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Socioeconomic health inequalities are a major field of action in public health and tackling them is one of its main goals. However, there has been little success in reducing these health inequalities. This points to a large research deficit. Inequalities in health are already evident in childhood and adolescence, showing that those with a low socioeconomic background have more risk factors and at the same time fewer resources than their socially more privileged peers. Although health promotion aims at achieving equity in health, interventions rarely consider the socioeconomic status and can therefore provide only little evidence regarding socioeconomically differentiated intervention effects. How can we ensure that all children and young people have equal chances to grow up healthy?In order to come closer to answering this question, it is the aim of this article to give an overview of health inequalities in childhood and adolescence and to highlight the contribution of school and school-based health promotion interventions for tackling health inequalities and increasing equity in health. School is not only a place where adolescents can always be reached, regardless of their socioeconomic background, it has the potential to both exacerbate and reduce health inequalities.Sozioökonomisch bedingte Ungleichheiten in der Gesundheit sind ein wichtiges Public-Health-Handlungsfeld und deren Reduzierung eines ihrer wichtigsten Ziele. Bislang ist es jedoch kaum gelungen, gesundheitliche Ungleichheiten zu verringern, was zugleich auch auf ein großes Forschungsdefizit hinweist. Auch im Kindes- und Jugendalter lassen sich bereits Ungleichheiten in der Gesundheit und dem Gesundheitsverhalten feststellen, wobei jene mit einem niedrigen sozioökonomischen Status verglichen mit sozial privilegierteren Gleichaltrigen oftmals mehr Risikofaktoren und gleichzeitig weniger Ressourcen aufweisen. Obwohl Gesundheitsförderung auf gesundheitliche Chancengleichheit abzielt, berücksichtigen Interventionen nur selten den sozioökonomischen Status und können entsprechend wenig Evidenz über sozioökonomisch differenzierte Interventionseffekte liefern. Wie kann es daher gelingen, allen Heranwachsenden die gleichen Chancen auf ein gesundes Aufwachsen zu ermöglichen?Um der Beantwortung dieser Frage näherzukommen, ist es zum einen das Ziel des Beitrags, einen Überblick über gesundheitliche Ungleichheiten im Kindes- und Jugendalter zu geben und die Rolle von Gesundheitsförderung sowie aktuelle Forschungsdefizite in diesem Zusammenhang aufzuzeigen. Zum anderen soll die Bedeutung der Schule und schulischer Gesundheitsförderungsmaßnahmen bei der Verringerung gesundheitlicher Ungleichheiten und der Erhöhung gesundheitlicher Chancengleichheit herausgestellt werden. Die Schule ist nicht nur ein Ort, an dem Heranwachsende unabhängig von ihrer sozialen Herkunft stets erreicht werden können, sondern hat das Potenzial, gesundheitliche Ungleichheiten sowohl zu verschärfen als auch zu reduzieren.

Health systems rely on commercial prediction algorithms to identify and help patients with complex health needs. We show that a widely used algorithm, typical of this industry-wide approach and affecting millions of patients, exhibits significant racial bias: At a given risk score, Black patients are considerably sicker than White patients, as evidenced by signs of uncontrolled illnesses. Remedying this disparity would increase the percentage of Black patients receiving additional help from 17.7 to 46.5%. The bias arises because the algorithm predicts health care costs rather than illness, but unequal access to care means that we spend less money caring for Black patients than for White patients. Thus, despite health care cost appearing to be an effective proxy for health by some measures of predictive accuracy, large racial biases arise. We suggest that the choice of convenient, seemingly effective proxies for ground truth can be an important source of algorithmic bias in many contexts.

The study of housing and living spaces has always played a central role in sociogerontological research. For example, living environments are seen as essential influencing factors on the quality of life and personal well-being (or the lack of it) of older people. The study of the relationship between space and age(ing) is dominated by psychologically influenced environmental gerontological approaches and social area-oriented research. While environmental perspectives in gerontology focus in particular on perceptions, experiences and affects to identify the relationships between space and age(ing), social area-oriented research tends to focus on social inequalities and strategies of participation.The results of ecogerontological approaches to affects and social area-oriented research on social inequalities are combined by means of a praxiological approach. A relational understanding of space and age is developed, which is able to focus on affects and is also sensitive to spatial exclusions based on social inequalities and which also have an affective component. This combination enables new insights into a gerontological designation of the relationship between space and age(ing).Such a remapping of age(ing) makes it possible to formulate other research questions regarding constructions of space through age or age through space and to provide impulses for gerontological research perspectives that take the complex interplay of humans, artefacts and spatial arrangements into account and explore the consequences for individual persons and also for their living spaces.

In view of the growing population, which is increasingly aging in diversity, questions of social justice and of avoiding discrimination in end of life nursing care become increasingly more relevant from an ethical point of view. This article addresses the discrepancies between normative claims of an equitable approach to provision of nursing services and the sources of structural barriers. In particular at the end of life, often already vulnerable groups are subjected to discrimination in nursing care. Further reflections refer to implications of intersectionality for care-ethical approaches and for the methodology of discourse analysis. This study investigated how diversity and justice are formed in the care policy discourse. It becomes evident how parts of the care policy discourse largely ignore individual ethical implications. Accordingly, critical reflections on inequalities in nursing care remain unconsidered in the discourses. Starting points for processes of change that begin from concepts of individual care ethics are presented.

