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Bildung und Gesundheit
Abstract
Bildung zählt zu den zentralen sozialen Determinanten von Gesundheit. In modernen Gesellschaften weisen besser gebildete Bevölkerungsgruppen in der Regel geringere Krankheitsrisiken sowie eine durchschnittlich höhere Lebenserwartung auf. Die Daten der Studie „Gesundheit in Deutschland aktuell“ (GEDA 2014/2015-EHIS) zeigen, dass Männer und Frauen mit niedriger Bildung ihren allgemeinen Gesundheitszustand schlechter einschätzen und häufiger von gesundheitlichen Einschränkungen berichten als Personen mit hoher Bildung. Erkrankungen wie Diabetes, koronare Herzkrankheit und Depressionen treten bei Personen mit niedriger Bildung deutlich häufiger auf als bei Höhergebildeten. Bildungsunterschiede zeichnen sich auch für die meisten gesundheitlichen Risikofaktoren ab. So nimmt z. B. der Anteil der Personen, die von Bluthochdruck und Adipositas betroffen sind, mit sinkendem Bildungsniveau zu. Personen mit hoher Bildung weisen hingegen ein gesünderes Bewegungs- bzw. Ernährungsverhalten auf und rauchen seltener. Angesichts dieser Zusammenhänge erscheint es auch aus Public-Health-Sicht sinnvoll, gezielt in Bildung zu investieren, Bildungschancen zu verbessern und bestehende Bildungsungleichheiten abzubauen.
Background
The demographic change makes comprehensive health reporting on health at older age an important topic.
Methods
Gesundheit 65+ is a longitudinal epidemiological study on the health status of persons aged 65 and older in Germany. Based on a two-stage stratified random sample from 128 local population registers, 3,694 persons participated in the baseline survey between June 2021 and April 2022 (47.9 % women, mean age 78.8 years). Weighted prevalences for 19 indicators of the baseline survey are presented overall and by age, sex, education and region of residence.
Results
Overall, 52.0 % of all participants of the baseline survey reported to be in good or very good health, and 78.5 % reported high or very high satisfaction with their life. This was in contrast to the large number of health/functional limitations whose prevalences ranged from 5.3 % for severe visual limitations to 69.2 % for multimorbidity. The health status of women was clearly worse than that of men, and the health status of persons aged 80 and older was worse than between 65 and 79 years of age. There was a clear educational gradient evident in the health status, but there were no differences between West and East Germany.
Conclusions
Gesundheit 65+ provides a comprehensive database for description of the health status of old and very old people in Germany, on the basis of which recommendations for action for policy and practice can be derived.
Background
Since 2003 the German Federal Government has been promoting the establishment and expansion of all-day schools. Linked with this is the hope to relieve parents and to enable them to work. Moreover, the conditions for learning are improved and children are offered additional educational opportunities. Ultimately, the dependence of educational success on social background should be reduced. For the field of health promotion, all-day schools are an important setting, as their quality-assured implementation can contribute to reducing health and social inequalities.
Objectives
In a mixed-methods study the author investigated what everyday life in an all-day school looks like, and how the school should be organized and designed in order for students to feel well and to grow into healthy adults. This question was assessed through the perspective of parents, teachers and students. The present paper exclusively portrays the perspective of students in secondary school.
Materials and methods
During a World Café, 94 student representatives from grades five and higher of a district discussed the organization of all-day schools and potential suggestions for improvement.
Results and conclusions
The findings show the potential of attending all-day schools but also the risks associated for children, adolescents, and ultimately also to the social space. On the one hand, students are supported in their learning and receive educational opportunities that, among other things, have a positive effect on a social sense of community at school. However, on the other hand, students are left with little self-determination and co-determination in their daily lives. They lack time and energy for organized hobbies and friends outside of school.
Die subjektive Gesundheit spiegelt nicht nur vorhandene Krankheiten und Gesundheitsbeschwerden wider, sondern insbesondere das persönliche Wohlbefinden. In Studien wird die subjektive Gesundheit häufig über die Selbsteinschätzung des allgemeinen Gesundheitszustandes erfasst. Im Rahmen der Studie GEDA 2014/2015-EHIS wurde dazu das international bewährte Minimum European Health Module (MEHM) eingesetzt. Danach schätzen 68,2 % der Erwachsenen in Deutschland ihren allgemeinen Gesundheitszustand als sehr gut oder gut ein, die verbleibenden 31,8 % als mittelmäßig, schlecht oder sehr schlecht. Der Anteil der Frauen, die ihre Gesundheit als sehr gut oder gut bewerten, liegt geringfügig unter dem entsprechenden Anteil der Männer (66,6 % gegenüber 69,9 %). Frauen wie Männer schätzen ihren allgemeinen
Gesundheitszustand im Altersverlauf zunehmend schlechter ein. Darüber hinaus sind Bildungsunterschiede zuungunsten von Frauen und Männern mit niedrigem Bildungsniveau und zum Teil auch regionale Unterschiede zu beobachten.
