There is substantial evidence that suicidal behaviour is disproportionately observed among those with lower socioeconomic positions. Prior literature suggests that policy measures tackling severe socioeconomic deprivation may have impacts on decreasing the health gaps. Yet, little research has been conducted to examine the effects of social and welfare policies on suicidal behaviour and its inequality. This is in part because the understanding of the socioeconomic inequity in suicidal behaviour has been limited by the strong biological individualism, thereby overlooking the potential importance of social and welfare policies to tackle the population-level determinants of suicide. Using jurisdictional and temporal variations in social policies and patterns of suicide, this dissertation contributes to the literature by providing a summary of the current knowledge base of socioeconomic inequality in suicide and suicidal behaviour, identifying the knowledge gaps and future research questions, and adding novel evidence on the impacts of individual social policy and aggregate welfare generosity on suicide mortality and its inequality. In Chapter Two, consists of a scoping review of studies addressing socioeconomic inequalities in suicide and suicidal behaviour or the relationship between socioeconomic positions and different outcomes of suicidal behaviour in high-income countries with quality data. The literature is summarized to map the findings on the socioeconomic inequity in suicidal behaviour. The chapter concludes with an assessment of gaps in the current knowledge base and suggests a future research agenda. In Chapter Three, I examined whether relative welfare generosity in Canadian provinces is associated with overall suicide mortality and employment-based inequalities in suicide mortality by exploiting the provincial differences within Canada. In Chapter Four, I investigated the effects of two recent social pension reforms targeting older adults—Basic Old Age Pension (BOAP) and Basic Pension (BP)—implemented in South Korea on suicide mortality. Taken together, the findings of the dissertation contribute to the existing literature by mapping the relevant literature, identifying research gaps about socioeconomic inequalities in suicide, and suicidal behaviour, and examining the roles of social policy as a moderator of socioeconomic inequalities in suicide. / Dissertation / Doctor of Philosophy (PhD) / There is substantial evidence that suicide and suicidal behaviour are disproportionately observed among those with lower socioeconomic positions. Prior literature suggests that policy measures tackling severe socioeconomic deprivation may have impacts on reducing health gaps. However, little research is conducted to examine what effects can be brought by social and welfare policies on suicidal behaviour. This dissertation contains three studies on socioeconomic inequality in suicide and suicidal behaviour and examines the impacts of socioeconomic policies and welfare generosity that may tackle inequality. The overarching aim of the dissertation is to advance our understandings of socioeconomic inequality in suicide and suicidal behaviour by providing a systematic analysis of socioeconomic inequality in suicide and suicidal behaviour and roles of social policy and welfare generosity on suicide and suicide inequality. The dissertation contributes to the literature by mapping the relevant literature, identifying research gaps about socioeconomic inequalities in suicide, and suicidal behaviour and demonstrate novel findings about the roles of social policy.

No description available.

Background: Non-communicable diseases (NCDs) are the leading causes of morbidity and mortality among adults in Vietnam. Little is known about the magnitude of socioeconomic inequalities in NCDs and other NCD-related factors in urban areas, in particular among the poor living in slum areas. Understanding these disparities are essential in contributing to the knowledge, needed to reduce inequalities and close the related health gaps burdening the disadvantaged populations in urban areas.  Objective: To examine the burden and health system responsiveness to NCDs in Hanoi, Vietnam and investigate the role of socioeconomic inequalities in their prevalence, subsequent healthcare utilization and related impoverishment due to health expenditures.  Methods: A cross-sectional study was conducted among 3,736 individuals aged 15 years and over who lived in 1211 randomly selected households in 2013 in urban Hanoi, Vietnam. The study collected information on household’s characteristics, household expenditures, and household member information. A qualitative approach was implemented to explore the responsiveness of commune health stations to the increasing burden of NCDs in urban Hanoi. In-depth interview approach was conducted among health staff involved in NCD tasks at four commune health stations in urban Hanoi. Furthermore, NCD managers at relevance district, provincial and national levels were interviewed.  