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Electronic Letters to:

Health Inequalities:
Tomas Hemmingsson and Ingvar Lundberg
Can large relative mortality differences between socio-economic groups among Swedish men be explained by risk indicator-associated social mobility?
Eur J Public Health 2005; 15: 518-522 [Abstract] [Full text] [PDF]
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[Read eLetter] Explanation for large health inequalities in Nordic countries
James P. Scanlan   (1 November 2006)

Explanation for large health inequalities in Nordic countries 1 November 2006
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James P. Scanlan,
Attorney
Washington, DC 20007, USA

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Re: Explanation for large health inequalities in Nordic countries

Nine years ago, a landmark study in The Lancet surprised most observers by finding that, though more egalitarian than most western European countries, Sweden and Norway appeared to have among the largest socioeconomic inequalities in morbidity and mortality in western Europe.1 Hemmingsson and Lundberg seek to explain this pattern as a result of there being greater social mobility in Nordic countries than other western European countries.2

Whether or not greater social mobility tends to lead to greater relative inequalities in health, Hemmingsson and Lundberg have overlooked an important explanation for the seemingly large health inequalities in Sweden and Norway. The findings in the Lancet study were based on the size of relative differences in mortality rates (or relative odds of morbidity). But the study failed to consider the statistical tendency whereby the rarer an outcome, the greater the relative difference in experiencing it (though the smaller the relative difference in avoiding it).3-9. Mortality is comparatively low in Sweden and Norway, as reflected, for example, by the fact their comparatively large relative differences in mortality translate into comparatively small absolute differences in mortality.10-11. Thus, it is to be expected that they will have comparatively large relative differences in mortality. But such differences do not necessarily suggest that health inequalities are particularly large in any meaningful sense.3,5.

References:

1. Mackenbach, J.P., Kunst, A.E., Cavelaars, et al. Socioeconomic inequalities in morbidity and mortality in western Europe, Lancet 1997; 349: 1655-59.

2. Hemmingsson T, Lundberg I. Can large relative mortality differences between socioeconomic groups among Swedish men be explained by risk indicator-associated social mobility? Eur J Public Health 200515:518 -522.

3. Scanlan JP. Can we actually measure health disparities? Chance. 2006:19(2):47-51: http://www.jpscanlan.com/images/Can_We_Actually_Measure_Health_Disparities.pdf

4. Scanlan JP. Measuring health disparities. J Public Health Manag Pract 2006;12(3):294 [Lttr]: http://www.nursingcenter.com/library/JournalArticle.asp?Article_ID=641470.

5. Scanlan JP. The misinterpretation of health inequalities in Nordic countries: Paper presented at: 5th Nordic Health Promotion Research Conference, Esbjerg, Denmark, June 15-17, 2006, Esjberg, Denmark: http://www.jpscanlan.com/images/Esbjerg_Oral.pdf

6. Scanlan JP. Measuring health inequalities. Paper presented at: 5th International Conference on Health Economics, Management and Policy, June 5-7, 2006, Athens, Greece: http://www.jpscanlan.com/images/Measuring_Health_Inequalities.pdf.

7. Scanlan JP. Race and mortality. Society. 2000;37(2):19-35: http://www.jpscanlan.com/images/race_and_mortality.pdf.

8. Scanlan JP. Divining difference. Chance. 1994;7(4):38-9,48.

9. Scanlan, JP. The perils of provocative statistics. The Public Interest 1991;102:3-14: http://www.jpscanlan.com/images/The_Perils_of_Provocative_Stat.pdf.

10. Vagero D., Eriksson R. Eriksson R. Socio-economic inequalities in morbidity and mortality in western Europe. Lancet 1997; 350:516 {Lttr].

11. Bostrom G, Rosen M. Measuring social inequalities in health – politics or science? Scand J Public Health. 2003:31:211-215.

Conflict of Interest:

None declared