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International Journal for Equity in Health
Published in: International Journal for Equity in Health 1/2016

Open Access 01-12-2016 | Systematic review

Connecting the dots on health inequalities – a systematic review on the social determinants of health in Portugal

Authors: Inês Campos-Matos, Giuliano Russo, Julian Perelman

Published in: International Journal for Equity in Health | Issue 1/2016

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Abstract

Introduction

Health inequalities are recognised as a public health issue worldwide, but only a few countries have developed national strategies to monitor and reduce them. Despite its considerable health inequalities, Portugal seems to lack a systematic strategy to tackle them, possibly due to the absence of organised evidence on the issue. We performed a systematic review that aimed to describe the available evidence on social inequalities in health in Portugal, in order to contribute towards a comprehensive and focused strategy to tackle them.

Methods

We followed the PRISMA guidelines and searched Scopus, Web of Science and PubMed for studies that looked at the association between a measure of socioeconomic status and a health outcome in the Portuguese resident population since the year 2000. We excluded health behaviours and healthcare use from our search. We performed a qualitative description of the results.

Results

Seventy-one publications were selected, all reporting observational analyses, most of them using cross-sectional data. These publications showed strong evidence for health inequalities related to education and gender, chiefly for obesity, self-rated health and mental health.

Conclusions

Analysis of the eligible publications showed that current research does not seem to have consistently covered the link between health and key Portuguese social problems. A strategy focusing on the monitoring of most prevalent diseases, most determining socioeconomic factors and vulnerable populations would be crucial to guide academic research in a country in which health inequalities are so ubiquitous and deeply rooted.

