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Objectives Education is an important tool to reduce health inequalities. Several factors influence the educational trajectory of children, with school satisfaction being one of them. The aim was to explore how learning difficulties, a disrupted social context and family affluence relate to school satisfaction. Methods We used data from the 2018 Slovak cross-sectional Health Behaviour in School-aged Children-study (age 15 years;N = 913; 50.3% boys). School satisfaction was categorized as liking school and caring about education (satisfied), disliking school but caring about education or vice versa (inconsistent), and disliking school and not caring about education (indifferent). We explored the association of learning difficulties, disrupted social context and family affluence with school satisfaction using multinomial logistic regression. Results Boys, and children having learning difficulties, or disruption in the social context and living in low affluence family were significantly less likely to be satisfied at school. Conclusions The key is to create a stimulating and encouraging environment at school, where children successfully learn functional literacy and feel well. The more satisfaction pupils get from school, the more likely is a favourable educational trajectory for them.

OBJECTIVES: Social policies help people to overcome various unfavourable living situations, such as unemployment, which may lead to health inequalities. The aim of this study is to examine how adults and children perceive the impact of social policies connected to unemployment on well-being in the household, and whether their views differ.METHODS: We obtained data from 123 stakeholders in Slovakia, 96 adults and 27 children aged 11-15 years. We used concept mapping, based on qualitative data collection and quantitative data analysis.RESULTS: We obtained four clusters related to: children and education; current workforce; disadvantaged groups; labour office support. Adults rated the current workforce as the most important and urgent, and children the disadvantaged groups. Contrasts were largest on the disadvantaged groups and on combining family life and working abroad which children rated as very important and urgent but adults less so.CONCLUSIONS: Stakeholders had many perceptions, which may help to improve social policies. Adults were more concerned about work, and children were more so about inequalities. In general, adults were more practical and individualistic, and children, more emphatic and idealistic.

Altres ajuts: CEGOT, Foundation for Science and Technology UIDB/04084/2020 Altres ajuts: Fundação para a Ciência e a Tecnologia (SFRH/BD/132218/2017, UIDB/04084/2020) Objective: To analyse the trends in chronic liver diseases and cirrhosis mortality, and the associated socioeconomic inequalities, in nine European cities and urban areas before and after the onset of the 2008 financial crisis. Methods: This is an ecological study of trends in three periods of time: two before (2000-2003 and 2004-2008), and one after (2009-2014) the onset of the economic crisis. The units of analysis were the geographical areas of nine cities or urban areas in Europe. We analysed chronic liver diseases and cirrhosis standardised mortality ratios, smoothing them with a hierarchical Bayesian model by each city, area, and sex. An ecological regression model was fitted to analyse the trends in socioeconomic inequalities, and included the socioeconomic deprivation index, the period, and their interaction. Results: In general, chronic liver diseases and cirrhosis mortality rates were higher in men than in women. These rates decreased in all cities during the financial crisis, except among men in Athens (rates increased from 8.50 per 100,000 inhabitants during the second period to 9.42 during the third). Socioeconomic inequalities in chronic liver diseases and cirrhosis mortality were found in six cities/metropolitan areas among men, and in four among women. Finally, in the periods studied, such inequalities did not significantly change. However, among men they increased in Turin and Barcelona and among women, several cities had lower inequalities in the third period. Conclusions: There are geographical socioeconomic inequalities in chronic liver diseases and cirrhosis mortality, mainly among men, that did not change during the 2008 financial crisis. These results should be monitored in the long term.

