Johan Mackenbach

Erasmus MC | Erasmus MC · Department of Public Health

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. In their tireless pursuit of a better life,...

Socioeconomic inequalities in health have been studied extensively in the past decades. In all high-income countries with available data, mortality and morbidity rates are higher among those in less advantaged socioeconomic positions, and as a result differences in health expectancy between socioeconomic groups typically amount to 10 years or more....

Background: We aimed to develop census-linked longitudinal mortality data for Japan and assess its 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 pe...

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 ≈ 0.6–...

Objective We investigated whether an in-hospital intervention consisting of fall risk screening and tailored advice could prompt patients to take preventive action. Method Patients (≥70) attending the emergency department and nephrology outpatient clinic in a Dutch hospital were screened. Patients at high risk received tailored advice based on the...

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 co...

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 disab...

Doel Nagaan hoe het verloop van de sterftecijfers in Nederland, Aruba en Curaçao zich verhoudt tot dat in andere westerse landen en hun Caribische gebieden. Opzet Beschrijvend, retrospectief onderzoek. Methode Er werden trendanalysen uitgevoerd van de sterfte- en doodsoorzaakgegevens uit de periode 1980-2014. Dit betrof analyse van voor leeftijd...

Purpose To study the trends of smoking-attributable mortality among the low and high educated in consecutive birth cohorts in 11 European countries. Methods Register-based mortality data were collected among adults aged 30 to 79 years in 11 European countries between 1971 and 2012. Smoking-attributable deaths were estimated indirectly from lung ca...

Socioeconomic inequalities in disability-free life expectancy (DFLE) exist across all European countries, yet the driving determinants of these differences are not completely known. We calculated the impact on educational inequalities in DFLE of equalizing the distribution of eight risk factors for mortality and disability using register-based mort...

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 d...

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 s...

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. The characterist...

Purpose: To study the trends of smoking-attributable mortality among the low- and high-educated in consecutive birth cohorts in 11 European countries. Methods: Register-based mortality data were collected among adults aged 30 to 79 years in 11 European countries between 1971 and 2012. Smoking-attributable deaths were estimated indirectly from lung...

Purpose: To study the trends of smoking-attributable mortality among the low- and high-educated in consecutive birth cohorts in 11 European countries. Methods: Register-based mortality data were collected among adults aged 30 to 79 years in 11 European countries between 1971 and 2012. Smoking-attributable deaths were estimated indirectly from lung...

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 u...

Background: We aimed to investigate the magnitude of occupational class (OC) and educational level (EL) inequalities in cardiovascular risk factors in Turkey from 2008 to 2016 and compare these inequalities with neighbouring European countries. Methods: We used the Turkey Health Survey among a representative sample of the Turkish population. We...

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 educati...

Unfavorable psychosocial working conditions can lead to cardiovascular disease (CVD) mortality. Lower-occupational groups typically experience unfavorable psychosocial working conditions as compared to higher-occupational groups. We investigate the extent to which CVD mortality inequalities might be reduced if psychosocial working conditions for ma...

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. Method: We analyzed data from the Comprehensive Survey of Living Conditions, a large nationally representat...

A widely used indicator for cultural class is strongly related to a lower body mass index (BMI): cultural capital measured as ‘highbrow' taste. This study’s objective was to theorise and measure aspects of cultural class that are more plausibly linked to low BMI, and subsequently explore their relevance. Building on Bourdieusian theory we derive fo...

Over the past three centuries, health of Europeans has improved spectacularly, with a doubling of life expectancy at birth. Below the surface of these changes in life expectancy lies a fascinating pattern of rising and then falling diseases. The explanation of these trends has been a battle of ideas, between those who believed rising life expectanc...

Objective. To identify specific health care areas whose optimization could improve population health in the Dutch Caribbean islands of Aruba and Curaçao. Methods. Comparative observational study using mortality and population data of the Dutch Caribbean islands and the Netherlands. Mortality trends were calculated, then analyzed with Joinpoint soft...