The concept of digital health literacy can be regarded as the result of the increasing social permeation of digital media and their use in everyday life. Due to increasing accessibility and ubiquity, there is an increasing need not only for searching and finding, but especially for assessing the reliability as well as selecting and applying health information for one's own health concerns. In the context of digitization, it needs to be emphasized that users are not just passive recipients, but rather actively participate in the communication process by interacting with existing content or by sharing their own health-related information.With particular focus on children and adolescents, this paper provides an overview of the current state of research on digital health literacy. In addition to its terminological and conceptual foundations and its links with media literacy, the relationship between digital health literacy and social and health inequality is discussed. Inequalities are not only generated by access to digital media but, above all, by the skills required for their use. After an overview of available instruments is provided, initial reflections on how to promote the individual and structural dimension of digital health literacy with focus on school settings is given.Das Konzept der digitalen Gesundheitskompetenz ist das Ergebnis der zunehmenden gesellschaftlichen Durchdringung von digitalen Medien und deren Nutzung im Alltag. Infolge der hohen Zugänglichkeit und Allgegenwärtigkeit von Gesundheitsinformationen steigt die Notwendigkeit nicht nur des Suchens und Findens, sondern insbesondere der Einschätzung ihrer Verlässlichkeit und der darauf bezogenen Selektion und Anwendung für eigene Gesundheitsbelange. Gerade im Kontext der Digitalisierung ist zudem zu berücksichtigen, dass die Nutzenden nicht nur passiv rezipieren, sondern aktiv am Kommunikationsgeschehen durch Interaktion mit bestehenden Inhalten oder durch eigene Informationsbeiträge teilhaben.Der vorliegende Beitrag gibt eine Übersicht über den aktuellen Forschungsstand zur digitalen Gesundheitskompetenz, wobei der Fokus vor allem auf dem Kindes- und Jugendalter liegt. Neben seiner terminologisch-konzeptionellen Verortung und der notwendigen Verschränkung mit dem Ansatz der Medienkompetenzen wird das Verhältnis von digitaler Gesundheitskompetenz und sozialer sowie gesundheitlicher Ungleichheit betrachtet. Als ungleichheitsgenerierend wird dabei weniger der unterschiedliche Zugang zu digitalen Medien angesehen, sondern vor allem die Unterschiede in den zum Umgang notwendigen Kompetenzen. Nach einer Übersicht über die wenigen bisher verfügbaren Instrumente zur Erfassung der digitalen Gesundheitskompetenz werden am Beispiel des Settings Schule erste Überlegungen zu ihrer individuellen und strukturellen Stärkung angestellt.

While it has been long known that health inequalities persist until higher ages, less is known about the underlying mechanisms and health trajectories over the life course. This article gives an overview on recent developments regarding theoretical concepts and methodological considerations in this field of research. It can be concluded that studies on the explanation of the social gradient in health are scarce and even less is known about societal contexts that enable healthy aging irrespective of the socioeconomic position. The existing evidence on causal mechanisms and developments over the life course warrants cautious interpretation due to selective study samples and cross-sectional study designs.

Although socioeconomic differences in the mortality of middle-aged persons is well-researched, little is known about socioeconomic inequalities in mortality in the very old population. Surveys and population census follow-up studies in this age group are associated with reliability and validity problems.The aim of the study was to investigate, by linking statistical information from register data, to what extent differences in mortality exist among very old Austrian men by socioeconomic variables (e.g. education and income) and if these can be explained by differences in health status.The data records on men aged 80-99 years counted in the Austrian register-based population census from 2011 were augmented by information from tax and social security data and merged with deaths in a 5-year follow-up period. Relative mortality risks were estimated by Cox regression. The health status was operationalized by the standardized level of care.Even in very old men significant differences in mortality exist depending on the socioeconomic status. A systematic effect was found for education and a poverty effect for income. When controlling not just for age but also for the standardized level of care, no socioeconomic disparities in mortality were observed. The higher mortality risk for less educated and low income very old men is thus a result of a poorer health status.At ages over 80 years the health status is the essential influencing factor on mortality. Measures to reduce socioeconomic disparities in mortality must therefore focus on earlier phases in life, in order to reduce the extent of care dependency among socially disadvantaged groups.

In 1989 the first international comparisons of mortality differences according to educational level and occupational status were published. A few years later systematic comparisons between European countries were initiated at the Erasmus University in Rotterdam. This became a trigger for several European Union (EU)-funded collaboration programs scrutinizing social inequalities in health. The collaboration revealed substantial differences in mortality within and between European populations.This article provides a synthesis of the most important research results over the past 30 years and also identifies existing research gaps and potentials.Descriptive summary of research results comparing European countries regarding male and female all-cause and cause-specific mortality according to educational level and occupational status.In all European populations analyzed there was a consistent gradient with substantial and in part increasing advantages for higher socioeconomic status groups. There is, however, substantial variation between individual countries. This also applies to trends and cause of death-specific analyses. While relative differences have increased in virtually all populations, absolute differences have often decreased in many populations. Among women and in higher ages the relative differences were smaller. Within Europe, the southern countries had the smallest and the eastern countries the largest gradients. Tobacco and alcohol-related diseases had an especially noteworthy impact on trends and gradients.The evidence for social health inequalities and their determinants has substantially improved during the past 30 years; however, there remains substantial potential for future research questions, for example concerning the contribution of the different phases of life to healthy aging.