Background Half of the people living in social exclusion in the Czech Republic are of Roma origin. The worse health of Roma could be partly explained by numerous barriers to accessing health care. Therefore, our study aimed to explore the perceptions of various stakeholders and experts who may have an impact on the inclusion of Roma and/or their access to health care on how to improve health care access for Roma living in social exclusion in the Czech Republic. Methods We conducted a concept mapping study and obtained data from 32 participants from health and social services, policymakers and others who were involved in different study phases (brainstorming, sorting, rating, interpretation). Results Out of 64 proposed measures sorted into six distinct clusters, 20 were rated as the most urgent and the most feasible and should be implemented with a priority to improve access to health care for Roma living in social exclusion. The proposed measures covered various topics, such as education and awareness of the target group as well as education and supervision of helping professionals, strengthening capacities and streamlining the health care system, health promotion and associated services and increasing the local and financial accessibility of health care. Overall, measures concerning the education and supervision of helping professionals were rated as both the most urgent and the most feasible. Individual priority measures targeted, for example, the health needs assessment of Roma living in social exclusion to set up interventions or to include topics such as participation, empowerment, cultural competence and communication training in the curricula of health care and helping professionals in postgraduate and continuing studies. Conclusions Stakeholders proposed a set of relevant and acceptable measures that may help improve access to health care for Roma living in social exclusion. The way they rated the proposed measures reflects both the current unfavourable mainstream and public discourse concerning Roma living in social exclusion and the most acute policy issues identified by several European and national bodies.

Background: Population health measurements are recognised as appropriate tools to support public health monitoring. Yet, there is still a lack of tools that offer a basis for policy appraisal and for foreseeing impacts on health equity. In the context of persistent regional inequalities, it is critical to ascertain which regions are performing best, which factors might shape future health outcomes and where there is room for improvement. Methods: Under the EURO-HEALTHY project, tools combining the technical elements of multi-criteria value models and the social elements of participatory processes were developed to measure health in multiple dimensions and to inform policies. The flagship tool is the Population Health Index (PHI), a multidimensional measure that evaluates health from the lens of equity in health determinants and health outcomes, further divided into sub-indices. Foresight tools for policy analysis were also developed, namely: (1) scenarios of future patterns of population health in Europe in 2030, combining group elicitation with the Extreme-World method and (2) a multi-criteria evaluation framework informing policy appraisal (case study of Lisbon). Finally, a WebGIS was built to map and communicate the results to wider audiences. Results: The Population Health Index was applied to all European Union (EU) regions, indicating which regions are lagging behind and where investments are most needed to close the health gap. Three scenarios for 2030 were produced - (1) the 'Failing Europe' scenario (worst case/increasing inequalities), (2) the 'Sustainable Prosperity' scenario (best case/decreasing inequalities) and (3) the 'Being Stuck' scenario (the EU and Member States maintain the status quo). Finally, the policy appraisal exercise conducted in Lisbon illustrates which policies have higher potential to improve health and how their feasibility can change according to different scenarios. Conclusions: The article makes a theoretical and practical contribution to the field of population health. Theoretically, it contributes to the conceptualisation of health in a broader sense by advancing a model able to integrate multiple aspects of health, including health outcomes and multisectoral determinants. Empirically, the model and tools are closely tied to what is measurable when using the EU context but offering opportunities to be upscaled to other settings. The EURO-HEALTHY project (Shaping EUROpean policies to promote HEALTH equity) has received funding from the European Union’s Horizon 2020 research and innovation programme under Grant Agreement No. 643398. Additionally, this study was supported by the Centre of Studies in Geography and Spatial Planning (CEGOT), funded by national funds through the Foundation for Science and Technology (FCT) under the reference UID/GEO/04084/2019. The authors Angela Freitas and Cláudia Costa are recipients of Individual Doctoral Fellowships funded by national funds through the Foundation for Science and Technology (FCT), under the references SFRH/BD/123091/2016 and SFRH/BD/132218/2017, respectively.

