Work Package 2 Measurement and Indicators: EQUITY Research Inventory of Child Health in Europe Mapping current and future Child Public Health Research Work Package 2 Measurement and Indicators: EQUITY Coordinators: Anders Hjern – Nordic School of Public Health, SE Mitch Blair – Imperial College, London, UK Equity: Hein Raat – Erasmus MC Rotterdam

Inequity A. METHODS  we need a uniform approach Indicators of social disadvantage, poverty, socio-economic status, migrant status, single parent family, neighbourhood status are social determinants of child health Indicators of inequities in health are the outcomes B. PUBLISHED RESULTS, since 2000 C. USE TO PROMOTE CHILD HEALTH D. ELECTRONIC RECORDS

Time schedule Time schedule: Indicators of equity (ms 3-12)

Collaboration INRICH sister initiative ‘unfunded’ on inequalities in childhood health http://www.centrelearoback.org/inrich/ International Network for Research on Inequalities in Child Health

Collaboration  CHICOS EU sister project on child cohorts http://www.chicosproject.eu/ CHICOS (Developing a Child Cohort Research Strategy for Europe)

Children, adults, life course Who’s socio-economic status: Unborn child: mother (and father) Young child: the family (mother and father) Adolescent: adolescent him/herself & family Young adults: him/herself

Equity: what is it about? Social disadvantage: general concept Socio-economic status: Education, occupation, income, (status ?) Poverty Ethnicity Neighbourhood status Single-parent-family

SES: Education levels Type, ‘level’, number of years: no education or primary education (up to approximately 6 years of education), lower secondary education (9 years) higher secondary education (11 years) tertiary education (bachelor’s degree or higher)

SES: Job status Full-time paid job (~ hours per week) Part-time paid job Self-employed Unemployed / seeking employment Unemployed / disability benefit Student ‘Housewife’ …

SES: Occupation: levels “manual” (considered the lower level) “nonmanual” Or more refined

SES: Income: levels Household income Gross or net income (Euro’s) Approximate quintiles of equivalent net household income After-tax incomes of all household members, including benefits, were added, and the total was corrected for household size by dividing it by the total number of persons in the household to the power of 0.36.

Poverty Household income Income benefits Indicators: other benefits (e.g. free school lunch) Self-reported financial difficulties Debts …

Ethnicity Self-assigned ethnicity (each parent; child) Country of birth: Child, 2 parents, 4 grandparents, etc. Ethnicity of mother, father, OR child Migration history (Level of) acculturation

Neighbourhood Aggregated indicators of disadvantage Influence in addition to family-level Geographical health-related characteristics

Single-parent family Associated with all social indicators Associated with culture/ethnicity Determinant of health, development and well-being independent of other indicators

Inequalities in health: The outcomes Both relative and absolute measures of inequalities in health are important: 1. The relative index of inequality 2. The slope index of inequality Mackenbach et al, N Engl J Med 2008;358:2468-81.

1. Relative index of inequality The relative index of inequality is the ratio between the estimated mortality, morbidity, or riskfactor prevalence among persons at rank 1 (the lowest education, occupation, or income level) and rank 0 (the highest level). (Poisson regression analysis)

2. Absolute: slope index of inequality The slope index of inequality measures absolute differences in rates (e.g., in deaths per 100,000 person-years) between the lowest and the highest ends of the socioeconomic scale. Mackenbach et al, N Engl J Med 2008;358:2468-81.

Sub-study WP2: Inequity A. METHODS  we need a uniform approach Indicators of social disadvantage Indicators of inequities in health B. PUBLISHED RESULTS, since 2000 C. USE TO PROMOTE CHILD HEALTH D. ELECTRONIC RECORDS Link to ‘INRICH’ and to ‘ CHICOS’