1. Using the ESEC to describe health inequalities in Europe Anton Kunst Department of Public Health a.kunst@erasmusmc.nl

2. Why look at occupational class in relation to health?  Large socioeconomic inequalities in health are observed in all European countries  We need measures that can help to accurately identify social groups with most health problems  Educational level and income level are often used in European research  Occupational class is much less often used

3. Potential advantages of the ESEC  Theoretical basis “Employment relationships” complementary to education and income  Internationally applicable and comparable In most countries, the population is evenly distributed across many classes

4. Questions  Is the ESEC practically applicable in the area of health? For example, would excluding people with “unknown” ESEC bias the observed patterns?  How does health differ according to ESEC class? Does this class pattern differ between men and women, or between countries?  Can these class differences in health be explained by class differences in education and income? Or has “class” an independent effect?

5. Material and methods  The European Community Household Panel, covering > 10 countries in the northern and southern part  Health is analysed using data from wave 1 (1994) “How rate do you rate your general health: very good, good, fair, poor, to very poor”  Smoking and overweight data were analyzed using data from wave 8 (year 2000)

6. Results (1) Proportion of respondents with “poor” health according to ESEC Class. Men, all countries.

7. Results (2) Prevalence of “poor” health by ESEC Class. Northern compared to southern countries. Men.

8. Results (3) Prevalence of “poor” health by ESEC Class. Women compared to men. All countries.

9. Results (4) Prevalence of “poor” health by ESEC Class. Women: household vs. individual assignment

10. Health outcomes Educational level Occupational class Income, wealth From description to explanation

11. Results (5) Prevalence of “poor” health compared to ESEC Class I. The role of education and income. Men.

12. Results (7) The prevalence of obesity (BMI>30) compared to class I. The role of education and income. Women.

13. Results (8) The prevalence of smoking compared to class I. Control for education, income and wealth/deprivation.

14. The relative importance of class compared to other socio-economic indicators in predicting smoking

15. Summary of results  We observed health differences along the entire occupational hierarchy, from the most to the least advantaged classes  The health differences were generalised, i.e. found among both men and women, within different age groups, and within different countries  The health differences could in part, but not entirely, be attributed to differences between ESEC classes in education and income level  ESEC class had independent effects as well on overweight and smoking

16. Evaluation of the ESEC as a tool to describe health inequalities  In each country, the ESEC enables a detailed description of class variations in health and health-related behaviours  The ESEC enables international overviews and cross-national comparisons with regards to these class differences  Further development and refinement of the ESEC is needed  The ESEC cannot account for all relevant differences between countries. This should be taken into account when interpreting results

17. Using the ESEC for explaining health inequalities  Occupational class adds to the explanation of health inequalities, independent from educational level and income  The ESEC emphasises the role of “employment relationships” or, more generally, factors intrinsic to the work of people  While ESEC provides a starting point, true understanding of health inequalities should come from multivariate or qualitative research

18. End  Thank you