Background Few studies have assessed the impact of the financial crisis on inequalities in suicide mortality in European urban areas. The objective of the study was to analyse the trend in area socioeconomic inequalities in suicide mortality in nine European urban areas before and after the beginning of the financial crisis. Methods This ecological study of trends was based on three periods, two before the economic crisis (2000–2003, 2004–2008) and one during the crisis (2009–2014). The units of analysis were the small areas of nine European cities or metropolitan areas, with a median population ranging from 271 (Turin) to 193 630 (Berlin). For each small area and sex, we analysed smoothed standardized mortality ratios of suicide mortality and their relationship with a socioeconomic deprivation index using a hierarchical Bayesian model. Results Among men, the relative risk (RR) comparing suicide mortality of the 95th percentile value of socioeconomic deprivation (severe deprivation) to its 5th percentile value (low deprivation) were higher than 1 in Stockholm and Lisbon in the three periods. In Barcelona, the RR was 2.06 (95% credible interval: 1.24–3.21) in the first period, decreasing in the other periods. No significant changes were observed across the periods. Among women, a positive significant association was identified only in Stockholm (RR around 2 in the three periods). There were no significant changes across the periods except in London with a RR of 0.49 (95% CI: 0.35–0.68) in the third period. Conclusions Area socioeconomic inequalities in suicide mortality did not change significantly after the onset of the crisis in the areas studied.

Objective: To analyse socioeconomic inequalities in all-cause mortality among men and women in nine European urban areas during the recent economic crisis, and to compare the results to those from two periods before the crisis. Method: This is an ecological study of trends based on three time periods (2000-2003, 2004-2008 and 2009-2014). The units of analysis were the small areas of nine European urban areas. We used a composite deprivation index as a socioeconomic indicator, along with other single indicators. As a mortality indicator, we used the smoothed standardized mortality ratio, calculated using the hierarchical Bayesian model proposed by Besag, York and Mollié. To analyse the evolution of socioeconomic inequalities, we fitted an ecological regression model that included the socioeconomic indicator, the period of time, and the interaction between these terms. Results: We observed significant inequalities in mortality among men for almost all the socioeconomic indicators, periods, and urban areas studied. However, no significant changes occurred during the period of the economic crisis. While inequalities among women were less common, there was a statistically significant increase in inequality during the crisis period in terms of unemployment and the deprivation index in Prague and Stockholm, respectively. Conclusions: Future analyses should also consider time-lag in the effect of crises on mortality and specific causes of death, and differential effects between genders. Resumen: Objetivo: Analizar las desigualdades socioeconómicas en la mortalidad por todas las causas en hombres y mujeres de nueve áreas urbanas europeas durante la reciente crisis económica, y comparar los resultados con dos periodos previos a la crisis. Método: Estudio ecológico de tendencias basado en tres periodos (2000-2003, 2004-2008 y 2009-2014). Las unidades de análisis fueron las áreas pequeñas de nueve zonas urbanas europeas. Se utilizaron un índice compuesto de privación socioeconómica como indicador socioeconómico y otros indicadores simples. Como indicador de mortalidad se usó la razón de mortalidad estandarizada suavizada, calculada utilizando el modelo jerárquico bayesiano propuesto por Besag, York y Mollié. Para analizar la evolución de las desigualdades socioeconómicas se utilizó un modelo de regresión ecológico que incluía el indicador socioeconómico, el periodo y la interacción de ambos. Resultados: Se observaron desigualdades significativas en la mortalidad en los hombres para casi todos los indicadores socioeconómicos, periodos y áreas urbanas. Sin embargo, no hubo cambios significativos en las desigualdades en el periodo de crisis. Aunque las desigualdades entre las mujeres fueron menos comunes, hubo un incremento significativo en las desigualdades en mortalidad en el periodo de crisis en términos de desempleo y del índice de privación en Praga y Estocolmo, respectivamente. Conclusiones: Futuros análisis deberán tener en cuenta el tiempo transcurrido entre la crisis y su efecto en la mortalidad, así como diferentes causas de mortalidad y el efecto diferencial entre géneros.