Depressionen sind häufige psychische Störungen, deren Bedeutung im Versorgungsgeschehen zunimmt. In der Studie GEDA 2014/2015-EHIS berichten 9,7 % der Frauen und 6,3 % der Männer in den letzten 12 Monaten von einer Ärztin oder einem Arzt die Diagnose einer Depression erhalten zu haben. Im Alter von 45 bis 64 Jahren sind diese aus dem Versorgungsgeschehen berichteten Depressionsdiagnosen bei beiden Geschlechtern am häufigsten. Deutliche Unterschiede bestehen nach Bildungsstatus: Bei Frauen liegen die Prävalenzen in der unteren Bildungs-gruppe etwa doppelt so hoch wie in der oberen (12,2 % vs. 6,5 %). Bei Männern zeigt sich ein geringerer Bildungs-gradient (7,5 % vs. 5,1 %). Auch zwischen den Bundesländern schwanken die Prävalenzen stark (Frauen 5,4 %-13,4 %; Männer 3,3 %-9,4 %). Die Ergebnisse werden im Kontext der bisherigen Datenlage diskutiert. DEPRESSION · ÄRZTLICHE DIAGNOSE · ERWACHSENE · GESUNDHEITSMONITORING · DEUTSCHLAND Einleitung Depressionen sind psychische Störungen, die geprägt sind von Niedergeschlagenheit, Antriebslosigkeit, starker Ermüdbarkeit und dem Verlust von Interesse an Aktivi-täten, die einem sonst Freude bereiteten [1]. Weitere Symp tome wie beispielsweise Konzentrationsprobleme, vermindertes Selbstvertrauen und in schweren Fällen auch Suizidalität können hinzukommen. Für den Einzel-nen sind Depressionen mit erheblichen Einschränkun-gen von Lebensqualität und Leistungsfähigkeit verbunden [2]. Unter allen chronischen Erkrankungen verursachen sie weltweit die größte Zahl der mit Beeinträchtigung gelebten Lebensjahre [3] und werden im Zusammenhang mit mindestens der Hälfte aller vollendeten Suizide gese-hen [4]. Sozialversicherungen dokumentieren eine zuneh
Soziale Unterstützung resultiert aus sozialen Bindungen und Netzwerken. Als psychosoziale Ressource hat soziale Unterstützung einen wesentlichen Einfluss auf die Gesundheit. Sie kann u.a. das psychische Wohlbefinden verbessern, Stress reduzieren und die Auswirkung ungünstiger Lebensbedingungen verringern. Auf Basis der Erhebung GEDA 2014/2015-EHIS des Robert Koch-Instituts (RKI) wird das Ausmaß und die Verteilung wahrgenommener sozialer Unterstützung in der erwachsenen Bevölkerung Deutschlands untersucht (n=23.617). Die Ergebnisse zeigen, dass sich Frauen und Männer zu einem großen Teil durch nahestehende Personen oder Nachbarn unterstützt fühlen. Soziale Unterstützung ist jedoch nicht in allen Bevölkerungsgruppen gleich verteilt: Ältere Personen, gering gebildete sowie nicht erwerbstätige Frauen und Männer berichten vergleichsweise häufig von geringer sozialer Unterstützung. Damit können insbesondere diejenigen Bevölkerungsgruppen, die häufiger von gesundheitlichen Problemen betroffen sind, seltener auf diese Ressource zurückgreifen.
Background: This methodological paper describes the integration of the ‘European Health Interview Survey wave 2’ (EHIS 2) into the ‘German Health Update’ 2014/2015 (GEDA 2014/2015-EHIS).
Methods: GEDA 2014/2015-EHIS is a cross-sectional health survey. A two-stage stratified cluster sampling approach was used to recruit persons aged 15 years and older with permanent residence in Germany. Two different modes of data collection were used, self-administered web questionnaire and self-administered paper questionnaire. The survey instrument implemented the EHIS 2 modules on health status, health care use, health determinants and social background variables and additional national questions. Data processing was conducted according to the quality and validation rules specified by Eurostat.
Results: In total, 24,824 questionnaires were completed. The response rate was 27.6%. The two-stage cluster sample method seems to have been successful in achieving a sample with high representativeness. The final micro data file was inspected, approved and certified by Eurostat. Access to micro data of the EHIS 2 can be provided by Eurostat via research contract and to the GEDA 2014/2015-EHIS public use file by the Research Data Centre of the Robert Koch Institute. First EHIS 2 results are available at the Eurostat website.
Conclusions: Integrating a multinational health survey into an existing national health monitoring system was a challenge in Germany. The national survey methodology for conducting the survey had to be further developed in order to meet the overarching goal of harmonizing the health information from national statistical offices and public health research institutes across the European Union. The harmonized EHIS 2 data source will profoundly impact international public health research in the near future. The next EHIS wave 3 will be conducted around 2019.