This study aims to analyze self-perceived health and chronic illness in the working population and to explore disparities between social groups.The annual EU-SILC Survey has been conducted in Germany since 2005. The reference population is defined as all private households. In the EU-SILC 2014, a random sample of 22,695 persons aged 16 years and older was interviewed in Germany (860 unemployed and 11,390 employed).In accordance to the EU-SILC-Surveys 2005 until 2014, the self-perceived general health of the population has improved in Germany. 65.2% of the population (aged 16 years and older) in Germany assessed their health as very good or good in 2014 vs. 60.7% in 2005, despite an ageing population. However, there was an increase in health inequalities between employment status groups. In 2014, only 37.2% among unemployed persons vs. 77.1% of the employed perceived their general health as very good or good (53.8 vs. 73.2% in 2005). Multivariate logistic regression models revealed strong associations of subjective general health and chronic illness with age groups and social determinants on the EU-SILC-Survey 2014. Cross-sectional analysis showed unemployed persons to be much less likely to have very good or good self-perceived health (OR=0.26) and more likely to have chronic illness (OR=3.99) compared to employed people after adjustment for sociodemographic characteristics. The probabilities of better health and lower chronic illness rose with the increasing disposable (net) income as well as educational levels. 78.8% of the household members in the highest income quintile vs. 51.7% of the household members in the lowest income quintile said they had very good or good health (OR=2.53). In all investigated age groups, members of the households at risk of poverty were more likely to have poor health on average. High educational level (ISCED 5-8) was associated with higher positive self-rated health (OR=1.78).The EU-SILC-Survey shows distinct health developments and inequalities in Germany. EU-SILC is useful as an annual general population survey to monitor public health targets and reduce health inequalities.Die Untersuchung zielt darauf, den subjektiven Gesundheitszustand und chronische Gesundheitseinschränkungen in der Erwerbsbevölkerung zu untersuchen und Disparitäten zwischen sozialen Gruppen zu explorieren.Der EU-SILC-Survey wird als Haushaltsbefragung seit dem Jahr 2005 in Deutschland jährlich durchgeführt. Die Erhebung umfasste in Deutschland im EU-SILC 2014 eine Zufallsstichprobe von 22 695 Personen ab 16 Jahren (darunter 860 Erwerbslose und 11 390 Erwerbstätige).Nach den EU-SILC-Surveys 2005–2014 verbesserte sich die subjektive Gesundheit in der Bevölkerung in Deutschland. 65,2% der Befragten im Alter ab 16 Jahren berichteten eine sehr gute oder gute Gesundheit trotz zunehmender Alterung der Bevölkerung in 2014 (vs. 60,7% in 2005). Die gesundheitliche Ungleichheit stieg zwischen den Erwerbsstatusgruppen jedoch an. Von den Erwerbslosen bewerteten nur 37,2% ihre Gesundheit als sehr gut oder gut in 2014, während bei den Erwerbstätigen dieser Anteil mit 77,1% erheblich höher lag (53,8 vs. 73,2% in 2005). Multivariate logistische Regressionsanalysen für den EU-SILC-Survey 2014 ergeben starke Assoziationen bei selbstbewerteten Gesundheitszustand und chronische Gesundheitseinschränkungen mit Alter und sozialen Determinanten. In der Querschnittsbetrachtung haben Erwerbslose im Vergleich zu Erwerbstätigen eine wesentlich geringere Chance auf einen sehr guten oder guten Gesundheitszustand (OR=0,26) und eine höhere Auftrittswahrscheinlichkeit von chronischen Gesundheitseinschränkungen (OR=3,99) bei Adjustierung von sozio-demografischen Merkmalen. Die Zunahme des Nettoäquivalenzeinkommens und des Bildungsniveaus geht mit verbesserten Gesundheitsprognosen und reduzierten Risiken für chronische Gesundheitseinschränkungen einher. 78,8% der Befragten im höchsten Quintil beim Nettoäquivalenzeinkommens berichteten einen sehr guten oder guten Gesundheitszustand im Gegensatz zu 51,7% im niedrigsten Einkommens-Quintil (OR=2,53). Die Angehörigen von armutsgefährdeten Haushalten geben im Durchschnitt eine schlechtere Gesundheit in allen untersuchten Altersgruppen an. Hoher Bildungsabschluss ist mit besserem subjektivem Gesundheitszustand assoziiert (OR=1,78).Der EU-SILC Survey zeigt zum einen positive Gesundheitsentwicklungen und zum anderen gesundheitliche Ungleichheiten in Deutschland auf. Der EU-SILC-Survey eignet sich als jährliche Wiederholungsbefragung für ein Monitoring von Public Health-Zielen und der Reduktion gesundheitlicher Ungleichheit.

