BACKGROUND: Health inequities exist within and between societies at different hierarchical levels. Despite overall improvements in health status in European Union countries, disparities persist among socially, economically, and societally disadvantaged individuals. This study aims to develop a holistic model of health determinants, examining the complex relationship between various determinants of health inequalities and their association with health condition. METHODS: Health inequalities and conditions were assessed at the territorial level of Local Administrative Units (LAU1) in the Czech Republic. A dataset of 57 indicators was created, categorized into seven determinants of health and one health condition category. The necessary data were obtained from publicly available databases. Comparisons were made between 2001-2003 and 2016-2019. Various methods were employed, including composite indicator creation, correlation analysis, the Wilcoxon test, aggregate index calculation, cluster analysis, and data visualization using the LISA method. RESULTS: The correlation matrix revealed strong relationships between health inequality categories in both periods. The most significant associations were observed between Economic status and social protection and Education in the first period. However, dependencies weakened in the later period, approaching values of approximately 0.50. The Wilcoxon test confirmed variations in determinant values over time, except for three specific determinants. Data visualization identified persistently adverse or worsening health inequalities in specific LAU1, focusing on categories such as Economic status and social protection, Education, Demographic situation, Environmental status, Individual living status, and Road safety and crime. The health condition indices showed no significant change over time, while the aggregate index of health inequalities improved with widened differences. CONCLUSION: Spatial inequalities in health persist in the Czech Republic, influenced by economic, social, demographic, and environmental factors, as well as local healthcare accessibility. Both inner and outer peripheries exhibit poor health outcomes, challenging the assumption that urban areas fare better. The combination of poverty and vulnerabilities exacerbates these inequalities. Despite the low rates of social exclusion and poverty, regional health inequalities persist in the long term. Effectively addressing health inequalities requires interdisciplinary collaboration and evidence-based policy interventions. Efforts should focus on creating supportive social and physical environments, strengthening the healthcare system, and fostering cooperation with non-medical disciplines.

• Klíčová slova
• Determinants of health, Health promotion and prevention, Healthcare system optimization, Regional disparities in health, Spatial differentiation of health,
• MeSH
• disparity zdravotního stavu * MeSH
• lidé MeSH
• veřejná politika MeSH
• zdravotní nespravedlnost MeSH
• zdravotní politika * MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Geografické názvy
• Česká republika MeSH

We use harmonized household panel data from Europe and the US and a three-state survival model to provide comparable measurements of education and gender inequalities in total, healthy, and unhealthy life expectancies at age 50. Common across countries, the education advantage in total life expectancy is larger for males but the education advantage in (fewer) unhealthy years is larger for females. Counterfactual decompositions show that these results arise because the education advantage in conditional survival rates is relatively more important for males, while the education advantage in better health transitions is relatively more important for females. Across countries, the US stands out with the largest education gradient in healthy life expectancy.

• Klíčová slova
• LIFE expectancy, education, gender, healthy life expectancy, inequality,
• MeSH
• disparity zdravotního stavu MeSH
• lidé středního věku MeSH
• lidé MeSH
• naděje dožití * MeSH
• stupeň vzdělání MeSH
• zdravotní stav * MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Geografické názvy
• Evropa MeSH

The prevalence of inequalities in the general health position of communities can be assessed by using selected determinants. The aims of this article are three-fold: (1) to apply a comprehensive approach to the assessment of inequalities in the general health position of communities, (2) to determine the spatial differentiation of determinants, and (3) to present selected assessment methods and their impact on the results. To present a quantitative assessment of these inequalities in health status in communities, a composite indicator (Health Index) was developed. This Health Index is composed of 8 areas of evaluation and 60 indicators which include, amongst others, determinants of health status and healthcare at district level (LAU 1) in the Czech Republic. The data are evaluated using multicriteria decision-making methods (the WSA and TOPSIS methods). Findings suggest that, when all eight domains are assigned the same weight of one, the spatial differentiation among the districts is similar when using both methods. If different weightings are assigned to the districts, changes occur in both the index values and the rankings of the analyzed districts. For example, the allocation of weightings in both methods results in a rearrangement of the ranking of districts for which the Health Index is around the average.