Gesundheitsschädlicher Alkoholkonsum wird als mitverursachend für über 200 Krankheiten angesehen. Rauschtrinken ist ein besonders riskantes Trinkmuster, welches akute Schäden wie Alkoholvergiftung und Verletzungen sowie Gewalt verursachen kann. In GEDA 2014/2015-EHIS wird als Rauschtrinken der mindestens monatliche Konsum von sechs oder mehr alkoholischen Getränken bei einer Gelegenheit definiert. 24,9 % der Frauen und 42,6 % der Männer praktizieren mindestens einmal im Monat Rauschtrinken. Bei den 18- bis 29-Jährigen ist das regelmäßige Rauschtrinken am stärksten verbreitet. Bei Frauen (alle Altersklassen) und Männern (ab 45 Jahren) aus der oberen Bildungsgruppe ist der Anteil der Rauschtrinkerinnen und -trinker niedriger als in den unteren Bildungsgruppen. Zur Prävention eines gesundheitsschädlichen Alkoholkonsums sind verhältnis- und verhaltenspräventive Maßnahmen notwendig, bei denen junge Erwachsene sowie die unterschiedlichen Konsummuster in den Bildungsgruppen im Fokus stehen sollten.
Gesundheitsschädlicher Alkoholkonsum wird als mitverursachend für über 200 Krankheiten angesehen. Die Grenzwerte für riskante Alkoholtrinkmengen liegen bei mehr als 10 g pro Tag für Frauen und 20 g für Männer. Nach den Daten von GEDA 2014/2015-EHIS weisen 13,8 % der Frauen und 18,2 % der Männer einen mindestens wöchentlichen riskanten Alkoholkonsum auf. Bei den 45- bis 64-Jährigen ist riskanter Alkoholkonsum am stärksten verbreitet. Frauen der oberen Bildungsgruppe weisen in allen Altersgruppen höhere Prävalenzen riskanten Alkoholkonsums auf als Frauen aus unteren Bildungsgruppen, bei Männern trifft dies lediglich auf die 65-Jährigen und Älteren zu. Durch verhältnispräventive Maßnahmen und das öffentliche Eintreten für einen verantwortungsvollen Umgang mit Alkohol sollte der riskante Alkoholkonsum in der Bevölkerung weiter reduziert werden.
Rauchen ist ein bedeutendes Gesundheitsrisiko und die führende Ursache vorzeitiger Sterblichkeit. In Deutschland wurden zahlreiche Maßnahmen (z. B. Steuererhöhungen, Nichtraucherschutz und Warnhinweise) auf den Weg gebracht, um den Tabakkonsum der Bevölkerung zu senken. Nach GEDA 2014/2015-EHIS rauchen 20,8 % der Frauen und 27,0 % der Männer ab 18 Jahren zumindest gelegentlich. Bei beiden Geschlechtern ist der Anteil der aktuell Rauchenden in den jüngeren Altersgruppen am höchsten. Das Rauchen ist in höheren Bildungsgruppen bei Frauen und Männern deutlich seltener verbreitet als in niedrigen Bildungsgruppen. Seit 2003 ist der Anteil der Raucherinnen und Raucher in der Erwachsenenbevölkerung gesunken. Trotz beachtlicher Fortschritte besteht in Deutschland hinsichtlich der Tabakpräventionspolitik – auch im europäischen Vergleich – in vielen Bereichen (z.B. Werbeverbote und Besteuerung) noch deutliches Verbesserungspotenzial.
Objective To examine and quantify the potential dose-response relation between fruit and vegetable consumption and risk of all cause, cardiovascular, and cancer mortality.
Data sources Medline, Embase, and the Cochrane library searched up to 30 August 2013 without language restrictions. Reference lists of retrieved articles.
Study selection Prospective cohort studies that reported risk estimates for all cause, cardiovascular, and cancer mortality by levels of fruit and vegetable consumption.
Data synthesis Random effects models were used to calculate pooled hazard ratios and 95% confidence intervals and to incorporate variation between studies. The linear and non-linear dose-response relations were evaluated with data from categories of fruit and vegetable consumption in each study.
Results Sixteen prospective cohort studies were eligible in this meta-analysis. During follow-up periods ranging from 4.6 to 26 years there were 56 423 deaths (11 512 from cardiovascular disease and 16 817 from cancer) among 833 234 participants. Higher consumption of fruit and vegetables was significantly associated with a lower risk of all cause mortality. Pooled hazard ratios of all cause mortality were 0.95 (95% confidence interval 0.92 to 0.98) for an increment of one serving a day of fruit and vegetables (P=0.001), 0.94 (0.90 to 0.98) for fruit (P=0.002), and 0.95 (0.92 to 0.99) for vegetables (P=0.006). There was a threshold around five servings of fruit and vegetables a day, after which the risk of all cause mortality did not reduce further. A significant inverse association was observed for cardiovascular mortality (hazard ratio for each additional serving a day of fruit and vegetables 0.96, 95% confidence interval 0.92 to 0.99), while higher consumption of fruit and vegetables was not appreciably associated with risk of cancer mortality.
Conclusions This meta-analysis provides further evidence that a higher consumption of fruit and vegetables is associated with a lower risk of all cause mortality, particularly cardiovascular mortality.