Eating habits are influenced by individual socioeconomic status (SES). As the association between neighbourhood characteristics and food availability is still unclear, we investigated the community nutrition environment in different neighbourhoods.Using official data of the city of Leipzig, we selected three neighbourhoods which differed in terms of their social (2 deprived vs. 1 affluent) and built (1 large housing estates vs. 2 historic buildings) environment. Data on food outlets were assessed via direct observation (ground truthing).Social and residential environment characteristics are associated with food availability. The proportion of fast food outlets is higher in deprived neighbourhoods compared to the affluent one (25%, 30.4% vs. 13.5%). Neighbourhoods with historic buildings offer a greater variety of food outlets.The greater availability of unhealthy food may contribute to the development of obesity. Preventive measures should consider the physical and social environment.Ernährungsgewohnheiten werden maßgeblich durch den individuellen Sozialstatus beeinflusst. Unklar ist, welcher Zusammenhang zwischen der Wohnumgebung und Lebensmittelverfügbarkeit besteht. Ziel der Studie war es, die Lebensmittelumwelt in sozial und baulich verschiedenen Stadtteilen zu untersuchen.Anhand offizieller Daten der Stadt Leipzig wurden 3 exemplarische Stadtteile ausgewählt, die sich hinsichtlich ihrer sozialen (2 depriviert, 1 privilegiert) und baulichen Struktur (2 Altbau, 1 Plattenbau) unterscheiden. Über Feldbeobachtungen wurden alle Lebensmittelanbieter kartiert und kategorisiert.Soziale und bauliche Merkmale sind mit der Lebensmittelverfügbarkeit assoziiert. Der Anteil an Fast-Food-Anbietern ist in den deprivierten Gebieten mehr als doppelt so hoch als im privilegierten Vergleichsgebiet (25%, 30,4% vs. 13,5%). Altbauquartiere verfügen über eine 70% höhere Angebotsvielfalt als das Plattenbaugebiet.Die erhöhte Verfügbarkeit von ungesunden Lebensmitteln in deprivierten Gebieten kann zur Entstehung von Adipositas beitragen. Präventionsmaßnahmen sollten den räumlichen und sozialen Kontext berücksichtigen.

Socioeconomic differences in health and life expectancy are key issues for public health and health policy. In the course of demographic change, in addition to childhood, adolescence and middle adulthood, old age is increasingly becoming the focus of attention in research on health inequalities, with a special emphasis on the transition from working age to retirement.How do health inequalities change in the transition from middle to older age and then to very old age?This article reviews the studies available for Germany, supplemented with new analyses based on the German Health Update study and the German Socioeconomic Panel study. In order to set the findings in the context of international research on health inequalities in old age, selected studies from other countries and international comparative studies are additionally considered.Social differences in health and remaining life-expectancy also exist in older age, although to a slightly lesser extent than in middle age. There is evidence that as age progresses, health inequalities narrow in some health domains but there is also isolated evidence that health inequalities may widen with age.The existence of health inequalities in old age indicates that older people from disadvantaged social groups have a particular need for healthcare and support. This poses special challenges for the medical, nursing and psychosocial care system as well as for the social security systems.

Big Data is a diffuse term, which can be described as an approach to linking gigantic and often unstructured data sets. Big Data is used in many corporate areas. For Public Health (PH), however, Big Data is not a well-developed topic. In this article, Big Data is explained according to the intention of use, information efficiency, prediction and clustering. Using the example of application in science, patient care, equal opportunities and smart cities, typical challenges and open questions of Big Data for PH are outlined. In addition to the inevitable use of Big Data, networking is necessary, especially with knowledge-carriers and decision-makers from politics and health care practice.Big Data ist ein diffuser Begriff, der als ein Ansatz zur Verknüpfung riesiger und häufig unstrukturierter Datensätze umschrieben werden könnte. Big Data wird in vielen Gesellschaftsbereichen genutzt. Für Public Health (PH) ist Big Data dagegen ein kaum entwickeltes Thema. In diesem Beitrag wird Big Data über die Anwendungsmotive Informationseffizienz, Vorhersage und Clustering erläutert. Am Beispiel der Anwendung in Wissenschaft, Patientenversorgung, Chancengleichheit und Smart Cities werden typische Herausforderungen und offene Fragen von Big Data für PH umrissen. Neben der unumgänglichen Beschäftigung mit Big Data, ist eine Vernetzung insbesondere mit Wissens- und Entscheidungsträgern aus Politik und Praxis notwendig.

Many dimensions of public health are now global. Therefore, global public health is essential for facing cross-border health problems, promoting health chances and reducing health inequalities on a global level. The aim of this interdisciplinary research field is to improve the health of the population and its subgroups in a global context, taking into account a variety of factors. The importance of global public health is shown in this paper. Central topics, concepts and methods, as well as challenges for global public health are identified and recommendations for the academic profiling of global public health in Germany are given.Viele Dimensionen von Public Health sind mittlerweile global. Zur Bekämpfung von grenzüberschreitenden Gesundheitsproblemen sowie zur Förderung von Gesundheitschancen und Senkung gesundheitlicher Ungleichheit auf globaler Ebene ist Global Public Health von zentraler Bedeutung. Die Zielsetzung dieses interdisziplinären Forschungsfeldes besteht darin, die Gesundheit der Gesamtbevölkerung und ihrer Subpopulationen im globalen Kontext unter Berücksichtigung einer Vielfalt von Einflussfaktoren zu verbessern. Die Bedeutung von Global Public Health soll im vorliegenden Beitrag herausgearbeitet werden. Dabei werden zentrale Themen, Konzepte und Methoden sowie Herausforderungen für Global Public Health aufgezeigt und Vorschläge zur akademischen Profilierung von Global Public Health in Deutschland unterbreitet.