Results: The prevalence of self-reported NCDs was significantly higher among individuals in non-slum areas (11.6%) than those in slum areas (7.9%). However, the prevalence of self-reported NCDs concentrated among the poor in both slum and non-slum areas. In slum areas, the poor needed more health care services, but the rich consumed more health care services. Among households with at least one household member reporting diagnosis of NCDs, the proportion of household facing catastrophic health expenditure and impoverishment were the greater in slum areas than in non-slum areas. Poor households in slum areas were more likely to face catastrophic health expenditure and impoverishment. The poor in non-slum areas were also more likely to face impoverishment if their household members experienced NCDs. Health system responses to NCDs at commune health stations in urban Hanoi were weak, characterized by the lack of health information, inadequate human resources, poor financing, inadequate quality and quantity of services, lack of essential medicines. The commune health stations were not prepared to respond to the rising prevalence of NCDs in urban Hanoi.  Conclusion: This thesis shows the existence of socioeconomic inequalities in the prevalence of self-reported NCDs in both non-slum and slum areas in urban Hanoi. NCDs associated with the inequalities in health care utilization, catastrophic health expenditure and impoverishment, particular in slum areas. Appropriate interventions should focus more on specific population groups to reduce the socioeconomic inequalities in the NCD prevalence and health care utilization related to NCDs to prevent catastrophic health expenditure and impoverishment among the households of NCD patients.  The functions of commune health stations in the urban setting should be strengthened through the development of NCDs service packages covered by the health insurance.

<p>Ill health is unevenly distributed across different groups in society, with the disadvantaged groups displaying higher rates of ill health than the more advantaged groups. The aim of the thesis is to study work-related inequalities in health, and to focus on how income, aspects of the physical and psychosocial work environment, and sense of coherence, individually or jointly, generate inequalities in a number of health outcomes in the Swedish working population. The studies are based on survey data and national registers during the period 1990-2003.</p><p>For cardiovascular disease (CVD) prevalence and mortality, the impact of income was stronger than that of work environment factors. The psychosocial work environment (women and men) and income (men only) were associated with psychological distress. Income (women) and the psychosocial work environment (men) were associated with musculoskeletal pain. Thus, both income and work environment are important in generating health inequalities in the working population.</p><p>A strong sense of coherence (SOC) moderated the effect of physical demands on musculoskeletal pain in both genders. SOC moderates, yet not consistently, the impact of adverse working conditions on psychological distress and musculoskeletal pain. Hence, the results do not fully support the hypothesis that sense of coherence is a global health-protective factor. However, differential vulnerability in terms of the strength of SOC contributed to work-related inequalities in health.</p><p>The risk of stroke was higher for women and men in occupations with low job control than for those with high job control. The risk of intracerebral hemorrhage was highest in women in low job-control occupations, while low job control did not significantly increase the risk of brain infarction in women. Job control was related to mortality from stroke in women, but not in men. The effect of job control on stroke mortality in women was consistent in all classes except for upper non-manuals.</p>

Ill health is unevenly distributed across different groups in society, with the disadvantaged groups displaying higher rates of ill health than the more advantaged groups. The aim of the thesis is to study work-related inequalities in health, and to focus on how income, aspects of the physical and psychosocial work environment, and sense of coherence, individually or jointly, generate inequalities in a number of health outcomes in the Swedish working population. The studies are based on survey data and national registers during the period 1990-2003. For cardiovascular disease (CVD) prevalence and mortality, the impact of income was stronger than that of work environment factors. The psychosocial work environment (women and men) and income (men only) were associated with psychological distress. Income (women) and the psychosocial work environment (men) were associated with musculoskeletal pain. Thus, both income and work environment are important in generating health inequalities in the working population. A strong sense of coherence (SOC) moderated the effect of physical demands on musculoskeletal pain in both genders. SOC moderates, yet not consistently, the impact of adverse working conditions on psychological distress and musculoskeletal pain. Hence, the results do not fully support the hypothesis that sense of coherence is a global health-protective factor. However, differential vulnerability in terms of the strength of SOC contributed to work-related inequalities in health. The risk of stroke was higher for women and men in occupations with low job control than for those with high job control. The risk of intracerebral hemorrhage was highest in women in low job-control occupations, while low job control did not significantly increase the risk of brain infarction in women. Job control was related to mortality from stroke in women, but not in men. The effect of job control on stroke mortality in women was consistent in all classes except for upper non-manuals.