Background The effect of inequalities aggravated by economic recessions in the mortality rates of certain diseases has been previously described. In this study, we analyzed the relationship between socio-economic deprivation and cancer mortality. We focused on lung, colon, prostate, and breast cancers in nine European urban areas over three periods: two before (2000–2003 and 2004–2008) and one after (2009–2014) the onset of the 2008 financial crisis. Methods This is an ecological study of trends. The units of analysis were small areas within nine European urban areas. We used a composite deprivation index as a socio-economic indicator. As a mortality indicator, we used the smoothed standardized mortality ratio, calculated using the hierarchical Bayesian model proposed by Besag, York and Mollie. To analyze the evolution of socio-economic inequalities, we fitted an ecological regression model that included the socio-economic indicator, the period of time, and the interaction between these terms. Results In men, socio-economic inequalities in all-cancer and lung cancer mortality were observed in most of the cities studied, but did not increase after the onset of the economic crisis. In women, only two cities (Stockholm and London) showed socio-economic inequalities in all-cancer and lung cancer mortality; there was also no increase in inequalities. Conclusions Our results did not validate our hypothesis that inequalities increase in times of crisis. However, they emphasize the importance of socio-economic measurements for understanding mortality inequalities, and can be used to inform prevention strategies and help plan local health programs aimed at reducing health inequalities.

Large socioeconomic inequalities in health are still present in the Central Europe. The aim was to explore socioeconomic inequalities in mortality in Visegrad countries—the Czech Republic, Hungary, Poland and Slovakia (V4), by three different socioeconomic indicators (unemployment, risk of poverty/social exclusion, education). The study was conducted within the H2020 Euro-Healthy project. The associations between selected socioeconomic indicators and the standardised mortality rates by four main causes (mortality related to cancer, circulatory, respiratory and digestive system) in the economically active population aged 20–64 years in the 35 NUTS 2 level regions of the V4 in the period 2011–2013 were explored, using linear regression models. Lower education level was the most significant predictor of mortality in the V4. The lowest mortality rates by all causes of death were found in the regions of the Czech Republic, the highest in regions of Hungary. Despite the common origin, the pathways of the V4 countries in employment, poverty and education seem to be different, also having impact on health equity. Therefore, where you live in the V4 can significantly influence your health.

Little is known about the impact of recessions on young people’s socioeconomic inequalities in health. This study investigates the impact of the economic recession in terms of youth unemployment on socioeconomic inequalities in psychological health complaints among adolescents across Europe and North America. Data from the WHO collaborative ‘Health Behaviour in School-aged Children’ (HBSC) study were collected in 2005/06 (N = 160,830) and 2009/10 (N = 166,590) in 31 European and North American countries. Logistic multilevel models were used to assess the contribution of youth unemployment in 2009/10 (enduring recession) and the change in youth unemployment (2005–2010) to adolescent psychological health complaints and socioeconomic inequalities in complaints in 2009/10. Youth unemployment during the recession is positively related to psychological health complaints, but not to inequalities in complaints. Changes in youth unemployment (2005–2010) were not associated with adolescents’ psychological health complaints, whereas greater inequalities in complaints were found in countries with greater increases in youth unemployment. This study highlights the need to tackle the impact of increasing unemployment on adolescent health and health inequalities during economic recessions.

Our earlier article showed that increased employability of segregated Roma may improve their well-being and health. To achieve that, appropriate employment based on a public&ndash, private partnership could be the key. For optimal design of such a partnership, we need insight into its potential mechanisms. Evidence on this is lacking, however. This paper builds on the previously published article by focusing on mechanisms for achieving better health. Therefore, our aim was to identify the potential mechanisms by which a public&ndash, private Roma employment project could increase employability. We investigated a Roma employment project called Equality of Opportunity established by a private company, U.S. Steel Kosice in eastern Slovakia. We conducted a multi-perspective qualitative study to obtain key stakeholders&rsquo, perspectives on the potential mechanisms of a public&ndash, private Roma employment project in terms of increased employability. We found three types of mechanisms. The first type regarded formal job mechanisms, such as an appropriate employment and salary offer and a bottom-up approach in capacity building. The second type involved sustainability mechanisms, such as the personal profile of project and work-shift coordinators, the continuous offer of training and cooperation with relevant stakeholders (municipalities, community centers, etc.). The third type was cultural mechanisms, such as personal contact with project participants, attention to less-voiced groups like children, the motivation of project participants, a counter-value reciprocity approach and respect for the specifics of Roma history. Our findings imply that policymakers could consider public&ndash, private partnerships for increasing the employability of segregated Roma, as they have the potential to address a wider range of social needs simultaneously.