Life course influences are being increasingly considered as a key to better understanding of health and social inequalities in health. Our aim is to examine the potential of a broader interdisciplinary perspective on the life course and health, one that integrates sociological and psychological theory and generates greater dialogue between epidemiology and the social sciences. The paper reviews major principles and concepts applied in different disciplines that deal with life course and proposes a theory-driven research framework which better informs interdisciplinary exchange and illustrates how a bio-psycho-social perspective on life course can be infused more fully into epidemiology. The paradigmatic principles of interdisciplinary life course research (human agency, timing in lives, linked lives, historical context) provide a strong theoretical framework for a holistic and theory-based view of life course and its interdependent pathways. The stress process represents an important aetiological mechanism between the organising concepts of the life course and health. To better understand the development of health and health inequalities across the life course, an interdisciplinary approach is required. The suggested theoretical contributions to models of epidemiological life course research supplement the long appreciated methodological focus of the field and will encourage interdisciplinary dialogue.Der Lebenslauf wird zunehmend als Schlüssel zu einem besseren Verständnis der Entwicklung von Gesundheit und gesundheitlicher Ungleichheiten angesehen. Ziel des Aufsatzes ist es, das Potenzial einer umfassenden, interdisziplinären Perspektive auf den Lebenslauf und die Gesundheit zu untersuchen, die soziologische und psychologische Theorien und Modelle integriert und so einen stärkeren Dialog zwischen der Epidemiologie und den Sozialwissenschaften ermöglicht. Dabei werden zentrale Prinzipien und Konzepte aus den verschiedenen Forschungsdisziplinen diskutiert, die sich mit der Bedeutung des Lebenslaufs auseinandersetzen. Es wird ein theoriegestützter Forschungsrahmen abgeleitet, der den interdisziplinären Austausch fördert und illustriert, wie eine bio-psycho-soziale Perspektive auf den Lebenslauf stärker in den Bereich der Epidemiologie übertragen werden kann. Die paradigmatischen Prinzipien der interdisziplinären Lebenslaufforschung (human agency, timing, linked lives und historical context) bieten einen wichtigen theoretischen Rahmen für eine holistische, theoriebasierte Sicht auf den Lebenslauf und seine ineinander verflochtenen Verläufe. Der Stressprozess repräsentiert in diesem Kontext einen wichtigen ätiologischen Mechanismus zwischen den Lebenslaufprinzipien und Gesundheit. Um die Entwicklung von Gesundheit und gesundheitlicher Ungleichheiten besser als bislang zu verstehen, bedarf es eines interdisziplinären Ansatzes. Die hier vorgeschlagenen theoretischen Beiträge zur Lebenslaufepidemiologie ergänzen den wertvollen methodischen Fokus des Forschungsfeldes und können den interdisziplinären Dialog stärken.

Owing to a lack of routine statistics on the health status and medical care of asylum seekers, empirical studies play a major role in the mapping of these aspects.The aim of this review is to provide a comprehensive overview of the research landscape in this area, synthesizing knowledge from empirical studies and identifying evidence gaps.A three-tiered search strategy included searching for empirical studies in national/international databases and on the internet, screening reference lists, and contacting experts. Studies meeting predefined inclusion criteria were thematically organized and described in a narrative synthesis.The searches generated 1,190 hits; 52 articles met the inclusion criteria. Of these, 41 were quantitative studies (78.9 %), 10 qualitative (19.2 %), and 1 was a review (1.9 %). A total of 30 primary articles (58.9 %) analyzed mental health aspects, followed by infectious diseases (n = 12, 23.5 %). Qualitative studies, mainly ethnographies and case studies, explored mental health and social determinants of health, providing evidence for the impact of living conditions on health and medical care. Few studies analyzed chronic diseases (n = 3) or childhood illnesses (n = 6). No studies analyzed the health needs or medical care of asylum-seeking women during pregnancy and child birth. In 62.7 % of the primary studies, a single sampling point was used to recruit asylum seekers. Nationwide external validity was given in two quantitative studies.The priority research areas identified are chronic diseases and childhood and maternal health. The divergency and heterogeneity of the studies hamper a comprehensive and comparable acquisition of knowledgeand emphasize the need for collaborative research to close the existing evidence gaps.

According to existing research, unemployment is related to health problems. The causal relationship is not yet fully understood. This secondary data analysis aims to study the interdependencies between unemployment and health.This study is based on data from the German Labour Market and Social Security (PASS) panel study comprising a sample of beneficiaries of the Federal Employment Agency and their household members as well as a representative household sample. A total of 12,570 persons (aged 15 to 64 years) from 8,392 households were interviewed in wave 7 (2013) of PASS.The employed and unemployed differ substantially in terms of socio-demographic and health-related characteristics. Unemployed persons more often report worse or bad self-rated health (unemployed men: 31.0 % vs. employed men: 14.0 %; unemployed women: 37.7 % vs. employed women: 21.7 %) and feel being rather or much impaired by mental problems (unemployed men: 21.9 % vs. employed men: 7.2 %; unemployed women: 20.4 % vs. employed women: 15.8 %). For the unemployed, the proportion with an officially certified severe disability as well as another severe health impairment is much higher. They also more often report at least one hospital stay in the previous 12 months (unemployed men: 16.3 % vs. employed men: 9.9 %; unemployed women: 19.6 % vs. employed women: 12.2 %) and more contacts with physicians. In spite of that, unemployed persons do less exercise. Multivariate, longitudinal, logistic regression models demonstrate strong health-related selection effects on labour market transitions. Lower self-rated health is associated with a higher unemployment risk for employed persons as well as a lower probability of reintegration for unemployed persons. The most influential determinants of bad self-rated health are self-rated health status in the year before, while job loss and re-employment tend to influence the occurrence of bad self-rated health.The analyses show substantial health disparities to the detriment of the unemployed. They also refer to a need for prevention regarding healthcare and employment.

