1. Work package 8 Inequalities in summary measures of population health Prof. Pekka Martikainen & Dr. Netta Mäki Population Research Unit / Faculty of Social Sciences University of Helsinki

2. Aims of work package 8  To quantify the magnitude of socioeconomic inequalities in  Healthy Life Years and  Disability-adjusted Life-Years lost in selected European countries (measures)  To assess the contribution of specific diseases and risk factors to inequalities (outcome)  To estimate the potential for reduction in these inequalities under “counterfactual” distributions of socioeconomic determinants and risk factors (counterfactuals)

3. Summary measures of population health  Healthy Life Years  Sullivan method  Based on SES-specific life-tables and prevalences of disease  Disability-adjusted Life-Years lost DALYs  Global Burden of Disease method  Years of Life Lost (YLL) + Years Lived with Disability (YLD)  High requirements for data in terms of comparability: feasible only for a limited number of countries

4. Outcome  Many previous studies based on the Sullivan method rely on self reported health  Comparability between countries may be compromised  Alternatives:  Chronic disease  Diabetes  Dementia  Functional disabilites

5. Outcome / Example Source: Health 2000 -survey

6. Measures / Example 1/2 Healthy Life Years: Disability-free life expectancy in Finland those aged 30–64 years Source: Finbalt –surveys in 1994, 1998, 2000, 2002 & 2004

7. Measures / Example 2/2 DALYs Brazil in 1998, all age groups included Source: Oliveira AF et al. 2009 YLL=Years of Life Lost YLD=Years Lived with Disability

8. Counterfactual scenarios / For example  What would be the SES differentials in Healthy Life Years if all SES groups experienced the morbidity level of the highest socioeconomic group  What would be the SES differentials in Health Life Years if smoking rates were 20% lower in the higher SES groups and 35% lower in the lower SES group  Results will be compared between countries to identify the lowest observed inequalities

9. Open issues  HLY or DALYs or both?  Selection of morbidity outcomes and their sources?  Counterfactuals used?