Obesity is, just like smoking, strongly socially patterned in many countries, and therefore potentially relevant for explaining international variations in health inequalities. Over the past decades, obesity has become more prevalent in the lower socioeconomic groups in many countries, sometimes with transitions from ‘reverse’ inequalities (higher rates of obesity in higher socioeconomic groups) to ‘regular’ inequalities (higher rates of obesity in lower socioeconomic groups) (Van Oort et al., 2005; Lopez et al., 1994; Huisman et al., 2005a; Ezzati et al., 2005; Sobal & Stunkard, 1989).

It is found that in Europe obesity is more common in lower educational groups, with larger inequalities among women than among men. Large inequalities in obesity are observed in the Southern region of Europe, particularly among women. In the East and Baltic regions inequalities in obesity tend to be smaller than the European average (Mackenbach et al., 2007).

Also see EUphact Overweight.

Among men, the overall prevalence of obesity was 11%, and ranged from 6.0% in France to 21.6% in England. Considerable variations in inequalities in obesity in men could be observed between different countries. Sweden, Czech Republic and the Netherlands showed the largest ‘negative’ educational inequalities in obesity and Ireland, Latvia and Lithuania the smallest. Among women, the overall prevalence of obesity was also 11%, and ranged from 5.0% in Italy to 23.3% in England. The educational inequalities in obesity were smallest in Latvia, Finland and Norway and largest in Portugal.

It can be concluded that the phenomenon of inverse gradients of obesity (prevalence is higher among lower socioeconomic groups) is present almost anywhere in Europe. Exceptions were men in all Baltic and most Eastern European countries, where obesity was (slightly) more common among men with a higher education. The inequalities were largest among women of Southern Europe. When general welfare levels increased obesity became increasingly more common among men of lower education, while the opposite was true for men of higher education. Women did not show a clear effect of general welfare level on inequalities in obesity.

See Relative inequalities by level of education in obesity in men and women in selected countries.

Evidence for socioeconomic inequalities in physical activity is scarce and inconclusive. Earlier studies show that, for total physical activity among males, the higher socioeconomic groups have lower levels of physical activity, while females display fewer differences between the socioeconomic groups (DoH, 2004; NCSR, 2003, 2004). When the focus is on sports activities, the relation shows the opposite; higher socioeconomic groups have higher levels of participation in sports (NCSR, 2003, 2004). Furthermore it was found that participants with primary level education were more sedentary than those with higher levels of education, with greater differences among females (Varo et al., 2003).

Also see EUphact Physical activity

A more recent study shows that the levels of physical activity during leisure time are low in general throughout Europe (Demarest et al., 2007). Overall, 36% of males and 42% of females in the age group 16 to 64 years describe their leisure time activity as predominantly of a sedentary nature. The prevalence of a sedentary lifestyle was lowest in the highest educational group. Northern countries (Finland, Norway, Denmark) have a distinct profile. Although the overall prevalence of a sedentary lifestyle is relatively low, relatively small differences between the highest and lowest educated groups can be observed. In both Southern and Eastern European countries, large parts of the population do indicate not to perform any leisure time activity. In Southern countries, this phenomenon is more explicitly socioeconomical determined than in Central European countries.

See Percentage age-adjusted prevalence of a sedentary lifestyle by educational level in men and women in selected countries.

Socio-economic inequalities in smoking have widened and persisted in the last decades (Giskes et al., 2005). Due to higher initiation rates and lower cessation rates, smoking prevalence is higher among lower socioeconomic groups compared to higher socioeconomic groups in most European countries. On average, lower socioeconomic groups smoke more cigarettes per day and are more susceptible to nicotine addiction compared to higher socioeconomic groups. The inequalities in smoking are somewhat more pronounced in northern Europe than in southern Europe. This is a consequence of a more advanced evolvement of the smoking epidemic in northern European countries (Schaap et al., 2007a; Huisman et al., 2005b; Cavelaars et al., 2000).

Countries in the South region are in an earlier stage of the smoking epidemic than countries in the North, West and Continental regions (Van Oort et al., 2005; Lopez et al., 1994). For women a reverse association between educational level and smoking was found (higher educated women smoke more often than lower educated women), while inequalities in smoking were small among men (Mackenbach et al., 2007b).

The history of the smoking epidemic is not extensively documented for the East and Baltic regions, contrary to other European regions. For decades smoking has been highly prevalent among men, and although smoking rates have traditionally been low among women, they have increased strongly in the 1990s (Kubik et al., 1995; Pudule et al., 1999). Although proper historical data on the social pattern in smoking is lacking in these countries, it can be assumed that smoking rates are higher in the lower socioeconomic groups. This is consistent with the larger inequalities in mortality from smoking related conditions (Mackenbach et al., 2007b).

In Europe as a whole, smoking is more common in lower educational groups, with inequalities in smoking being larger among men. In the North, West and Continental regions large inequalities in smoking can be identified. Small inequalities, even ‘reverse’ inequalities, among women in smoking are observed in the southern regions. In the East and Baltic regions the pattern is inconsistent (Mackenbach et al., 2007b).

See Relative inequalities by level of education in current smoking in men and women in selected countries

Inequalities in smoking quit ratios

Among both men and women, higher educated ever-smokers are more likely to have quitted than lower educated ever-smokers. Absolute differences in quit ratios between high and low educated are generally larger in the age group 25-39 years than in the age group 40-59 years. Quit ratios are especially high in Sweden, England, The Netherlands, Belgium and France, and relatively low in Lithuania and Latvia (Schaap et al., 2007b).

Men

For men in the age of 25-39 years, the largest inequalities in quit ratios are found in the Czech Republic and Latvia. Inequalities in quit ratios are smallest in Ireland and Sweden. For men in the age of 40-59 years, largest inequalities in quit ratios are found in Latvia, Lithuania and Estonia. In Portugal and Germany the inequalities in quit ratios are smallest in this subgroup (Schaap et al., 2007b).

See National levels and educational inequalities in quit ratios in men in selected countries

Women

For women in the age of 25-39 years, the largest inequalities in quit ratios are found in Latvia and Hungary, while Portugal had small inequalities in this subgroup. For women in the age of 40-59 years, the largest inequalities in quit ratios are observed in Denmark and Slovakia, while small inequalities are observed in Latvia and Portugal (Schaap et al., 2007b).

See National levels and educational inequalities in quit ratios in women in selected countries

Also see EUphacts Smoking and Smoking policies.