• Klíčová slova
• composite indicator, districts of the Czech Republic, health determinants and indicators, inequalities in health,
• MeSH
• poskytování zdravotní péče * MeSH
• socioekonomické faktory MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Geografické názvy
• Česká republika epidemiologie   MeSH

The Roma are the most populous marginalised community in Europe and have some of the greatest health needs. There is a higher prevalence of communicable and non-communicable diseases within the community and significantly shorter life expectancies than national averages. Efforts by governments across Europe to address these health inequalities have been relatively weak and the Roma suffer poorer access to health care, education and employment in every country that they inhabit in comparison to the majority population. As the socioeconomic determinants of health become better understood over the past decade, it is becoming clear that societies with greater inequalities are less healthy overall. It is important for public health across Central and Eastern Europe that the health needs of the Roma are prioritised by governments concerned. We provide a review of the literature on the health inequalities of the Roma community in Europe.

• MeSH
• chudoba MeSH
• disparity zdravotní péče * MeSH
• disparity zdravotního stavu * MeSH
• dostupnost zdravotnických služeb MeSH
• lidé MeSH
• předsudek MeSH
• Romové * psychologie   statistika a číselné údaje   MeSH
• socioekonomické faktory MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH
• Geografické názvy
• Evropa MeSH

Unfavorable health trends among the lowly educated have recently been reported from the United States. We analyzed health trends by education in European countries, paying particular attention to the possibility of recent trend interruptions, including interruptions related to the impact of the 2008 financial crisis. We collected and harmonized data on mortality from ca 1980 to ca 2014 for 17 countries covering 9.8 million deaths and data on self-reported morbidity from ca 2002 to ca 2014 for 27 countries covering 350,000 survey respondents. We used interrupted time-series analyses to study changes over time and country-fixed effects analyses to study the impact of crisis-related economic conditions on health outcomes. Recent trends were more favorable than in previous decades, particularly in Eastern Europe, where mortality started to decline among lowly educated men and where the decline in less-than-good self-assessed health accelerated, resulting in some narrowing of health inequalities. In Western Europe, mortality has continued to decline among the lowly and highly educated, and although the decline of less-than-good self-assessed health slowed in countries severely hit by the financial crisis, this affected lowly and highly educated equally. Crisis-related economic conditions were not associated with widening health inequalities. Our results show that the unfavorable trends observed in the United States are not found in Europe. There has also been no discernible short-term impact of the crisis on health inequalities at the population level. Both findings suggest that European countries have been successful in avoiding an aggravation of health inequalities.

• Klíčová slova
• Europe, financial crisis, health inequalities, morbidity, mortality,
• MeSH
• analýza přerušované časové série statistika a číselné údaje   MeSH
• disparity zdravotní péče ekonomika   statistika a číselné údaje   MeSH
• disparity zdravotního stavu MeSH
• dospělí MeSH
• ekonomická recese statistika a číselné údaje   MeSH
• lidé středního věku MeSH
• lidé MeSH
• sebezhodnocení (psychologie) MeSH
• senioři MeSH
• socioekonomické faktory MeSH
• zpráva o sobě MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Geografické názvy
• Evropa MeSH

The existence of geographic differences in health resources, health expenditures, the utilization of health services, and health outcomes have been documented by a lot of studies from various countries of the world. In a publicly financed health system, equal access is one of the main objectives of the national health policy. That is why inequalities in the geographic allocation of health resources are an important health policy issue. Measures of inequality express the complexity of variation in the observed variable by a single number, and there is a variety of inequality measures available. The objective of this study is to develop a measure of the geographic inequality in the case of multiple health resources. The measure uses data envelopment analysis (DEA), which is a non-parametric method of production function estimation, to transform multiple resources into a single virtual health resource. The study shows that the DEA originally developed for measuring efficiency can be used successfully to measure inequality. For the illustrative purpose, the inequality measure is calculated for the Czech Republic. The values of separate Robin Hood Indexes (RHIs) are 6.64% for physicians and 3.96% for nurses. In the next step, we use combined RHI for both health resources. Its value 5.06% takes into account that the combinations of two health resources serve regional populations.

• Klíčová slova
• Czech Republic, data envelopment analysis, geographic inequality, health resources, resource allocation,
• Publikační typ
• časopisecké články MeSH

BACKGROUND: An analysis of the regional distribution of health resources is one of the tools for evaluating equal geographic access to health care. The usual analytical approach to an assessment of regional differences is to evaluate each health resource separately. This is a sensible approach, because there may be systematic reasons for any differences, for example, higher salaries in urban areas. However, a separate evaluation of the regional distribution of health resource capacities may be misleading. We should evaluate all health resource capacities as a whole and consider the substitutability of resources. OBJECTIVE: This study aims to measure regional inequalities in the Czech Republic with the help of alternative approaches to the evaluation of regional inequalities in the case of several substitutable health resources. METHODS: Five alternative evaluation methods (models) are described and applied: the separate evaluation, expert model, market model, common weights model, and production frontier model. RESULTS: The regional distribution of physicians and nurses in the Czech Republic in 2017 was evaluated. In spite of many regulations at the national and regional levels, we have found inequalities in regional resource distribution. The models that consider all health resources and the possibility of a resource substitution show lower inequalities between regional health resource capacities. CONCLUSION: Both researchers and policy-makers should always consider the possibility of resource substitutions in the assessment of regional inequalities.