Im Verlauf des 20. Jahrhunderts war in Deutschland, wie in den meisten anderen modernen Gesellschaften, ein deutlicher Anstieg der durchschnittlichen Lebenserwartung zu verzeichnen. Innerhalb der letzten vierzig Jahre stieg beispielsweise die vom Statistischen Bundesamt ausgewiesene Lebenserwartung bei Geburt in Deutschland (West) sowohl für Männer als auch für Frauen um mehr als 8 Jahre an (Statistisches Bundesamt 2004). Während der Anstieg der Lebenserwartung zu Beginn des Jahrhunderts vor allem auf einen starken Rückgang der Säuglingssterblichkeit zurückzuführen war, sind in den letzten Jahrzehnten zunehmend bessere Überlebenschancen im mittleren und hohen Alter für die Zunahme der Lebenserwartung mitverantwortlich. In geringerem Umfang als die Lebenserwartung bei Geburt nahm damit auch die verbleibende Restlebenserwartung von Erwachsenen und betagten Menschen zu. So stieg beispielsweise die amtlich ermittelte Restlebenserwartung eines 65-jährigen Mannes im Zeitraum von 1960 bis 2000 um mehr als 3 Jahre an, die einer 65-jährigen Frau im gleichen Zeitraum um fast 5 Jahre (Statistisches Bundesamt 2004).
Hintergrund
Soziale Unterschiede im Gesundheitsverhalten von Jugendlichen lenken den Blick auf unzureichend ausgeschöpfte Präventions- und Gesundheitsförderungspotenziale. Untersucht wird die Bedeutung der elterlichen Bildung, des eigenen Bildungsstatus sowie der intergenerationalen Bildungsmobilität im Hinblick auf gesundheitsrelevante Verhaltensweisen im Jugendalter.
Material und Methoden
Die Datenbasis bildet eine Substichprobe des Kinder- und Jugendgesundheitssurveys (KiGGS; Alter=14–17 Jahre; n=3737). Berechnet werden geschlechtsspezifische Prävalenzen sowie binär logistische Regressionen für die 6 Verhaltensindikatoren Rauchen, Body-Mass-Index, körperlich-sportliche Inaktivität, übermäßige Nutzung elektronischer Medien, regelmäßiger Alkoholkonsum und täglicher Verzehr von frischem Obst und Gemüse.
Ergebnisse
Unabhängig von ihrer sozialen Herkunft verhalten sich Jungen und Mädchen an Gymnasien deutlich gesundheitsbewusster als ihre Altersgenossen an anderen Schulformen. Signifikante Unterschiede finden sich bei 4 von 6 (Jungen) bzw. bei 5 von 6 Verhaltensindikatoren (Mädchen). Der Bildungsstatus der Eltern weist lediglich bei Mädchen bei vier von sechs Verhaltensindikatoren einen eigenständigen, signifikanten Effekt auf.
Schlussfolgerung
Neben Jugendlichen mit konstant hohem Bildungsstatus zeichnen sich insbesondere potenzielle Bildungsaufsteigerinnen und -aufsteiger durch ein gesundheitsförderliches Verhalten aus. Auch aus Public-Health-Sicht unterstreichen die Ergebnisse somit die Forderung nach Bildungsinvestitionen und Chancengleichheit im Bildungssystem.
Comparisons among countries can help to identify opportunities for the reduction of inequalities in health. We compared the magnitude of inequalities in mortality and self-assessed health among 22 countries in all parts of Europe.
We obtained data on mortality according to education level and occupational class from census-based mortality studies. Deaths were classified according to cause, including common causes, such as cardiovascular disease and cancer; causes related to smoking; causes related to alcohol use; and causes amenable to medical intervention, such as tuberculosis and hypertension. Data on self-assessed health, smoking, and obesity according to education and income were obtained from health or multipurpose surveys. For each country, the association between socioeconomic status and health outcomes was measured with the use of regression-based inequality indexes.
In almost all countries, the rates of death and poorer self-assessments of health were substantially higher in groups of lower socioeconomic status, but the magnitude of the inequalities between groups of higher and lower socioeconomic status was much larger in some countries than in others. Inequalities in mortality were small in some southern European countries and very large in most countries in the eastern and Baltic regions. These variations among countries appeared to be attributable in part to causes of death related to smoking or alcohol use or amenable to medical intervention. The magnitude of inequalities in self-assessed health also varied substantially among countries, but in a different pattern.
We observed variation across Europe in the magnitude of inequalities in health associated with socioeconomic status. These inequalities might be reduced by improving educational opportunities, income distribution, health-related behavior, or access to health care.
Social determinants of health, such as inadequate education, contribute greatly to mortality rates. We examined whether correcting the social conditions that account for excess deaths among individuals with inadequate education might save more lives than medical advances (e.g., new drugs and devices).
Using US vital statistics data for 1996 through 2002, we applied indirect standardization techniques to estimate the maximum number of averted deaths attributable to medical advances and the number of deaths that would have been averted if mortality rates among adults with lesser education had been the same as those among college-educated adults.
Medical advances averted a maximum of 178193 deaths during the study period. Correcting disparities in education-associated mortality rates would have saved 1369335 lives during the same period, a ratio of 8:1.