Social inequalities on access and utilization of inpatient rehabilitation among adolescents have rarely been studied.Parents of children with chronic health conditions (age of 7-17) were interviewed about access and utilization of inpatient rehabilitation. Parents were recruited through pediatricians as well as rehabilitation centers in Central Germany.Despite of numerous recruitment measures the participation by pediatricians was low. Also expanding the sample did not remedial. Furthermore, fewer adolescents with need of rehabilitation were achieved than expected. The analysis is subject to these restrictions, nevertheless, they still allow explorative statements about access and utilization of pediatric rehabilitation.Despite major challenges in recruitment, pediatricians should be considered into analysis of inequalities in rehabilitation because of their gatekeeper function.

Due to their representativeness and consistent measurement standards the medical und sports data of the Swiss conscripts provide a valuable basis for a continuous health monitoring of young Swiss men. During three to four years, the prevalence of overweight and obesity seems to stabilise on a high level. After a longer period of decreasing performance at the endurance test between the 1980s and 2002, the level of physical performance in the fitness test does no longer decrease since 2006. However, health and health behaviour show significant regional and socioeconomic inequalities among young Swiss men. Besides economic resources and education, major driving factors behind these inequalities can be identified in health knowledge, values, and attitudes.

In 2003, the German Federal Center for Health Education (BZgA) initiated a national Cooperation Network named "Equity in Health" to address scientific results, focusing on the association between social inequalities and health. The main goal is to support setting approaches aimed at reducing these health inequalities.In the autumn of 2015 the Cooperation Network comprised a total of 65 (institutional) cooperation partners, e.g., from prevention and health promotion, from the medical profession, from the welfare associations, and from the municipal umbrella organziations. The website www.gesundheitliche-chancengleichheit.de was created to present the information available on all activities and structures. Further, Coordination Centers for Health Equity were established in all federal states of Germany to advise, coordinate and provide support for all those who are actively engaged in the key issues for each state. These Coordination Centers are sponsored by the statutory sickness funds and the Health Ministry of the respective states. They also support continuous quality improvement, based on the good practice criteria developed by the Cooperation Network. Since 2011, the local partner process "Health for All" (until November 2015 "Growing Up Healthily for All") has assisted the municipalities in developing their own integrated health strategies oriented toward the different stages in the life course ("prevention chains").The results and structures that have emerged from the Cooperation Network form a good basis for the implementation of the new national Prevention Law passed by German Parliament in July 2015, to expand and develop further, on a country-wide basis and in the various states, living-space-oriented prevention and health promotion consolidating activities. The paper also discusses the present and future challenges of the Cooperation Network.

Over the past 70 years, several million people have immigrated into Germany-from different countries of origin and for different reasons. The categories used by society to label immigrants ("guest workers", "persons with a migration background") have changed over time. This change has occurred in parallel with changes in the societal attitude towards immigrants and in their legal position. There is unequivocal evidence that the forms that migration takes, in addition to the societal responses towards immigrants, have an effect on their health. The spectrum of migration to Germany is likely to remain fluent because of the continuing process of globalization; also, societal responses to migration will change over time. Thus, migration will continue to pose challenges to society and to health. Only through continuous attentiveness will it be possible to identify, and then avoid or reduce, health disadvantages faced by persons with a migration background.

Health inequalities in the working population may partly be due to the unequal exposure to work-related risk factors among different occupational positions. Empirical data, however, exploring the distribution of exposures at work according to occupational position for Germany is missing.This paper summarizes existing literature on occupational inequalities and discusses the role of working conditions. In addition, using European survey data, we study how various exposures at work vary by occupational class.Analyses are based on the European Working Condition Survey, and we compare the German sample (n = 2096) with the sample from the EU-27 countries (n = 34,529). To measure occupational position we use occupational class (EGP-classes). First, we describe the prevalence of 16 different exposures at work by occupational class for men and women. Second, we estimate regression models, and thereby investigate if associations between occupational class and self-perceived health are related to an unequal distribution of exposures at work.For various exposures at work we found a higher prevalence among manual workers and lower-skilled employees for both physical and psychosocial conditions. With few exceptions only, this finding was true for men and women and consistent for Germany and Europe.Results indicate that the unequal distribution of health-adverse conditions at work contribute towards existing health inequalities among the working population.

Malnutrition is unhealthy: obesity, type 2 diabetes, cardiovascular diseases, some cancers, and premature mortality are reliably associated with poor nutrition. However, literature reveals that some population groups are at higher risk of poor nutrition than others. More specifically, evidence shows that people with low social status are more likely to have poor nutrition than those with higher status, what may contribute to health inequalities. In this article, selected reviews and meta-analyses on social inequalities in nutrition are presented. By showing current data from the Second National Food Consumption Study, the situation in Germany is highlighted. Further, potential causes of social inequalities in nutrition are discussed, drawing on the results of current research. More specifically, socioeconomic and structural deprivation (e.g., poverty, living in deprived neighborhoods) in addition to unfavorable psychosocial (e.g., poor knowledge of nutrition, low levels of social support) and sociocultural factors (e.g., unfavorable nutritional traditions) might be associated with poor nutrition in people with low social status. Interventions promoting nutritional quality in disadvantaged groups should take into account the various influences on nutrition and meet good practice criteria for health promotion. Using three examples of interventions, conceivable concrete measures that can reduce social inequalities in nutrition are presented.