Across Australia and other developed nations, morbidity and mortality follows a socioeconomic gradient whereby the lowest socioeconomic groups experience the poorest health. The dietary practices of low socioeconomic groups, which are comparatively less consistent with dietary recommendations, have been thought to contribute to the excess morbidity and mortality observed among low socioeconomic groups, although this phenomenon is not well understood. Using a socioecological framework, this thesis examines whether the local food retail environment and confidence to cook contribute to socioeconomic differences in fruit and vegetable purchasing. To achieve this, four quantitative analyses of data from two main sources were conducted. The food retail environment was examined via secondary analysis of the Brisbane Food Study (BFS) and confidence to cook was examined in a cross-sectional study designed and carried out by the author. The first three manuscripts were based on findings from the BFS. Briefly, the BFS was a multilevel cross-sectional study, designed to examine determinants of inequalities, that was conducted in Brisbane in the year 2000. A stratified random sample was taken of 50 small areas (census collection districts, CCDs) and 1003 residents who usually shopped for their households were interviewed face-to-face using a schedule that included a measure of fruit and vegetable purchasing and three socioeconomic markers: education, occupation and gross household income. The purchasing measure was based on how often (never, rarely, sometimes nearly always or always) participants bought common fruits and vegetables for their households in fresh or frozen form, when in season. Food shops within a 2.5 km radius of the CCDs in which survey respondents lived were identified and audited to determine their location, type, their opening hours, and their price and availability of a list of food items. The first publication demonstrated there was minimal to no difference in the availability of supermarkets, greengrocers and convenience stores between areas that were most and least disadvantaged, in terms of the number of shops, distance to the nearest shop, or opening hours. Similarly, the second publication showed the most disadvantaged and least disadvantaged areas had no large or significant difference in the price and availability of fruits and vegetables within supermarkets, greengrocers and convenience stores, but small differences were consistently apparent, such that on average, low socioeconomic areas had lower prices but also lesser availability than more advantaged areas. The third submitted manuscript presents results of multilevel logistic regression analyses of the BFS data. While there were some associations between environmental characteristics and fruit and vegetable purchasing, environmental characteristics did not mediate socioeconomic differences in purchasing the fruit and vegetable items since there was no substantial socioeconomic patterning of the price or availability of fruits and vegetables. The fourth submitted manuscript was based on the cross-sectional study of cooking skills. A stratified random sample of six CCDs in Brisbane was taken and 990 household members ‘mostly responsible’ for preparing food were invited to participate. A final response rate of 43% was achieved. Data were collected via a self-completed questionnaire, which covered household demographics, vegetable purchasing (using the same measure employed in the BFS for continuity), confidence to prepare these same vegetables, and confidence to cook vegetables using ten cooking techniques. Respondents were asked to indicate how confident they felt (ranging from not at all- to very- confident) to prepare each vegetable, and to use each technique. This fourth study found respondents with low education and low household income had significantly lower confidence to cook than their higher socioeconomic counterparts, and lower confidence to cook was in turn associated with less household vegetable purchasing. Collectively, the four manuscripts comprising this thesis provide an understanding of the contribution of food accessibility, affordability and cooking skills to socioeconomic differences in fruit and vegetable purchasing, within a socioecological framework. The evidence provided by this thesis is consistent with a contributory role of confidence to cook in socioeconomic differences in fruit and vegetable purchasing, but is not definitive. Additional research is necessary before promoting cooking skills to improve population nutrition or reduce nutritional inequalities. An area potentially useful to examine would be how cooking skills integrate with psychosocial correlates of food and nutrition, and socioeconomic position. For example, whether improvement of cooking skills can generate interest and knowledge, and improve dietary behaviours, and whether a lack of interest in food and nutrition contributes to a lack of both fruit and vegetable consumption and cooking skills. This thesis has demonstrated that an inequitably distributed food retail environment probably does not contribute to socioeconomic variation in fruit and vegetable purchasing, at least in contemporary Brisbane, Australia. Findings are unlikely to apply to other time periods, rural and regional settings, and perhaps other Australian cities as residential and retail development, and the supply and pricing of produce vary substantially across these dimensions. Overall, the main implication for public health is that interventions targeting the food supply in terms of ensuring greater provision of shops, or altering the available food and prices in shops may not necessarily carry a great benefit, at least in major cities similar to Brisbane. Future studies of equitable food access may need to look beyond mapping the distribution of shops and prices, perhaps to more personal and subjective facets of accessibility and affordability that incorporate individuals’ perceptions and ability to access and pay for foods.