Higher mortality rates among individuals with inadequate education reflect a complex causal pathway and the influence of confounding variables. Formidable efforts at social change would be necessary to eliminate disparities, but the changes would save more lives than would society's current heavy investment in medical advances. Spending large sums of money on such advances at the expense of social change may be jeopardizing public health.
The emphasis on risk factor intervention at the individual level has predominated in efforts to reduce mortality and promote health. Interest in social and other nonmedical interventions, particularly socioeconomic status (SES) influences, has increased in recent years. This article focuses on the interaction of social structure and socioeconomic status with other influences in complex pathways to affect health, and their contribution to health disparities. It examines both social class as an explanation of health differences and competing hypotheses concerning prenatal and early nutrition and cognitive capacity. Although education is associated with income, wealth, occupation, and other SES indicators and may not be the most important SES determinant, it influences a variety of pathways to health outcomes and offers strategic leverage for intervention because of social and political consensus on its value beyond health.
There is a large and persistent association between education and health. In this paper, we review what is known about this link. We first document the facts about the relationship between education and health. The education %u2018gradient%u2019 is found for both health behaviors and health status, though the former does not fully explain the latter. The effect of education increases with increasing years of education, with no evidence of a sheepskin effect. Nor are there differences between blacks and whites, or men and women. Gradients in behavior are biggest at young ages, and decline after age 50 or 60. We then consider differing reasons why education might be related to health. The obvious economic explanations %u2013 education is related to income or occupational choice %u2013 explain only a part of the education effect. We suggest that increasing levels of education lead to different thinking and decision-making patterns. The monetary value of the return to education in terms of health is perhaps half of the return to education on earnings, so policies that impact educational attainment could have a large effect on population health.
Bisherige Diskussionen zu den Erträgen von Bildung konzentrieren sich vor allem auf monetäre Bildungserträge im Lebensverlauf, die z.B. am Einkommen oder beruflichen Fortkommen festgemacht werden. Nicht-monetäre Erträge von Bildung werden hingegen nur selten systematisch beachtet und stellen den Gegenstand des hier vorgestellten Verbundprojektes "Erträge von Bildung für das Wohlbefinden von Eltern, Kindern, Jugendlichen und jungen Erwachsenen" dar. Auf Grundlage dreier repräsentativer Längsschnittstudien, AID:A, BELLA und pairfam, werden Veränderungen im Wohlbefinden an drei zentralen Übergängen im Lebensverlauf betrachtet und auf Einflüsse familiärer Bildungsressourcen sowie eigener Bildungsverläufe zurückgeführt. Ziel des Artikels ist es, einen inhaltlichen und theoretischen Rahmen aufzuspannen und Potenziale und Herausforderungen im Zusammenhang mit den im Verbundprojekt verfolgten Fragestellungen für Wissenschaft und Praxis darzustellen.
Background:
Social inequalities in health can already be found among children and adolescents to the disadvantage of socially deprived population groups. This paper aims to detect, whether differences in subjective health, mental health and health behavior among young people are due to the secondary school type attended and whether these associations exist independently of the family's socioeconomic position (SEP).
Methods:
The data basis was the German Health Interview and Examination Survey for Children and Adolescents (KiGGS Wave 1, 2009-2012). Data of 11- to 17-year-old girls and boys (n = 4665) who attend different types of secondary schools in Germany were analyzed. The dependent variables were self-rated health, findings of the Strengths and Difficulties Questionnaire (SDQ) for the detection of psychological abnormalities, as well as self-reported information regarding leisure sport, tobacco, and alcohol consumption. Prevalence and odds ratios (ORs) based on logistic regressions are shown.
Results:
For the majority of the examined indicators, it can be shown that adolescents in lower secondary schools are more likely to report worse self-rated health and mental problems and engage in unhealthy behavior than peers in grammar schools ("Gymnasium"). The differences decrease after controlling for family's SEP but mostly remain statistically significant. Adolescents who don't attend grammar schools are most strongly disadvantaged in terms of inattention/hyperactivity for both gender (OR: 2.29 [1.70-3.08]), smoking among girls (2.91 [1.85-4.57]) and physical inactivity (no leisure sport) among boys (OR: 2.71 [1.85-3.95]).
Discussion:
Unequal health opportunities should be viewed in relation to people's living conditions. For adolescents, school constitutes an important setting for learning, experience, and health. The results indicate divergent needs of school-based health promotion and prevention regarding differences among gender and type of school.
Introduction Tobacco use accounts for about 5 million annual premature deaths worldwide. Tobacco thus is the single most important preventable health risk. In this paper we present a recalculation of tobacco-attributable mortality in Germany, and examine gender and regional differences. Data and Methods The calculation is based on the prevalence of current and former smokers, the relative mortality risks for diseases for which tobacco use is associated with an increased mortality risk, and the number of deaths by ICD-10 diagnoses. For the first time, colorectal and liver cancer as well as type 2 diabetes and tuberculosis were taken into consideration. Results In 2013, 121 087 deaths were attributable to smoking (i. e. 13.5% of all deaths), including 84 782 deaths in men and 36 305 deaths in women. The tobacco-attributable mortality rate was higher in men than in women, and in terms of regional discrepancies a north-south-gradient was observed. Conclusion The number of tobacco-attributable deaths is substantial and higher than previously predicted. Compared to 2007, numbers have increased in absolute terms, whereas in relative terms the tobacco-attributable mortality rate declined. Given processes of demographic aging, a continued rise in absolute numbers of tobacco-attributable mortality is to be expected in the future.
