Wednesday, February 3, 2010

[EQ] Changing trends in indigenous inequalities in mortality: lessons from New Zealand

Changing trends in indigenous inequalities in mortality:
lessons from New Zealand

Martin Tobias1,*, Tony Blakely2, Don Matheson3, Kumanan Rasanathan4 and June Atkinson5

1 Public Health Physician, Health and Disability Intelligence, Ministry of Health, Wellington, New Zealand.
2 Director of Health Inequalities Research Programme, University of Otago, Wellington, Wellington, New Zealand.
3 Public Health Physician, University of Otago, Wellington, Wellington, New Zealand.
4 Department of Ethics, Equity, Trade and Human Rights, World Health Organization, Geneva, Switzerland.
5 Health Inequalities Research Programme, University of Otago, Wellington, Wellington, New Zealand.

International Journal of Epidemiology 2009 38(6):1711-1722; doi:10.1093/ije/dyp156
Volume 38, Number 6, December 2009   

Website: http://ije.oxfordjournals.org/cgi/content/abstract/38/6/1711

BACKGROUND:
We describe trends from 1951 to 2006 in inequalities in mortality between the indigenous (Māori) and non-indigenous (non-Māori, mainly European-descended) populations of New Zealand.

 

We relate these trends to the historical context in which they occurred, including major structural adjustment of the economy from the mid 1980s to the mid 1990s, followed by a retreat from neoliberal social and economic policies from the late 1990s onwards. This was accompanied by economic recovery and the introduction of health reforms, including a reorientation of the health system towards primary health care.

METHODS: Abridged period lifetables for Māori and non-Māori from 1951 to 2006 were constructed using standard demographic methods. Absolute [standardized rate difference (SRD)] and relative [standardized rate ratio (SRR)] mortality inequalities for Māori compared with European/Other ethnic groups (aged 1-74 years) were measured using the New Zealand Census-Mortality Study (an ongoing data linkage study that links mortality to census records) from 1981-84 to 2001-04. The SRDs were decomposed into their contributions from major causes of death. Poisson regression modelling was used to estimate the extent of socio-economic mediation of the ethnic mortality inequality over time.

RESULTS: Life expectancy gaps and relative inequalities in mortality rates (aged 1-74 years) widened and then narrowed again, in tandem with the trends in social inequalities (allowing for a short lag). Among females, the contribution of cardiovascular disease to absolute mortality inequalities steadily decreased, but was partly offset by an increasing contribution from cancer. Among males, the contribution of CVD increased from the early 1980s to the 1990s, then decreased again. The extent of socio-economic mediation of the ethnic mortality inequality peaked in 1991-94, again more notably among males.

CONCLUSION:
Our results are consistent with a causal association between changing economic inequalities and changing health inequalities between ethnic groups. However, causality cannot be established from a historical analysis alone.

Three lessons nevertheless emerge from the New Zealand experience:
- the lag between changes in ethnic social inequality and ethnic health inequality may be short (<5 years); both changes in the distribution of the social determinants of health and
- an appropriate health system response may be required to address ethnic health inequalities; and
- timely monitoring of ethnic health inequalities, based on high-quality ethnicity data, may help to sustain political commitment to pro-equity health and social policies…………"

 


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[EQ] The Burden of Mental Disorders

The Burden of Mental Disorders

William W. Eaton1, Silvia S. Martins1, Gerald Nestadt2, O. Joseph Bienvenu2, Diana Clarke3 and Pierre Alexandre1

1 Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
2 Department of Psychiatry and Behavioral Sciences, School of Medicine, Johns Hopkins University, Baltimore, MD
3 American Psychiatric Institute for Research and Education, American Psychiatric Association, Arlington, VA
ISSUE FREE ONLINE:
Epidemiologic Reviews Volume 30, Number 1, 1 November 2008   

Website: http://epirev.oxfordjournals.org/content/vol30/issue1/

“….In the last decade, there has been an increase in interest in the burden of chronic and disabling health conditions that are not necessarily fatal, such as the mental disorders.

This review systematically summarizes data on the burden associated with 11 major mental disorders of adults. The measures of burden include estimates of prevalence, mortality associated with the disorders, disabilities and impairments related to the disorders, and costs.

 

This review expands the range of mental disorders considered in a report on the global burden of disease, updates the literature, presents information on the range and depth of sources of information on burden, and adds estimates of costs.

 

The purpose is to provide an accessible guide to the burden of mental disorders, especially for researchers and policy makers who may not be familiar with this subfield of epidemiology………..”

 

Jessica J. Jalbert, Lori A. Daiello, and Kate L. Lapane

Dementia of the Alzheimer Type
Epidemiol Rev 2008 30: 15-34; doi:10.1093/epirev/mxn008  [FREE Full Text]  

Nicola Coley, Sandrine Andrieu, Virginie Gardette, Sophie Gillette-Guyonnet, Caroline Sanz, Bruno Vellas, and Alain Grand

Dementia Prevention: Methodological Explanations for Inconsistent Results
Epidemiol Rev 2008 30: 35-66; doi:10.1093/epirev/mxn010 [FREE Full Text]

Schizophrenia: A Concise Overview of Incidence, Prevalence, and Mortality
Epidemiol Rev 2008 30: 67-76; doi:10.1093/epirev/mxn001  [FREE Full Text]

Population-based Cohort Studies on Premorbid Cognitive Function in Schizophrenia
Epidemiol Rev 2008 30: 77-83; doi:10.1093/epirev/mxn007
[FREE Full Text]

Psychosis and Place
Epidemiol Rev 2008 30: 84-100; doi:10.1093/epirev/mxn006
  [FREE Full Text]

Blues from the Neighborhood? Neighborhood Characteristics and Depression
Epidemiol Rev 2008 30: 101-117; doi:10.1093/epirev/mxn009
 [FREE Full Text]  

Bo Netterstrøm, Nicole Conrad, Per Bech, Per Fink, Ole Olsen, Reiner Rugulies, and Stephen Stansfeld

The Relation between Work-related Psychosocial Factors and the Development of Depression
Epidemiol Rev 2008 30: 118-132; doi:10.1093/epirev/mxn004 [FREE Full Text]

Suicide and Suicidal Behavior
Epidemiol Rev 2008 30: 133-154; doi:10.1093/epirev/mxn002
  [FREE Full Text]

Comorbid Forms of Psychopathology: Key Patterns and Future Research Directions
Epidemiol Rev 2008 30: 155-177; doi:10.1093/epirev/mxn003
 [FREE Full Text]

 



 

 *      *     *
This message from the Pan American Health Organization, PAHO/WHO, is part of an effort to disseminate
information Related to: Equity; Health inequality; Socioeconomic inequality in health; Socioeconomic
health differentials; Gender; Violence; Poverty; Health Economics; Health Legislation; Ethnicity; Ethics;
Information Technology - Virtual libraries; Research & Science issues.  [DD/ KMC Area]

“Materials provided in this electronic list are provided "as is". Unless expressly stated otherwise, the findings
and interpretations included in the Materials are those of the authors and not necessarily of The Pan American
Health Organization PAHO/WHO or its country members”.
------------------------------------------------------------------------------------
PAHO/WHO Website

Equity List - Archives - Join/remove: http://listserv.paho.org/Archives/equidad.html
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    IMPORTANT: This transmission is for use by the intended recipient and it may contain privileged, proprietary or confidential information. If you are not the intended recipient or a person responsible for delivering this transmission to the intended recipient, you may not disclose, copy or distribute this transmission or take any action in reliance on it. If you received this transmission in error, please notify us immediately by email to infosec@paho.org, and please dispose of and delete this transmission. Thank you.