Orientadora: Profa. Dra. Silvana Maria Zioni / Dissertação (mestrado) - Universidade Federal do ABC, Programa de Pós-Graduação em Planejamento e Gestão do Território, 2017. / A presente pesquisa tem como objetivo construir um painel de observações da acessibilidade na Região Metropolitana de São Paulo (RMSP), apresentando e discutindo diferentes formas e perspectivas de medi-la e caracterizá-la, dentro do contexto das desigualdades socioeconômicas presentes na Região. São calculados cinco índices de acessibilidade, acompanhados pela espacialização dos resultados por meio de mapas temáticos e pela análise do que cada índice permite identificar. Os cálculos realizados para cada medida estão baseados no conceito de custo generalizado das viagens, atribuído a cada par possível de ser formado entre as 1.895 zonas de tráfego nas quais a RMSP foi subdividida. Uma análise estatística entre os níveis de acessibilidade calculados e a renda domiciliar per capita, obtida a partir dos dados do Censo Demográfico realizado em 2010 pelo IBGE, também compõe o painel de observações proposto. Dentre os resultados obtidos, destaca-se o maior nível de acessibilidade nas zonas de tráfego localizadas ao longo das linhas do sistema metroferroviário que atende a Região e, em alguns casos, também no entorno de corredores de ônibus que atendem o município de São Paulo, especialmente em sua região central e em seu quadrante sudoeste. Dentre as zonas de tráfego com os níveis mais baixos de acessibilidade, encontram-se áreas com alta porcentagem de cobertura vegetal. Na análise estatística envolvendo a renda, destaque para os domicílios que se encaixam na faixa entre 3 e 5 salários mínimos, que apresentaram moderada correlação positiva com as medidas de acessibilidade apresentadas. / The present research aims to build a panel of observations of accessibility in the Sao Paulo Metropolitan Area (SPMA), presenting and discussing different ways and perspectives to measure and characterize it, within the context of the socioeconomic inequalities present in the Region. Five indexes of accessibility are calculated, accompanied by the spatialization of the results through thematic maps and the analysis of what each index allows to identify. The calculations made for each measure are based on the concept of the generalized cost of travel, assigned to each possible pair among the 1,895 traffic zones in which the SPMA was subdivided. A statistical analysis between calculated levels of accessibility and per capita household income, obtained from data from the Demographic Census conducted in 2010 by IBGE, also composes the proposed panel of observations. Among the results obtained, the highest level of accessibility is highlighted in the traffic zones located along the lines of the metro-rail system that serves the Region and, in some cases, also in the surroundings of bus corridors that serve the city of São Paulo, especially in its central region and in its southwest quadrant. Among the traffic zones with the lowest levels of accessibility, there are areas with a high percentage of vegetation cover. In the statistical analysis involving income, we highlight the households that fit the range between 3 and 5 minimum wages, which presented a moderate positive correlation with the presented accessibility measures.