© Georg Thieme Verlag KG Stuttgart · New York.
Menschen mit geringem Bildungsstatus sind wahrscheinlicher von Krankheiten betroffen als Menschen mit hohem Bildungsabschluss. Dieser Zusammenhang ist darauf zurückzuführen, dass die Chancen auf gesellschaftliche Teilhabe und die Verfügbarkeit gesundheitsbezogener Ressourcen mit der Qualität des Bildungsabschlusses sinken. Um diesen Kreislauf zu durchbrechen, sollten in formellen und informellen Bildungskontexten Lernprozesse angeregt werden, durch die Wissen über Gesundheit, ein kompetenter Umgang mit Stressoren, die persönliche Eingebundenheit in positive Sozialbeziehungen sowie gesundheitsrelevante Verhaltensgewohnheiten und Einstellungen gefördert werden.
OBJECTIVE: There are many studies on health inequalities, but these are rarely combined with cost-of-illness analyses. If the cost-of-illness were to be calculated for the individual status groups, it would be possible to assess the economic potential of preventive measures aimed specifically at people from low status groups. The objective of this article is to demonstrate for the first time the preventive potential by taking the example of diabetes mellitus (DM) from an economic perspective.
METHODS: Based on a systematic literature review, the average direct costs per patient with DM were assessed. Then, the prevalence of DM among adults with different educational levels was estimated based on the nationwide survey 'German Health Update' (GEDA), conducted by the Robert Koch-Institute in Germany in 2009. Finally, the cost and prevalence data were used to calculate the direct costs for each educational level.
RESULTS: The direct costs of DM amount to about 13.1 billion € per year; about 35% of these costs can be attributed to patients with a low educational level. Thus, their share of the total costs is about 67% higher than their share of the total population. If the prevalence in the group with 'low educational level' (14.8%) could be reduced to the prevalence in the group with 'middle educational level' (7.9%), this would save about 2.2 billion (about 16.5%) € of direct costs.
DISCUSSION: The analysis provides a first estimate of the potential savings from an effective status specific prevention programme. However, the direct costs per patient used were only an average for all people with DM, as a breakdown by educational level was not available. Since education can also affect health behaviour and compliance, which are also determinants of cost, the analyses presented here are probably conservative.
Education has a large and increasing impact on health in America. This paper examines one reason why. Education gives individuals the ability to override the default American lifestyle. The default lifestyle has three elements: displacing human energy with mechanical energy, displacing household food production with industrial food production, and displacing health maintenance with medical dependency. Too little physical activity and too much food produce imperceptibly accumulating pathologies. The medical industry looks for products and services that promise to soften the consequences but do not eliminate the underlying pathologies. This "secondary prevention" creates pharmacologic accumulation: prolonging the use of medications, layering them, and accruing their side effects and interactions. Staying healthy depends on recognizing the risks of the default lifestyle. Overriding it requires insight, knowledge, critical analysis, long-range strategic thinking, personal agency, and self-direction. Education develops that ability directly and indirectly, by way of creative work and a sense of controlling one's own life.
© American Sociological Association 2015.
In today's information society, health literacy (HL) is considered important for health maintenance and disease management. In this context, dealing with health information is fundamental and requires different cognitive and social skills.
The aim of this study was to investigate the distribution of HL levels in the adult population of Germany, and to identify associations with health behaviours and health status.
The analyses were based on data from the German Health Update (GEDA) study, a cross-sectional survey of the German-speaking adult population of Germany, which was conducted from October 2013 to June 2014. Health literacy was assessed with the short form of the European Health Literacy Questionnaire (HLS-EU-Q16), along with questions about socio-demographics, health behaviours, and health status. The HLS-EU-Q16 index could be calculated for 4,845 respondents.
According to the criteria of the HLS-EU-Q16, more than half of the adults had "adequate" HL (55.8%). Every third person (31.9%) had "problematic" and almost every eighth person (12.3%) had "inadequate" HL. We found significant differences in HL by educational level, but no differences in HL by sex and age group. Certain health behaviours were positively associated with health literacy. A low HL level was associated with poorer physical and mental health.
The results point to a need for action to improve HL in the adult population. The strengthening of health literacy should not solely aim at the promotion of individual skills, but also give high priority to the development of health-literate settings.
The German Health Update (GEDA) study is one component of the recently established nationwide health monitoring system administered by the Robert Koch Institute. The repeated cross-sectional GEDA surveys aim to provide current data on health and disease, health determinants and time trends in health and morbidity in the adult population in Germany. This forms the basis for planning requirements and recommendations for public health policy. Between 2008 and 2013, three GEDA waves were carried out, involving a total of 62 606 computer-assisted telephone interviews with adults in Germany, living in private household, and reachable via landline. A core set of indicators was used in all GEDA waves to gather information on subjective health and health-related quality of life, chronic diseases, injuries, impairment to health and disabilities, mental health, health behaviours, social determinants, use of health services and socio-demographic characteristics. The data from the GEDA surveys are provided for public use and epidemiological research. After submitting an application form, the data are accessible from: [http://www.rki.de/EN/Content/Health_Monitoring/Public_Use_Files/public_use_file_node.htm].
