|Title||Ethnic inequalities in health in Israel: the contribution of socioeconomic position, psychosocial and behavioural factors|
|Keywords||Ethnicity; Health inequalities; Longstanding illness; Self-rated health; Socioeconomic position; Social support|
|Abstract||Background: Despite efforts in many countries to reduce inequalities in health, ethnic health inequalities (EHI) still persist for both mortality and morbidity. The relative contribution of different factors in explaining ethnic inequalities in health (EHI) is unclear. |
Setting: This study examines the magnitude of the EHI in self-rated health and limiting longstanding illness and explanatory factors (socio-economic position (SEP), psychological, and behavioural) for EHI in Israel.
Methods: Using national data, inequalities in self-reported health (SRH) and limiting longstanding illness (LLI) between randomly selected Arabs (N=902) and Jews (N=1087) in Israel surveyed in 2005 and 2003-04 respectively. One adult per household, aged 30-70y, was included. Block regression models explored the effects of SEP (income from social benefits and education), social support (community participation and social capital), and health behaviours (smoking and activity) on EHI.
Results: After age- and sex-adjustment, the odds ratio (OR,95%CI) of poor SRH were higher for Arabs compared with Jews (1.9, 1.5-2.4). Similarly OR (95%CI) of LLI were 1.3(1.0-1.6) among Arabs compared with Jews.
Adjustment for SEP reduced the EHI in poor SRH by 42% and of LLI by 39%. Social support contributed less to explaining the EHI: it reduced OR of poor SRH by 32% and OR of LLI by 23%. Health behaviours had little contribution to explaining the EHI, 11% and 7% for SRH and LLI respectively.
In the fully adjusted model of SRH, EHI were reduced dramatically and the association became non-significant (OR=0.8, 95%CI=0.6-1.0). OR of LLI in the full model was reversed, with Arabs significantly less likely to report LLI (OR=0.7, 95%CI=0.5-0.9).
Conclusions: EHI in Israel were explained fully, mostly by SEP. Reducing SEP inequalities should greatly reduce EHI and improve health. Comparing pathways to EHI can help facilitate polices to address the social determinants of health and reduce these inequalities.
|Last name||First name||Organization||Country|
|Daoud||Nihaya||Ben-Gurion University of the Negev||IL||daoud [ätt] bgu.ac.il|
|Mindell||Jenny||University College of London||GB||j.mindell [ätt] ucl.ac.uk|
|Roth||Marilyn A||University College of London||GB||marilyn.a.roth [ätt] gmail.com|
|Manor||Orly||Hebrew University in Jerusalem||IL||om [ätt] cc.huji.ac.il|
|Soskolne||Varda||Bar-Ilan University||IL||varda [ätt] vms.huji.ac.il|