Made available in DSpace on 2015-05-08T14:44:55Z (GMT). No. of bitstreams: 1 arquivototal.pdf: 873142 bytes, checksum: 065ce01190ec045e51f6bd2f31bf6be7 (MD5) Previous issue date: 2013-05-07 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Several studies support the idea that electoral campaign costs play a decisive role on the election results. It is common in Brazil the use of pork barreling (works aimed at the public and resources that are used as clientelistic tools by politicians). The objective of this work is to analyze if the vote cost varies among important regions, states, meso regions and micro regions and if those variations are affected by social-economic features. This study uses the constant information from the TSE´s repository as its database as well as social-economic indexes from Brazilian meso and micro regions. The analyses were carried out for the candidates to state and federal representatives in the e 2010 elections. The results from the nonparametric tests show that Brazilian elections cannot be analyzed by considering the whole country because the vote costs means are statistically different among large regions and states. By the Spearman´s correlation coefficient it is concluded that those differences are not related to the electoral quotient. This study also concludes, by the log-linear regressions, that votes are more expensive in poorer micro regions, that is, the larger the economic inequalities in the region, the higher the value the candidate must spend to obtain votes. / Diversos estudos sustentam a ideia de que os gastos de campanha têm papel decisivo nos resultados eleitorais. No Brasil é comum o uso de obras públicas e de recursos por políticos como instrumentos clientelísticos (pork-barrelling). Objetivou-se com este trabalho analisar se o custo do voto varia nas grandes regiões, nos estados e nas microrregiões e se essas variações são afetadas por características socioeconômicas. As informações constantes no repositório do Tribunal Superior Eleitoral (TSE) foram utilizadas como base de dados, além de indicadores socioeconômicos das mesorregiões e das microrregiões brasileiras. As análises foram feitas para os candidatos aos cargos de deputados federal, estadual e distrital no pleito de 2010. Os resultados obtidos por meio de testes não paramétricos indicaram que as eleições brasileiras não podem ser avaliadas considerando o Brasil como um todo, pois as médias dos custos por voto são estatisticamente diferentes entre as grandes regiões e entre os estados. Por meio do coeficiente de correlação de Spearman, concluiu-se que essas diferenças não estão relacionadas ao quociente eleitoral. O estudo também revelou, por meio de regressões loglineares, que os votos são mais caros em microrregiões mais pobres, isto é, quanto maior a desigualdade socioeconômica da região, maior tende a ser o valor que o candidato deve gastar para conquistar seus votos.

Background: Along with the austerity measures introduced in many countries, the economic crisis affecting Europe since 2008 seems to have impacted many aspects of the health of the Spanish population and has had a negative effect on the provision health services. An increasing body of knowledge has shown a clear impact of the current crisis on suicidal behaviour and mental health, and a less consistent effect on physical health and access to healthcare. However, little is known about the impact of the crisis on social inequalities in health and healthcare access, an area on which the present study seeks to shed light in the context of Spain, and specifically Andalusia, a region hit very hard by the crisis. Objective: To study the impact of the economic crisis starting in 2008 on health, health inequalities and health service utilisation in Spain and Andalusia and the roles of socio-demographic factors in these associations. Methods: Death rates were analysed to study the annual percent change in overall and cause-specific mortality in Spain between 1999 and 2011, and the Longitudinal Database of the Andalusian Population was used to study educational inequalities in overall mortality from 2002 to 2010 (study 1). To calculate suicide attempt rates, information from 2003 to 2012 on 11,494 men and 12,886 women provided by the Health Emergencies Public Enterprise Information System in Andalusia was utilised. The association between unemployment and suicide attempts was studied through linear regression models (study 2). Two waves of the Andalusian Health Survey (2007 and 2011–12) provided data for the third and fourth studies of this thesis. Educational and employment status inequalities in poor mental health in relation with the crisis were analysed through Poisson regression models (study 3). The change in inequalities (pre-crisis–crisis) in health care utilisation outcomes (general practitioner, specialist, hospitalisation and emergency attendance) was measured by the change in horizontal inequality indices. A decomposition analysis of change in inequality between periods was performed using the Oaxaca approach (study 4). Results: Study 1: Overall mortality in Spain decreased steadily during the period, with annual percent changes of -2.44% in men and -2.20% in women. An increase in educational inequality in mortality was observed in men in Andalusia. In women, the inequalities instead remained stable. Suicide mortality showed a downward trend in both sexes in Spain. Study 2: A sharp increase in suicide attempts in Andalusia was detected after the onset of the crisis in both sexes, with adults aged 35 to 54 years being the most affected. Suicide attempts were associated with unemployment rates only in men. Study 3: Poor mental health increased in working individuals with secondary and primary studies during the crisis compared to the pre-crisis period, while it decreased in the university study group. However, in unemployed individuals poor mental health increased only in the secondary studies group. Financial strain could partly explain the crisis effect on mental health among the unemployed. Study 4: Horizontal inequality in utilisation changed to a greater equality or a more pro-poor inequality in both sexes. In the decomposition analysis, socioeconomic position and health status showed greater contributions to the changes in inequalities. Conclusion: This thesis illustrates the complexity of the influences of the current economic crisis on health inequalities in a Southern European region. Specifically, no noticeable effects of the crisis on overall and suicide mortality were detected; instead, increasing educational inequalities in mortality in men and a large increase in suicide attempts in middle aged men and women were observed. The deterioration in poor mental health was mainly detected in those of intermediate educational level. Economic conditions such as unemployment and financial strain proved to be relevant. Finally, in the light of no increased inequalities in healthcare utilisation, the universal coverage health system seems to buffer the deleterious effect of the crisis and austerity policies in this context.