Since 2011, the SOPHIE project has accumulated evidence regarding the influence of social and economic policies on population health levels, as well as on health inequalities according to socioeconomic position, gender, and immigrant status. Through comparative analyses and evaluation case studies across Europe, SOPHIE has shown how these health inequalities vary according to contexts in macroeconomics, social protection, labor market, built environment, housing, gender equity, and immigrant integration and may be reduced by equity-oriented policies in these fields. These studies can help public health and social justice advocates to build a strong case for fairer social and economic policies that will lead to the reduction of health inequalities that most governments have included among their policy goals. In this article, we summarize the main findings and policy implications of the SOPHIE project and the lessons learned on civil society participation in research and results communication.

Background: The recent economic recession, which began in 2007, has had a detrimental effect on the health of the adult population, but no study yet has investigated the impact of this downturn on adolescent health. This article uniquely examines the effect of the crisis on adolescents’ psychological health complaints in a cross-national comparison. Methods: Data came from the World Health Organization collaborative ‘Health Behaviour in School-aged Children’ study in 2005–06 and 2009–10. We measured change in psychological health complaints from before to during the recession in the context of changing adult and adolescent unemployment rates. Furthermore, we used logistic multilevel regression to model the impact of absolute unemployment in 2010 and its change rate between 2005–06 and 2009–10 on adolescents’ psychological health complaints in 2010. Results: Descriptive results showed that although youth and adult unemployment has increased during the economic crisis, rates of psychological health complaints among adolescents were unaffected in some countries and even decreased in others. Multilevel regression models support this finding and reveal that only youth unemployment in 2010 increased the likelihood of psychological health complaints, whereas its change rate in light of the recession as well as adult unemployment did not relate to levels of psychological health complaints. Conclusion: In contrast to recent findings, our study indicates that the negative shift of the recent recession on the employment market in several countries has not affected adolescents’ psychological health complaints. Adolescents’ well-being instead seems to be influenced by the current situation on the labour market that shapes their occupational outlook.

Background: The aim of this study was to compare socioeconomic characteristics of the Roma population living in Roma settlements with the majority population. Moreover, it was aimed to assess socioeconomic differences in health and health-related behaviour within the population living in Roma settlements. Methods: Data from the cross-sectional HepaMeta study conducted in Slovakia in 2011 were used. The sample consisted of 452 Roma (mean age = 34.7; 35.2% men) and 403 non-Roma (mean age = 33.5; 45.9% men) respondents. Roma in selected settlements were recruited by local Roma community workers. Respondents from the major population were randomly selected from a list of patients from general practitioners. Data were collected via questionnaire, anthropometric measures and analysed blood samples. Differences in socioeconomic characteristics between the population living in Roma settlements and the majority population were tested using the chi-square test. The contribution of selected socioeconomic characteristics on health and health-related behaviour of the population living in Roma settlements was assessed by logistic regression models adjusted for age and gender. Results: The population living in Roma settlements is characterised by significantly lower socioeconomic standards, and the living conditions are significantly worse compared with the majority. With few exceptions, the study did not confirm any significant association between socioeconomic indicators and health and health-related behaviour within the population living in Roma settlements. Conclusions: The deteriorating effect of living in Roma settlement on health and health-related behaviour seems to be immense regardless differences in socioeconomic characteristics or living condition within the settlement population.

Increasing employment opportunities for segregated Roma might prevent major economic losses and improve their health. Involvement of the private sector in Roma employment, on top of intensified governmental actions, is likely to be a key to sustainable improvement, but evidence on this is scarce. Our aim was to determine the potential outcomes of such a partnership regarding increased employability and the resulting improved well-being and health. We therefore investigated a Roma employment project called Equality of Opportunity, run since 2002 by a private company, U.S. Steel Kosice, in eastern Slovakia. We conducted a multi-perspective qualitative study to obtain the perspectives of key stakeholders on the outcomes of this project. We found that they expected the employability of segregated Roma to increase in particular via improvements in their work ethic and working habits, education, skills acquisition, self-confidence, courage and social inclusion. They further expected as the main health effects of increased employability an improvement in Roma well-being and health via a stable income, better housing, crime reduction, improved hygienic standards, access to prevention and improved mental resilience. Social policies regarding segregated Roma could thus be best directed at increasing employment and at these topics in particular to increase their effects on Roma health.

