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![Page 1: Health inequalities in adolescence Matthias Richter, Matthias Richter, Department of Prevention and Health Promotion School of Public health | WHO CC University.](https://reader036.fdocuments.us/reader036/viewer/2022070402/56649f225503460f94c3b3b3/html5/thumbnails/1.jpg)
Health inequalities in adolescence
Matthias Richter, Department of Prevention and Health Promotion School of Public health | WHO CC University of Bielefeld Germany
from description to explanation
beta v0.2
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• Socioeconomic inequalities in health have been observed in all industrialised countries.
• They are observable in most measures of health and longevity using different measures of SES.
Socioeconomic inequalitiesin health (Overview_part 1)
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Socioeconomic inequalitiesin health (Overview_part 2)
• Health and longevity tend to have a stepwise, not threshold, relationship with SES (social gradient).
• Inequalities in health are observable in childhood and adulthood
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Do we find a similar patternin adolescence?
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Health inequalities in adolescence (Part 1)• Compared to childhood and adulthood there
is no consistent pattern of inequalities in health - esp. for early youth (11 to 16 year-olds).
• Where inequalities exist, they are less pronounced than in any other part of the life-course.
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The pattern of inequalities in health might changes in adolescence.
Health inequalities in adolescence (Part 2)
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Health inequalities in adolescence (Part 3)
There are a number of exceptions and variations (gender, age groups, countries and social indicators)
The most important variation is across health outcomes.
... but:
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Theoretical models of the relationship between SES and health in childhood and adolescence Source: Chen et al. 2002
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1. The persistent model
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low SES medium SES high SES
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for example: Mortality (due to accidents/injuries), severe asthma
adolescencechildhood
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2. The childhood-limitedmodel
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for example: injuries, Infectious diseases
adolescencechildhood
low SES medium SES high SES
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3. The adolescent-emergent model
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for example: passive smoking - smoking, physical activity
adolescencechildhood
low SES medium SES high SES
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Two different patterns of inequalities in health in adolescence:
2. Changing inequalities in health
1. Persistent inequalities in health
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What we need are two different explanatory models:
2. to explain changing/ equalising inequalities in health
1. to explain (persisting)inequalities in health
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Explanations for persisting inequalities in health(Source: Macinytre 1997)
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1. Artefact
Magnitude of observed class gradients will depend on themeasurement of both class andhealth
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2. Social selection
Health can contribute to achievedclass position via social mobilityand help to explain observedgradients
Selection (Health influences SES)
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3. Behavioural factors
Health damaging behaviours aredifferentially distributed across social classes and contribute toobserved gradients
Causation (SES influences health)(Part 1)
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4. Material/ structural factors
Physical and psychosocial featuresassociated with class structureinfluence health and contribute toobserved gradients
Causation (SES influences health)(Part 2)
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Causation hypothesis(Source: Richter/Mielck 2000)
Socio-economic status
Behavioural factors e.g. Tobacco, Alcohol
Structural factors e.g. working conditions,
social support
Health
(social) unequal distribution of
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Explanations for changing/ equalising inequalities in healthin adolescence
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1. Latent differences
Inequalities in health are already present, but not (yet) measurable with currentoutcome measures of health.
The prelude is visible in the unequaldistribution of different determinants(behavioural/ structural factors) of healthamong social groups.
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2. Buffer hypothesisCentral elements of adolescence (school, peers, youth culture) and related mechanisms„break“ the traditional SES-barriers and forma buffer form young people against the health-damaging effect of SES.
As children develop, other factors (may)play a more important role in determiningadolescent health while the strength of(parent) SES decreases.
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Conclusion Understanding those factorscontributing to the existenceor absence of socioeconomicdifferences in health can provide a better insight into themechanisms which shape thehealth of youth.
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Interested tolearn more ?
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Gecková, A. (2002). Inequality in health among Slovak adolescents.Groningen: Proefschrift Rijksuniversiteit Groningen. Download
Tuinstra, J. (1998). Health in adolescence: an empirical study of social inequality in health, health risk behaviour and decision making styles. Groningen: Proefschrift Rijksuniversiteit Groningen. Download
Recommended readings:
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Socioeconomic Determinants of Healthbmj.com collected resources
and more collected resources onSocioeconomic Determinants of Health
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