Health for Everyone?: Social Inequalities in Health and Health Systems

Abstract

Health is one of the main components of a good life.In addition to having value in itself, good health also translates into a better chance of succeeding in education and in the labour market -ultimately contributing to enhance opportunities for people to improve their standing in life.At the same time, inequalities in income and educational attainment contribute to health inequality.Ensuring that everyone, regardless of socio-economic circumstances, has access to the health system can help make sure that economic prosperity is shared by the entire population.This publication analyses inequalities in health and health systems and thus provides a key insight for the discussion of how societies can become more inclusive.It looks into socio-economic differences in the exposure to risk factors to health, health status, the utilisation of health services, unmet health care needs and coverage.To assess these inequalities, the report undertakes detailed analyses of micro-level data from a range of national health surveys representing 33 OECD and EU countries, presenting differences between the most and least well-off as well as population-level summary measures of inequalities. Poor health behaviour tends to be more prevalent among the disadvantaged, but the relationship between risk factors and educational level can be complexOverall, less educated people are more likely to be overweight and smoke.This applies to both sexes but the extent of these inequalities differs.In all countries, there is a greater risk of women with low education to be obese or overweight.For men, this holds true in about 55% of countries.Regarding tobacco consumption, the less educated men are significantly more likely to smoke in all countries and in 80% of countries in the case of women.The picture for hazardous alcohol consumption is less clear.For women, there are no significant differences in drinking habits across education levels in around two-thirds of the countries but in 25% of them, alcohol consumption rises with income.Men with a high education level are less likely to be heavy drinkers but the population-level gradient is only significant in around half of the countries. No matter how it is measured, the least educated are more likely to be in bad healthAcross all countries, people in the lowest education category are twice more likely to view their health as poor compared to those with tertiary education (44% vs. 23%).Similar results can be observed for other variables of health status, such as limitations in daily activities and prevalence of multiple chronic conditions. 15 HEALTH FOR EVERYONE?© OECD 2019 Why a report on health-related inequalities? Introduction and method Health is essential to well-being and increases a person's chance of being productive…Health is one of the main components of a good life, and it is of intrinsic value.Data collected in the context of the OECD's Better Life Index 1 from around 145 000 citizens around the world suggest that health is the number one priority for living a good life for the majority of people.Being in good health also contributes to other important outcomes such as labour market outcomes, educational achievement and allows for an active participation in community life.Particularly important in an economic context is the impact on labour market outcomes: good health translates into a better chance of finding a job, being more productive and ultimately creates opportunities for people to improve their standing in life (Chapter 2 of this report will discuss this further).The Preventing Ageing Unequally report (OECD, 2017[1]), showed that, at all ages, men and women in bad health work less and earn less when they work.Over the course of a career, bad health reduces lifetime earnings by 33% and 17% for men with low and high levels of education, respectively (and with smaller effects overall for women).This is detrimental to economies and societies at large. Annex 1.A. Summary tablesAnnex Table 1.A.1.Key results, country-by-country