[Social inequalities in health less pronounced in women than in men: A question of measurements?]. / Des inégalités sociales de santé moins marquées chez les femmes que chez les hommes: une question de mesure?

Social inequalities in mortality are generally less pronounced for women than for men. Are women's health risks and behaviours more homogeneous, or does this pattern arise from a measurement issue inducing an under-estimation of these inequalities? This article reviews a number of studies covering different dimensions of health and different dimensions of social status. Their findings show that there are large social inequalities in health among women. The focus on the working careers, family histories and conciliation of multiple activities provides evidence of major social determinants of health to which women are widely exposed. This article highlights the need to broaden the notion of social inequality and to redefine the social categories, notably by considering the distinct trajectories of men and women and their different spheres of activity. It highlights that gender differences in health are themselves partly socially constructed, as suggested by the gender approaches in the social sciences.

Socioeconomic differences in the prevalence of common chronic diseases: an overview of eight European countries.

BACKGROUND: Few studies have compared socioeconomic inequalities in the prevalence of both fatal and non-fatal diseases. This paper aims to give the first international overview for several common chronic diseases. METHODS: Micro-level data were pooled from non-standardized national health surveys conducted in eight European countries in the 1990s. Surveys ranged in size from 3700 to 41 200 participants. The prevalence of 17 chronic disease groups were analysed in relation to education. Standardized prevalence rates and age-adjusted odds ratios (ORs) were calculated. RESULTS: Most diseases showed higher prevalence among the lower education group. Stroke, diseases of the nervous system, diabetes, and arthritis displayed relatively large inequalities (OR > 1.50). No socioeconomic differences were evident for cancer, kidney diseases, and skin diseases. Allergy was more common in the higher education group. Relative socioeconomic differences were often smaller among the 60-79 age group as compared with the 25-59 age group. Cancer was more prevalent among the lower educated in the 25-59 age group, but among the higher educated in the 60-79 age group. For diabetes, hypertension, and heart disease, socioeconomic differences were larger among women as compared with men. Inequalities in heart disease were larger in northern European countries as compared with southern European countries. CONCLUSION: There are large variations between chronic diseases in the size and pattern of socioeconomic differences in their prevalence. The large inequalities that are found for some specific fatal diseases (e.g. stroke) and non-fatal diseases (e.g. arthritis) require special attention in equity-oriented research and policies.

Social inequalities in disability-free life expectancy in the French male population, 1980-1991.

We calculate aggregate indicators of population health for occupational groups to gauge changes in health disparities during the 1980-1991 period. The study is based on the experiences of French adult men in three major occupational classes: managers, manual workers, and an intermediary occupational group. Life table models show that managers have longer life expectancy and disability-free life expectancy (DFLE) than manual workers, and a shorter life expectancy with disability. The concurrent increases in life expectancy and DFLE during the period maintained the occupational disparities in health; the years lived with disability, however, declined for all groups, as for the entire French population.

[Contribution of disability-free life expectancy indicators to the study of social inequities in health]. / Apport des indicateurs d'espérance de vie sans incapacité à l'étude des inégalités sociales de santé.

In looking at increases in disability-free life expectancy we examine the scope and evolution of social inequalities in health. As early as the end of the 18th century, Moheau had already emphasised the differences in life expectancy according to profession but it wasn't until much later that official statistics could confirm them. Despite the growing concern related to this phenomenon, the data are lacking for tracking its evolution and understanding its causes. The indicators of disability-free life expectancy that we established for socio-professional groups allowed us to respond to certain outstanding questions. The results of this study are summarised in this article. They serve to re-open the debate around the problems involved in measuring social inequalities and their place in public health.

[Life expectancy in health: major indicators of health in a population]. / Espérances de vie en santé: indicateurs majeurs de la santé d'une population.

The concepts of life expectation, life expectation without disability, are explained. Their importance for defining a health policy and a healthcare policy is emphasized. A concrete example is given: the inequalities in life expectancy without disability follow the same pattern as the inequalities in mortality.

Health expectancy indicators.

An outline is presented of progress in the development of health expectancy indicators, which are growing in importance as a means of assessing the health status of populations and determining public health priorities.

[The estimation of years lived in disability: a global initiative]. / La estimacion de los anos vividos con discapacidad: una iniciativa universal.

PIP: "This paper [translated from the original French] sets out the main information brought by the calculations of health expectancies at a global level: sex differences, national geographical comparisons, socio-economic differences; causes of disability and handicap; time trends; and nature of the years lived with disabilities. The study illustrates the policy relevance of health expectancies to (i) appraise the quality of the years lived, (ii) supervise health inequalities, (iii) allocate resources to different programmes, or (iv) assess health policies. It also illustrates the large diversity of potential indicators of the quality of years lived." (EXCERPT)^ieng

[Evolution of the curves of total survivorship, without chronic illness and without incapacity in France from 1981 to 1991: the application of an OMS model]. / Evolution des courbes de survie totale, sans maladie chronique et sans incapacité en France de 1981 à 1991: application d'un modèle de l'OMS.

In 1984, World Health Organisation (WHO) has proposed a demo-epidemiological model which allows the assessment of the possible consequences of the lengthening of life on the level of health. This model is represented in a graphic form by three curves: the observed survival curve, the hypothetical survival curve without chronic diseases and the hypothetical survival curve without disability; thus, as life expectancy at any age is calculated from the survival curve, this model allows the computation of life expectancy without chronic diseases and life expectancy without disability. The relationships between the three curves, can be used to illustrate the numerous theories dealing with the evolution of the populations' health which enliven debates in public health since several decades. Application of the model to French data on mortality, morbidity and disability also allows to enlighten the evolution of the health status of the French population over the last decade.