Type 2 diabetes mellitus (T2DM) has become a major health problem worldwide. The St. Vincent declaration emphasized the urgent need to improve the epidemiological knowledge of this disease in Europe. Within Europe, research on the link between socioeconomic position (SEP) and type 2 diabetes is scarce. The objective of this thesis was to conduct an extensive review of the current literature on socioeconomic inequalities in type 2 diabetes within European countries, while analyzing the relationship between, incidence, prevalence and mortality due to T2DM and SEP. In addition, we also analyzed trends on SEP inequalities in the prevalence of T2DM in Spain (1983-2006). Finally, we also assessed the appropriate use of health surveys with self-reported diagnosis in order to further analyze the relation between SEP and T2DM. Different sources of information were used throughout the study. The systematic review was completed using the PUBMED database while the empirical studies used data of two European projects, the EUROTHINE, SHARE and the Spanish National Health Survey (study of trends in SEP inequalities in T2DM) along with the Catalonia health surveys (study of validation). The thesis consists of 5 papers that attempt to respond to the different objectives. The studies included in this thesis suggest that socio-economic position (SEP) inequalities affect the incidence, prevalence and mortality by T2DM in Europe. These SEP inequalities are partly explained for body mass index, diet and physical activity. Moreover, these inequalities seemed to have remained constant or increased over time. Finally, health interview surveys with self-reported T2DM seems to be a good instrument to evaluate SEP inequalities in T2DM. / La Diabetis Mellitus Tipus 2 (DM2) ha esdevingut un dels principals problemes de salut a nivell mundial. La declaració de ST VINCENT emfatitzava la necessitat i la urgència de millorar-ne el coneixement epidemiològic a nivell Europeu. Els estudis a nivell europeu sobre les desigualtats per Posició Socioeconòmica (PSE) en la DM2 eren força escassos. L’objectiu d’aquesta tesi era fer una revisió extensa dels estudis publicats sobre desigualtats per PSE en la DM2 a Europa, així com analitzar la relació entre la incidència, la prevalença i la mortalitat per DM2 i la PSE. Un altre objectiu també era analitzar la tendència de les desigualtats per PSE en la prevalença de DM2 a Espanya (1983-2006). Finalment, com a objectiu també hi figurava el valorar l’ús adequat de les enquestes de salut amb auto - declaració de DM2 per tal d’avaluar les desigualtats per PSE en la DM2. Per tal de dur a terme els objectius es van emprar diferents fonts d’informació. Per tal de dur a terme la revisió sistemàtica es va emprar la base de dades de PUBMED mentre que pels estudis empírics es van utilitzar les dades de dos projectes europeus com són el projecte EUROTHINE i el SHARE i les enquestes nacionals de salut d’Espanya (per la tendència de diabetis) i de Catalunya (per la validació). La tesi consta de 5 articles que intenten donar resposta als diferents objectius. Els estudis inclosos en aquesta tesi suggereixen que existeixen desigualtats per posició socioeconòmica (SEP) en la DM2, tant en la incidència, en la prevalença com en la mortalitat a Europa. Aquestes desigualtats per PSE s’expliquen en part per l’índex de massa corporal, la dieta o l’activitat física. A més a més, aquestes desigualtats sembla que s’han mantingut constants o han crescut al llarg del temps. Finalment, s’ha vist que les enquestes de salut amb la pregunta d’auto-declaració de la diabetis són un bon instrument per avaluar les desigualtats per PSE en la DM2.