• Klíčová slova
• Common weights model, Czech Republic, Data envelopment analysis, Inequality measures, Production frontier model, Regional inequality,
• MeSH
• lidé MeSH
• poskytování zdravotní péče * MeSH
• zdravotnické zdroje * MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Geografické názvy
• Česká republika MeSH

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.

• Klíčová slova
• Adolescence, Health inequalities, Multilevel analysis, Recession, Social spending,
• MeSH
• disparity zdravotního stavu * MeSH
• dítě MeSH
• duševní poruchy etiologie   MeSH
• duševní zdraví * MeSH
• ekonomická recese * MeSH
• lidé MeSH
• logistické modely MeSH
• mladiství MeSH
• mladý dospělý MeSH
• rodina MeSH
• sociální péče * MeSH
• socioekonomické faktory MeSH
• společenská třída MeSH
• veřejné zdravotnictví MeSH
• víceúrovňová analýza MeSH
• zdraví dítěte * MeSH
• zdraví dospívajících * MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Evropa epidemiologie   MeSH

AIM: A great amount of non-communicable disease deaths poses a threat for all people and therefore represents the challenge for health policy makers, health providers and other health or social policy actors. The aim of this study is to analyse regional differences in non-communicable disease mortality in the Slovak Republic, and to quantify the relationship between mortality and economic indicators of the Slovak regions. METHODS: Standardised mortality rates adjusted for age, sex, region, and period were calculated applying direct standardisation methods with the European standard population covering the time span from 2005 to 2013. The impact of income indicators on standardised mortality rates was calculated using the panel regression models. RESULTS: The Bratislava region reaches the lowest values of standardised mortality rate for non-communicable diseases for both sexes. On the other side, the Nitra region has the highest standardised mortality rate for non-communicable diseases. Income quintile ratio has the highest effect on mortality, however, the expected positive impact is not confirmed. Gini coefficient at the 0.001 significance level and social benefits at the 0.01 significance level look like the most influencing variables on the standardised mortality rate. By addition of one percentage point of Gini coefficient, mortality rate increases by 148.19 units. When a share of population receiving social benefits increases by one percentage point, the standardised mortality rate will increase by 22.36 units. CONCLUSIONS: Non-communicable disease mortality together with income inequalities among the regions of the Slovak Republic highlight the importance of economic impact on population health.

• Klíčová slova
• economic indicators, income inequality, non-communicable diseases, regional mortality,
• MeSH
• lidé MeSH
• neinfekční nemoci mortalita   MeSH
• příjem statistika a číselné údaje   MeSH
• sexuální faktory MeSH
• socioekonomické faktory MeSH
• věkové faktory MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Slovenská republika epidemiologie   MeSH

OBJECTIVES: The main aim of the article is to indicate how selected socioeconomic factors contribute to the selected characteristics of the subjectively perceived health of seniors 65+ living in the Czech Republic. METHODS: Data collection took place in the Czech Republic from 27 January 2020 to 14 February 2020. The total number of interviews carried out in the research was 1,172, from a representative quota sample of seniors from the senior population living in the Czech Republic. Questionnaires were distributed in the form of PAPI interviews. RESULTS: The assessment of subjective social status increases with education and employment (these three aspects are closely linked), and the assessment transferred to the senior years. CONCLUSION: The accumulation of advantages and disadvantages should encourage the Government of the Czech Republic, as well as other European states, to focus on those who, based on their low levels of education and social status, have very low assessments of their subjective health. Prevention (in both health and social fields), which includes access to information and the subsequent better life decisions, must be implemented throughout a person's lifetime (so as to reduce the disadvantages that accumulate from the cradle to the grave).

• Klíčová slova
• elderly, health, social exclusion, social status, socioeconomic inequalities,
• MeSH
• disparity zdravotního stavu MeSH
• lidé MeSH
• průzkumy a dotazníky MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• socioekonomické faktory * MeSH
• zdravotní stav MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Česká republika MeSH