Making international comparisons in health and inequality

We recently completed a project funded by the Belgian Government, and collaborating with colleagues at the Scientific Institute of Public Health in Brussels and at the Institut Santé et Société, Université Catholique de Louvain. The project was focused on health inequalities in Belgium, and on making comparisons with the UK. In particular there was an interest in the role which national level contextual characteristics might have in influencing health and how these might be better identified and modelled.

In the project we developed a method for making international comparisons. The design was to identify areas which could plausibly belong in either country, akin to two ‘treatment’ groups; one exposed to UK society and culture and the other exposed to Belgian society and culture. Data describing the social, economic and historical characteristics of areas in the UK and in Belgium were obtained from national census data. A principal component analysis of these variables was undertaken and areas in the UK and Belgium with similar scores on the resulting components were matched into pairs. A sequence of logistic regression models was then run in which between country-difference in the risk of reporting poor health was identified. Our final model compared the risk of reporting poor health among Belgians and people from the UK living in similar local contexts, adjusting for any residual differences in individual level characteristics. The modelling sequence also included more conventional approaches, enabling us to identify differences between results from these and our ‘matched areas’ approach.

Results show that residence in the UK is associated with a substantial and significantly higher risk of reporting poor health for both men and women, but that the excess risk detected by our approach is smaller than that detected by conventional models. This suggests that some of the apparent difference in the risk of reporting poor health between the two countries is because more people in the UK are exposed to adverse contextual characteristics.

One paper, focused on informal care has been published from the collaboration so far, and two more have been submitted.

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