Report on the Joint Workshop on the Relations between Health Inequalities, Ageing and Multimorbidity, Iceland, May 3-4, 2023.

This paper is a summary of key presentations from a workshop in Iceland on May 3-4, 2023 arranged by Aarhus University and with participation of the below-mentioned scientists. Below you will find the key messages from the presentations made by: Professor Jan Vandenbroucke, Department of Clinical Epidemiology, Aarhus University, Emeritus Professor, Leiden University; Honorary Professor, London School of Hygiene & Tropical Medicine, UKProfessor, Chair Henrik Toft Sørensen, Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, DenmarkProfessor David H. Rehkopf, Director, the Stanford Center for Population Health Sciences, Stanford University, CA.

[Artworks from medieval and early-modern hospitals in The Netherlands].

In the Middle Ages and early modern times, hospitals were omnipresent in Western Europe, including the area within the current borders of the Netherlands. It is not generally known that these institutions not only left an architectural heritage, but also an interesting art patrimony. This article describes this patrimony, which consists of 71 works of art.

[Planetary health: a new field of research, education and practice].

'Planetary health' is a new field of research, education and practice focusing on the relationship between global environmental change and human health. This includes climate change, but also biodiversity loss, environmental pollution, and other large-scale changes in the natural environment that may affect human health. This article provides an overview of the extent to which scientific knowledge is available about these health risks.

Widening educational inequalities in mortality in more recent birth cohorts: a study of 14 European countries.

Background: Studies of period changes in educational inequalities in mortality have shown important changes over time. It is unknown whether a birth cohort perspective paints the same picture. We compared changes in inequalities in mortality between a period and cohort perspective and explored mortality trends among low-educated and high-educated birth cohorts.

Socioeconomic inequalities in self-rated health in Japan, 32 European countries and the United States: an international comparative study.

Aims: Japan is known as a country with low self-rated health despite high life expectancy. We compared socioeconomic inequalities in self-rated health in Japan with those in 32 European countries and the US using nationally representative samples.

Methods: We analysed individual data from the Comprehensive Survey of Living Conditions (Japan), the European Union Statistics on Income and Living Conditions, and the Behavioral Risk Factor Surveillance System (US) in 2016.

Projecting years in good health between age 50-69 by education in the Netherlands until 2030 using several health indicators - an application in the context of a changing pension age.

Objective: We investigate whether there are changes over time in years in good health people can expect to live above (surplus) or below (deficit) the pension age, by level of attained education, for the past (2006), present (2018) and future (2030) in the Netherlands.

Methods: We used regression analysis to estimate linear trends in prevalence of four health indicators: self-assessed health (SAH), the Organization for Economic Co-operation and Development (OECD) functional limitation indicator, the OECD indicator without hearing and seeing, and the activities-of-daily-living (ADL) disability indicator, for individuals between 50 and 69 years of age, by age category, gender and education using the Dutch National Health Survey (1989-2018). We combined these prevalence estimates with past and projected mortality data to obtain estimates of years lived in good health.

Patient cost-sharing, mental health care and inequalities: A population-based natural experiment at the transition to adulthood.

Background: Patient cost-sharing has been increasing around the world, despite the evidence that it reduces both unnecessary and necessary health care utilisation. Financial barriers could compound to poor transitional care into adulthood, when forgoing mental health treatment may have long-term consequences on health and development. We evaluate the impact of increasing deductibles on mental health care use by young adults, and the heterogeneous effects for vulnerable groups.

Estimation of Socioeconomic Inequalities in Mortality in Japan Using National Census-linked Longitudinal Mortality Data.

Background: We aimed to develop census-linked longitudinal mortality data for Japan and assess their validity as a new resource for estimating socioeconomic inequalities in health.

Methods: Using deterministic linkage, we identified, from national censuses for 2000 and 2010 and national death records, persons and deceased persons who had unique personal identifiers (generated using sex, birth year/month, address, and marital status). For the period 2010-2015, 1,537,337 Japanese men and women aged 30-79 years (1.

Trends and socioeconomic inequalities in self-rated health in Japan, 1986-2016.

Introduction: Despite having very high life expectancy, Japan has relatively poor self-rated health, compared to other high-income countries. We studied trends and socioeconomic inequalities in self-rated health in Japan using nationally representative data.