Anxiety and depression are commonly found in patients with diabetes, but little is known about how the anxiety and depression symptoms of diabetes patients and the health-related quality of life (HRQoL) over time influence each other. Therefore, we conducted a survey among patients with diabetes (T1) and repeated the survey after 3 months (T2). Lin...

Funded by the European Commission Horizon 2020 programme, the Lifepath research consortium aimed to investigate the effects of socioeconomic inequalities on the biology of healthy aging. The main research questions included the impact of inequalities on health, the role of behavioral and other risk factors, the underlying biological mechanisms, the...

We aimed to gain insight into the barriers and facilitators to fall risk screening of older adults visiting the hospital as experienced by patients and healthcare professionals, and to examine the differences between chronic- and acute-care patients. We invited patients (≥ 70 years) attending the nephrology and emergency department to participate i...

Background Interventions that reduce morbidity, in addition to mortality, warrant prioritisation. It is important to understand the magnitude of potential morbidity and health gains from changing risk factor distributions. We quantified the impact of tobacco compared with overweight/obesity eradication on future morbidity and health-adjusted life e...

Chapter 1. Introduction Over the past three centuries, health of Europeans has improved spectacularly, with a doubling of life expectancy at birth. Below the surface of these changes in life expectancy lies a fascinating pattern of rising and then falling diseases. The explanation of these trends has been a battle of ideas, between those who believ...

Socioeconomic inequalities in mortality are a challenge for public health around the world, but appear to be resistant to policy-making. We aimed to identify European countries which have been more successful than others in narrowing inequalities in mortality, and the factors associated with narrowing inequalities. We collected and harmonised morta...

Background This study aims to investigate the magnitude of occupational class (OC) and educational inequalities in cardiovascular risk factors in Turkey from 2008 to 2016. Methods We used the Turkey Health Survey, a bi-annual health interview survey among a representative sample of the Turkish population. We calculated the age-standardized prevale...

Background: Socioeconomic inequalities in longevity have been found in all European countries. We aimed to assess which determinants make the largest contribution to these inequalities. Methods: We did an international comparative study of inequalities in risk factors for shorter life expectancy in Europe. We collected register-based mortality d...

Background: Comprehensive tobacco control policies can help to protect children from tobacco smoke exposure and associated adverse respiratory health consequences. We investigated the impact of England's 2015 regulation that prohibits smoking in a private vehicle with children present on changes in environmental tobacco smoke exposure and respirat...

Chapter 2 (‘Patterns of health inequalities’) sets the scene for the rest of the book, by explaining the measurement of health inequalities and by providing a profusely illustrated overview of inequalities in morbidity and mortality by education and occupational class in 30 European countries. It shows that health inequalities are a generalized phe...

Chapter 4 (‘Patterns of health inequalities explained’) is based on in-depth studies of the macro-level determinants of health inequalities, especially conducted for this book. It shows that the persistence of health inequalities is partly due to broader changes in society, such as educational expansion, increasing rates of intergenerational mobili...

Chapter 5 (‘A broader picture’) first discusses why not only health inequalities, but also social inequality is so persistent. After reviewing sociological theories from both the ‘functionalist’ and ‘conflict’ traditions, it chooses a middle road which acknowledges the ineradicable nature of social inequality. It then describes recent trends in wel...

‘Health inequalities—persistence and change in European welfare states’ studies why frequencies of disease, disability, and premature mortality are higher among people with a lower socioeconomic position, even in countries with advanced welfare states. Drawing upon data from 30 countries covering more than three decades, it provides a comprehensive...

Chapter 3 (‘Explanatory perspectives’) provides a digest of the vast amounts of explanatory research on health inequalities that has been conducted over the past three decades. It introduces recent methodological advances, such as the counterfactual approach to causality, quasi-experimental study designs, and mediation analysis. It reviews the scie...

Chapter 6 (‘Policy implications’) describes how several European countries have tried to reduce health inequalities. Even the well-resourced English strategy (1997–2010) has not reduced health inequalities at the population level, due to a combination of lack of evidence-based interventions and lack of scale of the efforts. Quantitative analyses of...

