidable malignant conditions

Small or no inequalities are found in mortality from all avoidable malignant conditions in Northern and Western European countries. In CEE and Baltic countries, inequalities in mortality from these causes are clearly larger, in favour of the higher educated (Stirbu et al., 2007).

See Relative index of inequality (RII) for avoidable mortility of all malignant diseases in selected countries.

Inequalities in mortality from cardio-respiratory conditions

For all countries, inequalities by education are observed for mortality from all cardio-respiratory conditions, favouring the higher educated. Inequalities are especially large in CEE and Baltic countries (Stirbu et al., 2007).

See Relative index of inequality (RII) for all cardio-respiratory conditions in selected countries.

Inequalities in mortality from all avoidable acute conditions

Relatively large inequalities, with higher mortality in the lower educated, are found in all European countries for all avoidable acute conditions. The level of inequalities varies substantially between countries however (Stirbu et al., 2007).

See Relative index of inequality (RII) for all avoidable acute conditions in selected countries.