© The Author 2015; all rights reserved. Published by Oxford University Press on behalf of the International Epidemiological Association.
The positive association between education and health is well established, but explanations for this association are not. Our explanations fall into three categories: (1) work and economic conditions, (2) social-psychological resources, and (3) health lifestyle. We replicate analyses with two samples, cross-sectionally and over time, using two health measures (self-reported health and physical functioning). The first data set comes from a national probability sample of U.S. households in which respondents were interviewed by telephone in 1990 (2,031 respondents, ages 18 to 90). The second data set comes from a national probability sample of U.S. households in which respondents ages 20 to 64 were interviewed by telephone first in 1979 (3,025 respondents), and then again in 1980 (2,436 respondents). Results demonstrate a positive association between education and health and help explain why the association exists. (1) Compared to the poorly educated, well educated respondents are less likely to be unemployed, are more likely to work full-time, to have fulfilling, subjectively rewarding jobs, high incomes, and low economic hardship. Full-time work, fulfilling work, high income, and low economic hardship in turn significantly improve health in all analyses. (2) The well educated report a greater sense of control over their lives and their health, and they have higher levels of social support. The sense of control, and to a lesser extent support, are associated with good health. (3) The well educated are less likely to smoke, are more likely to exercise, to get health check-ups, and to drink moderately, all of which, except check-ups, are associated with good health. We conclude that high educational attainment improves health directly, and it improves health indirectly through work and economic conditions, social-psychological resources, and health lifestyle.
Objective:
There are many studies on health inequalities, but these are rarely combined with cost-of-illness analyses. If the cost-of-illness were to be calculated for the individual status groups, it would be possible to assess the economic potential of preventive measures aimed specifically at people from low status groups. The objective of this article is to demonstrate for the first time the preventive potential by taking the example of diabetes mellitus (DM) from an economic perspective.
Methods:
Based on a systematic literature review, the average direct costs per patient with DM were assessed. Then, the prevalence of DM among adults with different educational levels was estimated based on the nationwide survey 'German Health Update' (GEDA), conducted by the Robert Koch-Institute in Germany in 2009. Finally, the cost and prevalence data were used to calculate the direct costs for each educational level.
Results:
The direct costs of DM amount to about 13.1 billion € per year; about 35% of these costs can be attributed to patients with a low educational level. Thus, their share of the total costs is about 67% higher than their share of the total population. If the prevalence in the group with 'low educational level' (14.8%) could be reduced to the prevalence in the group with 'middle educational level' (7.9%), this would save about 2.2 billion (about 16.5%) € of direct costs.
Discussion:
The analysis provides a first estimate of the potential savings from an effective status specific prevention programme. However, the direct costs per patient used were only an average for all people with DM, as a breakdown by educational level was not available. Since education can also affect health behaviour and compliance, which are also determinants of cost, the analyses presented here are probably conservative.
Educational attainment is a well-established social determinant of health. It affects health through many mechanisms such as neural development, biological aging, health literacy and health behaviors, sense of control and empowerment, and life chances. Education-from preschool to beyond college-is also one of the social determinants of health for which there are clear policy pathways for intervention. We reviewed evidence from studies of early childhood, kindergarten through 12th grade, and higher education to identify which components of educational policies and programs are essential for good health outcomes. We have discussed implications for public health interventions and health equity. (Am J Public Health. Published online ahead of print April 18, 2013: e1-e5. doi:10.2105/AJPH.2012.300993).
Aim
Socio-economic status is associated with a variety of health-related behaviours. In our study, we determined the independent effects of income, educational attainment and occupational status on overweight, smoking and physical activity in the German population.
Subjects and methods
The German National Health Interview and Examination Survey is a representative sample of the German adult population and includes 7,124 men and women. Prevalences of obesity, smoking and physical inactivity stratified for education, income and occupational status were calculated. Multiple logistic regression models were used to estimate the odds ratios (OR) and 95% confidence intervals (CI) for education, income, occupational status and health-related behaviour, adjusted for age and gender.
Results
Health risk behaviours were more prevalent in subjects with lower education, income or occupational status. After mutual adjustment, education, income and occupation were independently associated with physical inactivity. Low education was strongly associated with both obesity (OR: 2.58, 95% CI: 1.99–3.34) and smoking (OR: 2.09, 95% CI: 1.71–2.54). Low income was associated with smoking (OR: 1.40, 95% CI: 1.07–1.83), but not with obesity, and low occupational status was associated with obesity (OR: 1.42, 95% CI: 1.05–1.92), but not with smoking. High income or occupation could not compensate for the impact of low education on obesity and smoking.
Conclusion
Low socio-economic status is associated with health risk behaviours. Concerning obesity and smoking, education was more important than income or occupational status. Public health programmes to reduce these risk factors should focus on early-life health education.