Objective To assess whether recent declines in cardiovascular mortality have benefited all socioeconomic groups equally and whether these declines have narrowed or widened inequalities in cardiovascular mortality in Europe. Methods In this prospective registry-based study, we determined changes in cardiovascular mortality between the 1990s and the...

Background: Previous studies have shown the existence of social inequalities in disability in many European countries. However, it is not clear what factors are associated with these inequalities. The aim of this study was to assess the contribution of behavioral factors, work-related factors and living conditions to educational inequalities in di...

Objectives: To assess to what extent educational differences in total life expectancy (TLE) and disability-free life expectancy (DFLE) could be reduced by improving fruit and vegetable consumption in ten European countries. Methods: Data from national census or registries with mortality follow-up, EU-SILC, and ESS were used in two scenarios to c...

Inequalities in health are pervasive and durable, but they are not uniform. To date, however, the drivers of these between-country patters in health inequalities remain largely unknown. In this analysis, we draw on data from 17 European countries to explore whether inequalities in political participation, that is, inequalities in voting by educatio...

Objectives To explore whether ‘distinction’, a well-known mechanism that produces and reproduces social inequalities, can explain the socio-economic gradient in healthy diet and physical activity in contemporary obesogenic environments. If this is the case, we would expect a well-established indicator of distinction, ‘highbrow’ cultural participati...

Background: In the Caribbean, life expectancy in politically independent territories has increasingly diverged from that of territories that remained affiliated to their former colonizers. Because these affiliated territories differ in degree of political independence, they are not all governed in the same way. We assessed whether differences in l...

Inequalities in health are pervasive and durable, but they are not uniform. To date, however, the drivers of these between-country patters in health inequalities remain largely unknown. In this analysis, we draw on data from 17 European countries to explore whether inequalities in political participation, that is, inequalities in voting by educatio...

Background We compared mortality inequalities by occupational class in Japan and South Korea with those in European countries, in order to determine whether patterns are similar. Methods National register-based data from Japan, South Korea and eight European countries (Finland, Denmark, England/Wales, France, Switzerland, Italy (Turin), Estonia, L...

Full access: http://publications.iarc.fr/_publications/media/download/5323/9b854740fa98a2f8a7d5244d1b1b40046e767b19.pdf

Background 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 p...

Objectives: To determine whether Caribbean states vary in health policy performance in 11 different areas; to explore the association with sociodemographic, economical, and governance determinants; and to estimate the potential health gains of "best-practice" health policies. Methods: We selected 50 indicators that included data on mortality (la...

Over the last decades several self-report instruments have been developed to identify diabetes at risk for depression. In a sample of diabetes outpatients, we assessed the accuracy of three widely-used instruments, and recommend the instruments with the best sensitivity and specificity for identifying diabetes in need of early treatment for depress...

Objectives To assess the sensitivity of prevalence and inequality estimates of Global Activity Limitation Indicator (GALI) to the choice of survey in European countries. Methods We use logistic regression to estimate adjusted risk ratios, quantifying differences in prevalence and educational inequalities, the impact of survey characteristics and K...

Background: Material and behavioural factors play an important role in explaining educational inequalities in mortality, but gender differences in these contributions have received little attention thus far. We examined the contribution of a range of possible mediators to relative educational inequalities in mortality for men and women separately....

Social inequalities in cancer are a global problem, as has been well documented inthe World Health Organization (WHO)/International Agency for Research onCancer (IARC) publication Social Inequalities and Cancer.1Inequalities in income,wealth, education, and power disproportionally impact the most disadvantagedindividuals, communities, and countries...

Background: Did the global financial crisis and its aftermath impact upon the performance of health systems in Europe? We investigated trends in amenable and other mortality in the EU since 2000 across 28 EU countries. Methods: We use WHO detailed mortality files from 28 EU countries to calculate age-standardized deaths rates from amenable and o...

Significance Inequalities in mortality and morbidity among socioeconomic groups are a highly persistent phenomenon despite having been the focus of public health policy in many countries. The United States has recently witnessed a widening of health inequalities due to rising mortality and morbidity among the lowly educated. Our study shows that, d...