In an EU-funded project, we examined on the basis of international comparative analyses which factors were associated with and contributed to socioeconomic inequalities in adolescent smoking. This paper presents the results obtained and discusses their implications for policy and research.Analyses were based on the "Health Behaviour in School-aged Children (HBSC)" study in 2006 and included more than 50,000 adolescents from 37 countries. The focus was on the association between family affluence and weekly smoking (regularly, at least once a week) among adolescents. Explanatory variables at the individual level refer to psychosocial resources and burdens of school, family, and peers. At the country level, national income, various tobacco control policies, and an index of external differentiation of the educational system were used.The psychosocial factors of school and family explained many of the inequalities in the smoking behavior of adolescents. In an international comparison, socioeconomic inequalities in smoking were stronger in richer countries. Absolute smoking rates were lower and inequalities in smoking smaller for boys in countries with higher tobacco prices. On the other hand, educational systems with higher degrees of external differentiation showed lower inequalities in smoking beahviour by girls, and relatively higher rates of smoking (for boys and girls). Stronger inequalities in smoking behaviour were demonstrated in countries with a greater range of preventative measures for tobacco dependence (for boys) and with higher levels of government spending on tobacco control (for girls).Experiences in richer countries revealed that tobacco control needs to be strengthened for socially disadvantaged adolescents. The reduction of smoking prevalence and socioeconomic inequalities in smoking behavior should be based not only on a strengthening of psychosocial resources in the family and at school, but also on an increase in tobacco prices.

The analysis of inequalities in health care provision in Germany is of high sociopolitical relevance. For medical rehabilitation, which is an essential part of health care provision, only a few studies exist.With the example of psychosomatic and orthopedic medical rehabilitation, the present article investigates how features of social inequality influence different aspects of medical rehabilitation.The database consists of a written survey on the quality assurance of medical rehabilitation in northern Germany that includes 687 patients aged between 21 and 87 years. Aspects of the access to rehabilitation (e.g., the motivation for application), the process (participation in therapies) and the outcomes (e.g., subjective health and occupational risk) of rehabilitation were investigated in relation to social inequality. Social inequality was measured by means of a social class index. For the analysis, Chi-squared tests, t tests and a repeated measures analysis of variance, adjusted for sex and age, were conducted.Initially, the analyses indicate that social inequality is of minor importance for access to rehabilitation and processes within rehabilitation. As subjective health is unequally distributed at the beginning of rehabilitation, however, equal treatment has to be discussed critically in terms of demand-driven treatment. In rehabilitation outcome distinct differences between social classes exist. To reduce these differences, rehabilitation aftercare close to the individual's living environment is necessary, which promotes the empowerment of vulnerable social groups in burdensome living conditions.

There is controversy about social disparities in healthcare services in Germany, but a differentiated analysis regarding various dimensions of healthcare is lacking. This narrative review intends to summarize conceptually the current state of research and draw subsequent conclusions. Separated into access, utilization and quality, the findings of social inequality in outpatient and inpatient care in Germany are summarized. Besides the common individual indicators of socioeconomic status (SES), regional deprivation and health insurance status are also included. Despite methodical diversity, the results show that healthcare inequalities due to SES exist, but not universally. Furthermore, there is a differentiated pattern respecting separate dimensions of healthcare. Concerning access (e.g. waiting times, co-payments) lower status groups and patients covered by statutory health insurance are deprived. Higher utilization becomes apparent among higher status groups and privately insured patients in terms of specialist consultations and prevention services. The findings regarding quality of process and outcome differ depending on quality indicator and disease. In different dimensions of medical healthcare, social disparities still exist, though the impact on health remains unclear for some types of healthcare inequalities. Moreover, it is often difficult to conclude from unequal outcome quality the inequalities of healthcare. Depending on access, utilization and quality, separate interventions for reducing these disparities are to be introduced.

This study analyzes the association of unemployment and health using national and international research data. It is based on data from the 2010 and 2012 German Health Update (GEDA), conducted by the Robert Koch Institute. For our analysis, participants aged from 18 to 64 years were selected if they gave information on their unemployment experiences within the five years prior to the study (n = 31,955). The results show that the self-rated health of the unemployed in Germany is significantly worse compared to the workforce. Additionally, the unemployed suffer from medically diagnosed depression. The association of unemployment and health is more pronounced in men than in women for all major outcomes. When compared to workers of the same age, the unemployed smoke more frequently and do less sports. Regarding alcohol consumption, no systematic relationship was found. While the use of medical screening measures for the early detection of diseases is lower among the unemployed than among the employed, they visit general practitioners and hospitals more often than their counterparts. Overall, our findings suggest that unemployed people should remain an important target group of preventive measures in Germany and that the corresponding measures should be intensified.

Social differences in morbidity and mortality have always been a central topic in public health research. In recent years, there has been a growing research interest that has clearly resonated with the general public and the political arena as well. This article describes the development and establishment of social epidemiology in Germany and presents the current status of research. In addition, it describes different models for explaining health inequalities. On this basis, selected challenges and prospects of socio-epidemiological research are demonstrated. The reason why the analysis of social differences in morbidity and mortality will continue to be a key task of public health research in the national and international context in the future is also explained.