Methods: The Comprehensive Survey of Living Conditions was analyzed, every 3 years (n ≈ 0.

[Fundamental causes of disease].

When one approaches diseases from a historical perspective, it is striking that most diseases display a spectacular pattern of rise and fall. This article discusses an 'ecological-evolutionary theory' of the origins of disease, which explains the emergence of ever-new diseases from the fact that humans, in their tireless pursuit of better living conditions, have engaged in activities that exposed them to new health risks, at a pace that evolution cannot keep up with. This is illustrated by examples in the field of infectious diseases, ischemic heart disease and cancer.

Trends in inequalities in disability in Europe between 2002 and 2017.

Background: Monitoring socioeconomic inequalities in population health is important in order to reduce them. We aim to determine if educational inequalities in Global Activity Limitation Indicator (GALI) disability have changed between 2002 and 2017 in Europe (26 countries).

Methods: We used logistic regression to quantify the annual change in disability prevalence by education, as well as the annual change in prevalence difference and ratio, both for the pooled sample and each country, as reported in the European Union Statistics on Income and Living Conditions (EU-SILC) and the European Social Survey (ESS) for individuals aged 30-79 years.

The rise and fall of diseases: reflections on the history of population health in Europe since ca. 1700.

This essay explores the amazing phenomenon that in Europe since ca. 1700 most diseases have shown a pattern of 'rise-and-fall'. It argues that the rise of so many diseases indicates that their ultimate cause is not to be sought within the body, but in the interaction between humans and their environment.

Mixed evidence for the compression of morbidity hypothesis for smoking elimination-a systematic literature review.

Background: There is debate around the composition of life years gained from smoking elimination. The aim of this study was to conduct a systematic review of the literature to synthesize existing evidence on the effect of smoking status on health expectancy and to examine whether smoking elimination leads to compression of morbidity.

Methods: Five databases were systematically searched for peer-reviewed articles.

Determinants of inequalities in years with disability: an international-comparative study.

Background: Persons with a lower socioeconomic position spend more years with disability, despite their shorter life expectancy, but it is unknown what the important determinants are. This study aimed to quantify the contribution to educational inequalities in years with disability of eight risk factors: father's manual occupation, low income, few social contacts, smoking, high alcohol consumption, high body-weight, low physical exercise and low fruit and vegetable consumption.

Methods: We collected register-based mortality and survey-based disability and risk factor data from 15 European countries covering the period 2010-14 for most countries.

[Homeless patients in Rotterdam with a need for medical care: data from the Rotterdam Street Doctors' office in the years 2006-2017].

Objective: To describe the demographic and medical characteristics and changes of the patients who visit the Rotterdam Street Doctors' office hours.

Design: Retrospective study of registered patient contacts from 2006-2017.

Method: Street doctors registered age, gender and ICPC diagnoses of patients in a GP information system.

Changing social inequalities in smoking, obesity and cause-specific mortality: Cross-national comparisons using compass typology.

Background: In many countries smoking rates have declined and obesity rates have increased, and social inequalities in each have varied over time. At the same time, mortality has declined in most high-income countries, but gaps by educational qualification persist-at least partially due to differential smoking and obesity distributions. This study uses a compass typology to simultaneously examine the magnitude and trends in educational inequalities across multiple countries in: a) smoking and obesity; b) smoking-related mortality and c) cause-specific mortality.

Educational inequalities in mortality amenable to healthcare. A comparison of European healthcare systems.

Background: Educational inequalities in health and mortality in European countries have often been studied in the context of welfare regimes or political systems. We argue that the healthcare system is the national level feature most directly linkable to mortality amenable to healthcare. In this article, we ask to what extent the strength of educational differences in mortality amenable to healthcare vary among European countries and between European healthcare system types.

Widening Socioeconomic Inequalities in Smoking in Japan, 2001-2016.

Background: Japan is one of the world's largest tobacco epidemic countries but few studies have focused on socioeconomic inequalities. We aimed to examine whether socioeconomic inequalities in smoking have reduced in Japan in recent times.

Methods: We analyzed data from the Comprehensive Survey of Living Conditions, a large nationally representative survey conducted every 3 years (n ≈ 700,000 per year) in Japan, during 2001-2016.