Numerous economic studies have shown a strong positive correlation between health and years of schooling. The question at the centre of this research is whether the correlation between health and education represents a causal relation. This paper uses changes in compulsory schooling laws in the United Kingdom to test this hypothesis. Multiple measures of overall health are used. The results provide evidence of a causal relation running from more schooling to better health which is much larger than standard regression estimates suggest.
Bildung gehört sowohl in wohlhabenden und modernen Gesellschaften als auch in den Entwicklungs- und Schwellenländern dieser
Welt zu den wichtigsten sozialen Determinanten von Morbidität und Mortalität. Bereits in der berühmten Ottawa Charta von 1986
betonte die Weltgesundheitsorganisation (WHO) die Bedeutung der Bildung als eine von neun grundlegenden Bedingungen und konstituierenden
Momenten von Gesundheit (WHO 1986: 5). Der britische Epidemiologe Geoffrey Rose bezeichnet in seinem renommierten Werk „The
strategy of preventive medicine“ Bildung als fundamentalen Wegbereiter von Gesundheit („foremost enabler of health“) (Rose
1995: 122). In dem 1998 erschienenen ersten Gesundheitsbericht für Deutschland heißt es: „Unter den drei wichtigsten Merkmalen
zur Charakterisierung der sozialen Stellung einer Person – Einkommen, Bildung und Beruf – kommt dem Bildungsstatus bei gesundheitsbezogenen
Untersuchungen ein besonderes Gewicht zu“ (Statistisches Bundesamt 1998: 108).
I exploit exogenous variation in the likelihood to obtain any sort of educational qualification between January- and February-born individuals for 13 academic cohorts in England. For these cohorts compulsory schooling laws interacted with the timing of the CSE and O-level exams to change the probability of obtaining a qualification by around 2-3 percentage points. I then use data on individuals born in these two months from the British Labour Force Survey and the Health Survey for England to investigate the effects of education on health using being February-born as an instrument for education. The results indicate neither an effect of education on various health related measures nor an effect on health related behaviour, e.g., smoking, drinking or eating various types of food.
Socioeconomic status (SES) underlies three major determinants of health: health care, environmental exposure, and health behavior. In addition, chronic stress associated with lower SES may also increase morbidity and mortality. Reducing SES disparities in health will require policy initiatives addressing the components of socioeconomic status (income, education, and occupation) as well as the pathways by which these affect health. Lessons for U.S. policy approaches are taken from the Acheson Commission in England, which was charged with reducing health disparities in that country.
The association of poor education and poor health has been consistently observed in many studies and in various countries. Thus far, studies examining the mechanisms underlying this association have looked at only a limited set of potential pathways. This study simultaneously examines six distinctive pathways, which have been hypothesized to link education and health and found support from previous studies. A causal analysis of education and health was performed using structural equation models. Data were used from six phases of the National Child Development Study, which is based on following up an initial sample of 17416 children who were born in 1958. The association between education and health appears to be explained by a combination of mechanisms: adolescent health and adult health behaviours for men and women, adult social class among men and parental social class among women. We conclude that improvements in population educational attainment may not automatically lead to improvements in population health, and that health policies for improving health and reducing health inequalities need to target specific causal pathways. Copyright 2006 Royal Statistical Society.
12-Monats-Prävalenz einer koronaren Herzkrankheit in Deutschland
- M A Busch
- R Kuhnert
- MA Busch
Internationale Standardklassifikation für das Bildungswesen (ISCED)
- Eurostat
Gesundheitsbedingte Einschränkungen bei alltäglichen Aktivitäten in Deutschland
- Lippe E Von Der
- A Fehr
- C Lange
Hrsg) (2012) Alcohol in the European Union. Consumption, harm and policy approaches. World Health Organization Regional Office for Europe
- P Anderson
- L Moller
- G Galea
Gesundheitsfördernde körperliche Aktivität in der Freizeit bei Erwachsenen in Deutschland
- J D Finger
- Gbm Mensink
- C Lange
- JD Finger
Health inequalities: Europe in profile. An independent, expert report commissioned by the UK Presidency of the EU
- J P Mackenbach
Gesundheit in Deutschland aktuell“ - Neue Daten für Deutschland und Europa. Hintergrund und Studienmethodik von GEDA 2014/2015-EHIS
- A C Saß
- C Lange
- J D Finger
- AC Saß
Social determinants of health: the solid facts, 2. Aufl. World Health Organization Regional Office for Europe
- R G Wilkinson
- M G Marmot
- RG Wilkinson
12-Monats-Prävalenz des bekannten Diabetes mellitus in Deutschland
- C Heidemann
- R Kuhnert
- S Born
Ergebnisse der Studie „Gesundheit in Deutschland aktuell“ (GEDA)
- S Jordan
- J Hoebel
12-Monats-Prävalenz von Bluthochdruck in Deutschland
- H Neuhauser
- R Kuhnert
- S Born
Fragebogen zur Studie „Gesundheit in Deutschland aktuell“: GEDA 2014/2015-EHIS
- Robert Koch-Institut