Registration

This systematic review is not registered.
Appendix
Available only for authorised users
Literature
1.
Marmot M, Friel S, Bell R, Houweling TA, Taylor S. Closing the gap in a generation: health equity through action on the social determinants of health. Lancet. 2008;372(9650):1661–9.CrossRefPubMed
2.
Black D, Morris J, Smith C, Townsend P. Inequalities in health: report of a Research Working Group. London: Department of Health and Social Security; 1980. p. 19.
3.
Pereira J, Furtado C. Equidade em saúde: do conhecimento à acção. In: A Nova Saúde Pública: A saúde Pública na Era do Conhecimento, editor. DGS/ENSP. Lisbon: Gradiva; 2011.
4.
World Health Organization. WHO evaluation of the national health plan of Portugal (2004–2010). Copenhagen: WHO Regional Office for Europe; 2010.
5.
World Health Organization. Portugal Health System Performance Assessment. WHO and Alto Comissariado da Saúde [Portuguese High Comissioner for Health]. 2010.
6.
7.
Mackenbach JP, Stirbu I, Roskam AJ, Schaap MM, Menvielle G, Leinsalu M, et al. Socioeconomic inequalities in health in 22 European countries. N Engl J Med. 2008;358(23):2468–81.CrossRefPubMed
8.
Bago d’Uva T. Equidade no sector da saúde em Portugal. In: Almedina E, editor. 30 Anos do Serviço Nacional de Saúde - um percurso comentado. Lisbon: Simões, Jorge; 2010.
9.
Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ. 2009;349:g7716.
10.
O’Neill J, Tabish H, Welch V, Petticrew M, Pottie K, Clarke M, et al. Applying an equity lens to interventions: using PROGRESS ensures consideration of socially stratifying factors to illuminate inequities in health. J Clin Epidemiol. 2014;67(1):56–64.CrossRefPubMed
11.
Blaxter M. A comparison of measures of inequality in morbidity. Gower: Health inequalities in European countries Aldershot; 1989. p. 199–230.
12.
13.
Alda de Caetano Carvalho & José Pereira Miguel. Inquérito Nacional de Saúde 2005/2006. Instituto Nacional de Estatística and Instituto Nacional de Saúde Dr. Ricardo Jorge. 2009.
14.
15.
16.
Miranda MJ, Costa C, Santana P, Barrozo LV. Associação espacial entre variáveis socioeconômicas e risco relativo de nascimentos pré-termo na Região Metropolitana de São Paulo (RMSP) e na Área Metropolitana de Lisboa (AML). Saúde Soc. 2014;23(4):1142–53.CrossRef
17.
Harding S, Boroujerdi M, Santana P, Cruickshank J. Decline in, and lack of difference between, average birth weights among African and Portuguese babies in Portugal. Int J Epidemiol. 2006;35(2):270–6.CrossRefPubMed
18.
Oliveira C, Economou T, Bailey T, Mendonça D, Pina M. The interactions between municipal socioeconomic status and age on hip fracture risk. Osteoporos Int. 2015;26(2):489–98.CrossRefPubMed
19.
von Humboldt S, Leal I, Pimenta F. Living well in later life: the influence of sense of coherence, and socio-demographic, lifestyle and health-related factors on older adults’ satisfaction with life. Applied Research in Quality of Life. 2014;9(3):631–42.CrossRef
20.
Bastos J, Peleteiro B, Barros R, Alves L, Severo M, Fátima Pina M, et al. Sociodemographic determinants of prevalence and incidence of Helicobacter pylori infection in Portuguese adults. Helicobacter. 2013;18(6):413–22.CrossRefPubMed
21.
Williamson LM, Rosato M, Teyhan A, Santana P, Harding S. AIDS mortality in African migrants living in Portugal: evidence of large social inequalities. Sex Transm Infect. 2009;85(6):427–31.PubMedCentralCrossRefPubMed
22.
Harding S, Teyhan A, Rosato M, Santana P. All cause and cardiovascular mortality in African migrants living in Portugal: evidence of large social inequalities. Eur J Cardiovasc Prev Rehabil. 2008;15(6):670–6.CrossRefPubMed
23.
Neto F. Predictors of mental health among adolescents from immigrant families in Portugal. J Fam Psychol. 2009;23(3):375.CrossRefPubMed
24.
Neto F. Mental health among adolescents from returned Portuguese immigrant families from North America. N Am J Psychol. 2010;12(2):265.
25.
Santos DA, Silva AM, Santa-Clara H, Matias CN, Fields DA, Sardinha LB. Determinant factors of cardiorespiratory fitness in Portuguese adolescents of different ethnicities. Revista Brasileira de Cineantropometria & Desempenho Humano. 2011;13(4):243–9.
26.
Fraga S, Marques-Vidal P, Vollenweider P, Waeber G, Guessous I, Paccaud F, et al. Association of socioeconomic status with inflammatory markers: A two cohort comparison. Preventive medicine. 2014.
27.
Harding S, Santana P, Cruickshank JK, Boroujerdi M. Birth weights of black African babies of migrant and nonmigrant mothers compared with those of babies of European mothers in Portugal. Ann Epidemiol. 2006;16(7):572–9.CrossRefPubMed
28.
Silva PA. Individual and social determinants of self-rated health and well-being in the elderly population of Portugal. Cadernos de saude publica. 2014;30(11):2387–400.CrossRefPubMed
29.
Sousa-Ribeiro M, Sverke M, Coimbra JL. Perceived quality of the psychosocial environment and well-being in employed and unemployed older adults: the importance of latent benefits and environmental vitamins. Econ Ind Democr. 2014;35(4):629–52.CrossRef
30.
Azevedo LF, Costa-Pereira A, Mendonça L, Dias CC, Castro-Lopes JM. Epidemiology of chronic pain: a population-based nationwide study on its prevalence, characteristics and associated disability in Portugal. The journal of pain. 2012;13(8):773–83.CrossRefPubMed
31.
Alves E, Correia S, Barros H, Azevedo A. Prevalence of self-reported cardiovascular risk factors in Portuguese women: a survey after delivery. International journal of public health. 2012;57(5):837–47.CrossRefPubMed
32.