Background Suicide has been decreasing over the past decade. However, we do not know whether socioeconomic inequality in suicide has been decreasing as well. Aims We assessed recent trends in socioeconomic inequalities in suicide in 15 European populations. Method The DEMETRIQ study collected and harmonised register-based data on suicide mortalit...

Objectives To study socioeconomic inequalities in mental health in rural and urban Colombia, a country with a history of internal conflict and large socioeconomic inequalities. Recent survey data are available to study this understudied topic in a middle-income country. Methods Using data from 9656 respondents from the 2015 Colombian Mental Health...

Unhealthy behaviors and their social patterning have been frequently proposed as factors mediating socioeconomic differences in health. However, a clear quantification of the contribution of health behaviors to the socioeconomic gradient in health is lacking. This study systematically reviews the role of health behaviors in explaining socioeconomic...

Four decades ago, U.S. life expectancy was within the same range as other high-income peer countries. However, during the past decades, the United States has fared worse in many key health domains resulting in shorter life expectancy and poorer health—a health disadvantage. The National Heart, Lung, and Blood Institute convened a panel of national...

Background: This article examines risk factor and health differences between Antillean migrants in the Netherlands and Antillean and Dutch non-migrants, and relates these findings to four commonly used explanations for migrant health disparities. Methods: Nationally representative data from the 2012 Dutch Public Health Monitor and the 2013 Natio...

Four decades ago, U.S. life expectancy was within the same range as other high-income peer countries. However, during the past decades, the United States has fared worse in many key health domains resulting in shorter life expectancy and poorer health-a health disadvantage. The National Heart, Lung, and Blood Institute convened a panel of national...

Objective To assess the association of low socioeconomic status and risk factors for non-communicable diseases (diabetes, high alcohol intake, high blood pressure, obesity, physical inactivity, smoking) with loss of physical functioning at older ages. Design Multi-cohort population based study. Setting 37 cohort studies from 24 countries in Europ...

Supplementary information: descriptions of included cohort studies, tables S1-S7, figures S1-S8, and sensitivity analyses using a two step approach

Background Tobacco smoking and smoke exposure during pregnancy and childhood cause considerable childhood morbidity and mortality. We aimed to determine whether implementation of the World Health Organization's recommended tobacco control policies (MPOWER) were of benefit to perinatal and child health. Methods We searched 19 electronic databases,...

De uitgaven aan gezondheidszorg zijn, zoals bekend, in de twintigste eeuw enorm gestegen. In de jaren twintig lagen de uitgaven volgens een ruwe schatting rond de 2% van het nationaal inkomen; in 1950, het eerste jaar waarvoor we redelijk betrouwbare gegevens hebben, was dat nog rond de 3%. Daarna begon echter een snelle stijging tot zo’n 10% in he...

Socioeconomic differences in health have been consistently observed worldwide. Physical health deteriorates more rapidly with age among men and women with lower socioeconomic status (SES) than among those with higher SES. The biological processes underlying these differences are best understood by adopting a life course approach. In this paper we i...

The persistence of socioeconomic inequalities in health, despite all that has been done to reduce social and economic inequalities in many European countries, is one of the great disappointments of public health. In this paper, I summarize the results of a series of studies into the explanation of variations and trends in inequalities in mortality...

The magnitude of socioeconomic inequalities in mortality differs importantly between countries, but these variations have not been satisfactorily explained. We explored the role of behavioral and structural determinants of these variations, by using a dataset covering 17 European countries in the period 1970–2010, and by conducting multilevel multi...

Background: Tobacco smoking and smoke exposure during pregnancy and childhood cause considerable childhood morbidity and mortality. We did a systematic review and meta-analysis to investigate whether implementation of WHO's recommended tobacco control policies (MPOWER) was of benefit to perinatal and child health. Methods: We searched 19 electronic...

Cijfers van het Centraal Bureau voor de Statistiek (CBS) laten zien dat de levensverwachting van hoogopgeleide mensen ruim zes jaar hoger is dan die van laagopgeleiden. De verschillen in gezonde levensverwachting zijn beduidend groter. Deze grote verschillen in gezonde levensverwachting hebben belangrijke implicaties voor het kunnen blijven werken...