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Health disparities and health opportunities

Introduction and summary


 
It's regularly in the newspaper: poor people die earlier. The question of why rich people live longer was also the subject of the television program "Sander en de kloof" in early 2022. National figures show that Dutch people with a low level of education live as much as 14 years less in good health than people with a high level of education. We also see differences in Utrecht. For example, people in the Overvecht district live 15 years less in good health than those in Noordoost. This special edition of the Utrecht Public Health Monitor (VMU) describes the latest developments in health disparities among adults in Utrecht.

The monitor describes not only differences in health, but also in lifestyle and in opportunities for health. Opportunities for health are determined by the conditions in which people grow up, learn, work, live, and age. We call these the underlying causes of health.

This monitor focuses on the root causes that the World Health Organization (WHO) and the G4 proposal against opportunity inequality also identify. These are: health care, income situation, education and skills, work situation and working conditions, physical environment, safety and social environment. These underlying causes of health are also listed in the Utrecht Health Model.

This monitor on health disparities and health opportunities describes differences between men and women, age groups, different education, different migration backgrounds, and residents who can or cannot make ends meet. We also describe differences between districts.

This monitor about health differences and health opportunities concerns adult Utrechters who speak the Dutch language. The figures are mainly based on data collected with written questionnaires. We have also included a summary of a special study on healthy living, health and corona among Utrechters in a vulnerable situation, conducted by the panel Meetellen in Utrecht. Simultaneously with this second issue on adults, for the first time, we are also publishing a special issue on health disparities in children (ages 10-12).

The first monitor on health disparities and health opportunities was based, among other things, on figures from the 2018 Utrecht Health Survey. In this second issue, we also present figures collected during the corona pandemic, in the fall of 2020. These figures provide initial insight into the situation during the first year of the corona pandemic. We point out that the 2020 Health Survey is a snapshot and only one measurement point in an exceptional period, from which we cannot yet draw definitive conclusions. The figures provide a good opportunity to explore whether we can learn something from this period about what can work in addressing health disparities. We will do this in 2022 by critically assessing and thoroughly interpreting these figures with national experts and Utrecht professionals and residents. The results of this study will be available in the fall of 2022.

Summary

Differences in health and lifestyle
Health and lifestyle is the poorest among Utrechters with:
  • primary education or a secondary school education
  • who have difficulty making ends meet
Also, their health gap is getting worse as we look over time.

In addition, the health and lifestyle of the following groups of Utrecht residents are also poorer:
  • Utrechters with a non-Western migration background
  • Inhabitants of the district Overvecht
Between 2018 and 2020, partly in corona time, health and lifestyle disparities did not increase additionally.

Differences in opportunities for a healthy life
The following groups of Utrechters have fewer opportunities for a healthy life due to a disadvantage in the underlying causes of health:
  • residents with primary education or a secondary school education are more likely not to receive needed care, use less preventive care, are also more likely to have financial problems, unfavorable working conditions, fewer skills and a less favorable social environment.
  • residents of the Overvecht and Zuidwest districts are less satisfied with care facilities in the neighborhood, have more financial problems, and a less favorable or safe living environment.
  • residents who struggle to make ends meet are more likely to not receive needed care, are less satisfied with their healthcare providers, are more likely to have financial problems, and have unfavorable working conditions.
  • Utrechters with a non-Western migration background more often do not receive needed care, are less satisfied with their healthcare providers and the care facilities, have more financial problems and a less favorable social environment.
The lag in the following underlying causes often increases. With that, the above groups have fewer and fewer chances to live healthy lives. This relates to their:
  • access to health care
  • income situation
  • social contacts and loneliness
Starting points in addressing health disparities in adults
Some groups of Utrechters need something more or something different to make up for their health deficits or to have equal opportunities for health. Utrechters who structurally lag behind in health, lifestyle and opportunities for healthy living, and are often falling further and further behind, are:
  • residents with primary education or pre-vocational secondary education
  • residents who have difficulty making ends meet
Utrechters with a non-Western migration background and residents of Overvecht and Zuidwest also have poorer health, lifestyle or fewer opportunities for a healthy life.
Increasing disparities in access to care, income status, and social contacts and loneliness are important starting points for addressing health disparities.

Distribution of Utrecht population by age, gender, education level, income, migration background and district, 2021
Distribution of Utrecht population, 51% is male and 49% is female. 84% of the population has no difficulty making ends meet and 63% does not have a migration background.

 

Health and lifestyle