The contribution of health policy and care to income differences in life expectancy – a register based cohort study

BACKGROUND Growing mortality differences between socioeconomic groups have been reported in both Finland and elsewhere. While health behaviours and other lifestyle factors are important in contributing to health differences, some researchers have suggested that some of the mortality differences attributable to lifestyle factors could be preventable by health policy measures and that health care may play a role. It has also been suggested that its role is increasing due to better results in disease prevention, improved diagnostic tools and treatment methods. This study aimed to assess the impact of mortality amenable to health policy and health care on increasing income disparities in life expectancy in 1996-2007 in Finland. METHODS The study data were based on an 11% random sample of Finnish residents in 1988-2007 obtained from individually linked cause of death and population registries and an oversample of deaths. We examined differences in life expectancy at age 35 (e35) in Finland. We calculated e35 for periods 1996-97 and 2006-07 by income decile and gender. Differences in life expectancies and change in them between the richest and the poorest deciles were decomposed by cause of death group. RESULTS Overall, the difference in e35 between the extreme income deciles was 11.6 years among men and 4.2 years among women in 2006-07. Together, mortality amenable to health policy and care and ischaemic heart disease mortality contributed up to two thirds to socioeconomic differences. Socioeconomic differences increased from 1996-97 by 3.4 years among men and 1.7 years among women. The main contributor to changes was mortality amenable through health policy measures, mainly alcohol related mortality, but also conditions amenable through health care, ischaemic heart disease among men and other diseases contributed to the increase of the differences. CONCLUSIONS The results underline the importance of active health policy and health care measures in tackling socioeconomic health inequalities.