Health and care services are an important aspect of public services as a basic obligation of the welfare state. Particularly in old-age, social inclusion, relatedness and integrity become the aims of health and care services beyond independence and autonomy.Provide an overview of inequalities related to socio-economic status, gender, and immigrant background in the context of health and care services.Analysis of differences in risks and problem situations, access to prevention measures, ambulatory and in-patient treatment, availability of social support, and care services in middle and older adulthood. Thereby, the contribution proceeds from our own contributions to prevention and rehabilitation research as well as from representative surveys.People with lower socio-economic status, women, and migrants more often suffer from risks and problem situations and have less access to prevention measures and medical specialist care. Regarding in-patient treatment, people with private health insurance have a higher probability of being admitted to hospital. Migrants more often visit emergency rooms and less often get rehabilitation measures. The availability of social support depends on age, gender, and education; applicants from higher status groups more often receive services from nursing care insurance.The results point to the necessity of status-, milieu- and culture-sensitive counselling, particularly focusing on patient rights and usefulness of optional health and nursing care services. Qualified professionals could take responsibility for respective tasks.

Prevention and reduction of poverty are key elements of social welfare policy in Germany. This study is the first analysis of self-rated health of individuals that escape poverty by benefiting form public transfers.Analyses are based on the German Socio-economic Panel (GSOEP) of 2010. Self-rated health was based on subjective assessment of general health status. Subjects were directly asked about receipt of public transfers. Income poverty was based on the equalized disposable income and is applied to a threshold of 60% of the median-based average income. We analyzed the association between self-rated health and pre- and post-transfer poverty by means of descriptive analyses and binary logistic regression.After adjusting for age, we found a significantly higher risk of poor self-rated health among those who escaped income poverty due to the receipt of social transfers compared to others (ORWomen: 1.85; 95%-CI: 1.27-2.69; ORMen: 2.57; 95%-CI: 1.63-4.05), in particular to those at risk of post-transfer poverty. These poverty-related inequalities in health were predominantly explained by nationality, occupational status, household type and long-term care within the household.This study provides first evidence that the receipt of public transfers is associated with increased risk of poor health in the light of impending income-poverty. This study adds to the current debate about the social and health implications of public transfers in the relationship between poverty and health.

Regular physical activity has positive effects on health at all ages. This study aims to investigate how far physical activity and regular sports engagement, as a more specific type of physical activity, are associated with socioeconomic factors in the middle-aged working population.Data were obtained from 21,699 working men and women aged between 30 and 64 years who participated in the 2009 and 2010 population-based national German Health Update (GEDA) surveys conducted by the Robert Koch Institute. Besides a multi-dimensional index of socioeconomic status (SES), three single dimensions of SES (education, occupation, and income) were used to analyse socioeconomic differences in total physical activity and regular sports engagement.While the prevalence of total physical activity increased with lower SES, the proportion of people with regular sports engagement decreased with lower SES. These associations remained after adjusting for age in men and women. After mutual adjustment of the three single socioeconomic dimensions, physical activity was independently associated with lower education and lower occupational status. Regular sports engagement was observed to be independently associated with higher education, higher occupational status, as well as higher income after mutual adjustment.This study demonstrates significant socioeconomic differences in physical and sports activity in the middle-aged working population. Education, occupation, and income show varying independent associations with physical activity behaviour. Such differences need to be considered when identifying target groups for health-enhancing physical activity interventions.

The risks of the occurrence of most chronic diseases are unequally distributed. The highest risks occur in men and women with the lowest incomes, the lowest educational qualifications, and in occupations with the lowest decision latitude. Education, occupational position, and income as indicators of socio-economic position differ with regard to their latent content and can thus not be considered to be interchangeable. The relative magnitudes of their effects differ according to the diseases considered, but all three are not available in all studies. After an explanation of the latent content of the most frequently used indicators of social differentiation, health inequalities are considered by using four groups of chronic illnesses: oral, type 2 diabetes, cardiovascular diseases, and cancers. The description is not designed to be an exhaustive assessment of the available empirical findings, but rather a representative presentation of the results and the explanatory value of education, occupation and income.

The aim of this article is to describe the potential with respect to volunteer work among 55 to 70-year-old persons along with a two-dimensional typology (actual volunteer work and intention of volunteering or expanding actual volunteer work) and to identify the influencing factors.Based on the dataset from the transitions and old age potential (TOP) study, a total of 4421 men and women born between 1942 and 1958 were included. A multinomial regression model showed the predictors for group affiliation along with an engagement-related typology (internal, utilized and external volunteer potential as well as definite non-volunteers).More than a half of the persons in the study sample could be classified as internal or external volunteer potential. Volunteers and potential volunteers revealed more similarities regarding resources and social factors than potential volunteers and definite non-volunteers. Potential volunteers were more active in other informal fields of activity (e.g. nursing or child care) than definite non-volunteers.With respect to volunteer work, definite non-volunteers showed various social disadvantages (in particular with respect to education and health) compared to (potential) volunteers. Other informal activities did not seem to be in major conflict with volunteer activities, e.g. nursing or child care, as long as they were carried out with moderate or low intensity.