The paper presents the utility function model applicable within the first stage of starting a new business abroad. An applied auxiliary mathematical model was constructed to assist in the preliminary screening phase of the country selection process. The model is based on a comparison of countries according to utility function. This paper also illustrates a short example, where selected economic criteria serve as input data for determining the utility values of particular countries. The suggested model is parsimonious, easy to understand and, within the above mentioned context, potentially suitable for entrepreneurs from various economic sectors.

Objectives Participation in organized activities is related with a range of positive outcomes, but the way such participation is measured has not been scrutinized. Test-retest reliability as an important indicator of a scale's reliability has been assessed rarely and for "The scale of participation in organized activities'' lacks completely. This test-retest study is based on the Health Behaviour in School-aged Children study and is consistent with its methodology.Methods We obtained data from 353 Czech (51.9 % boys) and 227 Slovak (52.9 % boys) primary school pupils, grades five and nine, who participated in this study in 2013. We used Cohen's kappa statistic and single measures of the intraclass correlation coefficient to estimate the test-retest reliability of all selected items in the sample, stratified by gender, age and country.Results We mostly observed a large correlation between the test and retest in all of the examined variables (kappa ranged from 0.46 to 0.68). Test-retest reliability of the sum score of individual items showed substantial agreement (ICC = 0.64).Conclusions The scale of participation in organized activities has an acceptable level of agreement, indicating good reliability.

Background: Like most Central European countries Slovakia has experienced a period of socioeconomic changes and at the same time a decline in the mortality rate. Therefore, the aim is to study socioeconomic factors that changed over time and simultaneously contributed to regional differences in mortality.Methods: The associations between selected socioeconomic indicators and the standardised mortality rate in the population aged 20-64 years in the districts of the Slovak Republic in the periods 1997-1998 and 2012-2013 were analysed using linear regression models.Results: A higher proportion of inhabitants in material need, and among males also lower income, significantly contributed to higher standardised mortality in both periods. The unemployment rate did not contribute to this prediction. Between the two periods no significant changes in regional mortality differences by the selected socioeconomic factors were found.Conclusions: Despite the fact that economic growth combined with investments of European structural funds contributed to the improvement of the socioeconomic situation in many districts of Slovakia, there are still districts which remain "poor" and which maintain regional mortality differences.

Background Many OECD countries have replied to economic recessions with an adaption in public spending on social benefits for families and young people in need. So far, no study has examined the impact of public social spending during the recent economic recession on health, and social inequalities in health among young people. This study investigates whether an increase in public spending relates to a lower prevalence in health complaints and buffers health inequalities among adolescents. Methods Data were obtained from the 2009/2010 “Health Behaviour in School-aged Children (HBSC)” study comprising 11 – 15-year-old adolescents from 27 European countries (N = 144,754). Socioeconomic position was measured by the Family Affluence Scale (FAS). Logistic multilevel models were conducted for the association between the absolute rate of public spending on family benefits per capita in 2010 and the relative change rate in family benefits (2006–2010) in relation to adolescent psychological health complaints in 2009/2010. Results The absolute rate of public spending on family benefits in 2010 did not show a significant association with adolescents’ psychological health complaints. Relative change rates of public spending on family benefits (2006–2010) were related to better health. Greater socioeconomic inequalities in psychological health complaints were found for countries with higher change rates in public spending on family benefits (2006–2010). Conclusions The results partially support our hypothesis and highlight that policy initiatives in terms of an increase in family benefits might partially benefit adolescent health, but tend to widen social inequalities in adolescent health during the recent recession. Electronic supplementary material The online version of this article (doi:10.1186/s12889-016-3551-6) contains supplementary material, which is available to authorized users.