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Open Access Research article

The contribution of health policy and care to income differences in life expectancy – a register based cohort study

Kristiina Manderbacka1*, Riina Peltonen2, Sonja Lumme1, Ilmo Keskimäki34, Lasse Tarkiainen2 and Pekka Martikainen2

Author Affiliations

1 Service System Research Unit, National Institute for Health and Welfare, P.O. Box 30, Helsinki 00271, Finland

2 Department of Social Research, Population Research Unit, University of Helsinki, P.O. Box 54, Helsinki 00014, Finland

3 Service System Department, National Institute for Health and Welfare, P.O. Box 30, Helsinki 00271, Finland

4 School of Health Sciences, University of Tampere, Tampere 33014, Finland

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BMC Public Health 2013, 13:812  doi:10.1186/1471-2458-13-812

Published: 8 September 2013

Abstract

Background

Growing mortality differences between socioeconomic groups have been reported in both Finland and elsewhere. While health behaviours and other lifestyle factors are important in contributing to health differences, some researchers have suggested that some of the mortality differences attributable to lifestyle factors could be preventable by health policy measures and that health care may play a role. It has also been suggested that its role is increasing due to better results in disease prevention, improved diagnostic tools and treatment methods. This study aimed to assess the impact of mortality amenable to health policy and health care on increasing income disparities in life expectancy in 1996-2007 in Finland.

Methods

The study data were based on an 11% random sample of Finnish residents in 1988–2007 obtained from individually linked cause of death and population registries and an oversample of deaths. We examined differences in life expectancy at age 35 (e35) in Finland. We calculated e35 for periods 1996-97 and 2006-07 by income decile and gender. Differences in life expectancies and change in them between the richest and the poorest deciles were decomposed by cause of death group.

Results

Overall, the difference in e35 between the extreme income deciles was 11.6 years among men and 4.2 years among women in 2006-07. Together, mortality amenable to health policy and care and ischaemic heart disease mortality contributed up to two thirds to socioeconomic differences. Socioeconomic differences increased from 1996-97 by 3.4 years among men and 1.7 years among women. The main contributor to changes was mortality amenable through health policy measures, mainly alcohol related mortality, but also conditions amenable through health care, ischaemic heart disease among men and other diseases contributed to the increase of the differences.

Conclusions

The results underline the importance of active health policy and health care measures in tackling socioeconomic health inequalities.

Keywords:
Mortality; Life expectancy; Socioeconomic factors; Amenable mortality; Equity research