Perelman J, Fernandes A, Mateus C. Gender disparities in health and healthcare: results from the Portuguese National Health Interview Survey. Cadernos de saude publica. 2012;28(12):2339–48.CrossRefPubMed
33.
Stewart-Knox B, Duffy ME, Bunting B, Parr H, de Almeida MDV, Gibney M. Associations between obesity (BMI and waist circumference) and socio-demographic factors, physical activity, dietary habits, life events, resilience, mood, perceived stress and hopelessness in healthy older Europeans. BMC Public Health. 2012;12(1):424.PubMedCentralCrossRefPubMed
34.
Carvalho J, Nobre P. Gender issues and sexual desire: the role of emotional and relationship variables. J Sexual Med. 2010;7(7):2469–78.CrossRef
35.
Costa C, Ramos E, Severo M, Barros H, Lopes C. Determinants of eating disorders symptomatology in Portuguese adolescents. Archives of pediatrics & adolescent medicine. 2008;162(12):1126–32.CrossRef
36.
Lawlor DA, Harro M, Wedderkopp N, Andersen LB, Sardinha LB, Riddoch CJ, et al. Association of socioeconomic position with insulin resistance among children from Denmark, Estonia, and Portugal: cross sectional study. BMJ. 2005;331(7510):183.PubMedCentralCrossRefPubMed
37.
Correia S, Barros H. Small-for-gestational age Portuguese babies: the effect of childhood social environment, growth and adult socioeconomic conditions. Prev Med. 2015;70:102–7.CrossRefPubMed
38.
Mello T, Antunes I, Waldman E, Ramos E, Relvas M, Barros H. Prevalence and severity of dental caries in schoolchildren of Porto, Portugal. Community Dent Health. 2008;25(2):119–25.PubMed
39.
Schütte S, Chastang J-F, Parent-Thirion A, Vermeylen G, Niedhammer I. Social differences in self-reported health among men and women in 31 countries in Europe. Scandinavian journal of public health. 2013;41(1):51–7.CrossRefPubMed
40.
Correia S, Rodrigues T, Barros H. Socioeconomic variations in female fertility impairment: a study in a cohort of Portuguese mothers. BMJ open. 2014;4(1):e003985.PubMedCentralCrossRefPubMed
41.
Pimenta F, Leal I, Maroco J, Ramos C. Perceived control, lifestyle, health, socio-demographic factors and menopause: Impact on hot flashes and night sweats. Maturitas. 2011;69(4):338–42.CrossRefPubMed
42.
Ferreira-Valente MA, Pais-Ribeiro JL, Jensen MP. Associations between psychosocial factors and pain intensity, physical functioning, and psychological functioning in patients with chronic pain: a cross-cultural comparison. Clin J Pain. 2014;30(8):713–23.CrossRefPubMed
43.
Camões M, Lopes C, Oliveira A, Santos AC, Barros H. Overall and central obesity incidence in an urban Portuguese population. Prev Med. 2010;50(1):50–5.CrossRefPubMed
44.
Santos A-C, Barros H. Prevalence and determinants of obesity in an urban sample of Portuguese adults. Public Health. 2003;117(6):430–7.CrossRefPubMed
45.
Nogueira H, Ferrão M, Gama A, Mourão I, Rosado Marques V, Padez C. Perceptions of neighborhood environments and childhood obesity: evidence of harmful gender inequities among Portuguese children. Health & place. 2013;19:69–73.CrossRef
46.
Bingham DD, Varela‐Silva MI, Ferrão MM, Augusta G, Mourão MI, Nogueira H, et al. Socio‐demographic and behavioral risk factors associated with the high prevalence of overweight and obesity in portuguese children. Am J Hum Biol. 2013;25(6):733–42.CrossRefPubMed
47.
Dias S, Gama A, Martins MO. Health status and preventative behaviors of immigrants by gender and origin: a Portuguese cross‐sectional study. Nursing Health Sci. 2013;15(3):309–17.CrossRef
48.
Eikemo TA, Huisman M, Bambra C, Kunst AE. Health inequalities according to educational level in different welfare regimes: a comparison of 23 European countries. Sociology of health & illness. 2008;30(4):565–82.CrossRef
49.
Von Dem Knesebeck O, Verde PE, Dragano N. Education and health in 22 European countries. Soc Sci Med. 2006;63(5):1344–51.CrossRef
50.
Pereira M, Canavarro MC. Gender and age differences in quality of life and the impact of psychopathological symptoms among HIV-infected patients. AIDS Behav. 2011;15(8):1857–69.CrossRefPubMed
51.
Bambra C, Pope D, Swami V, Stanistreet D, Roskam A, Kunst A, et al. Gender, health inequalities and welfare state regimes: a cross-national study of 13 European countries. J Epidemiol Community Health. 2009;63(1):38–44.CrossRefPubMed
52.
Ribeiro O, Teixeira L, Araújo L, Afonso RM, Pachana N. Predictors of anxiety in centenarians: health, economic factors, and loneliness. International Psychogeriatrics. 2014. p. 1–10.
53.
Amaral MOP, de Figueiredo Pereira CM, Martins DIS, Sakellarides CT. Prevalence and risk factors for insomnia among Portuguese adolescents. Eur J Pediatr. 2013;172(10):1305–11.CrossRefPubMed
54.
Carvalho M, de Matos MG. Psychosocial determinants of mental health and risk behaviours in adolescents. Global J Health Sci. 2014;6(4):22.CrossRef
55.
Bulhões C, Ramos E, Lindert J, Dias S, Barros H. Depressive symptoms and its associated factors in 13-year-old urban adolescents. International journal of environmental research and public health. 2013;10(10):5026–38.PubMedCentralCrossRefPubMed
56.
Santos NC, Costa PS, Cunha P, Portugal-Nunes C, Amorim L, Cotter J, et al. Clinical, physical and lifestyle variables and relationship with cognition and mood in aging: a cross-sectional analysis of distinct educational groups. Frontiers in aging neuroscience. 2014. p. 6.
57.
Roskam A-JR, Kunst AE, Van Oyen H, Demarest S, Klumbiene J, Regidor E, et al. Comparative appraisal of educational inequalities in overweight and obesity among adults in 19 European countries. Int J Epidemiol. 2010;39(2):392–404.CrossRefPubMed
58.
Gal DL, Santos A-C, Barros H. Leisure-time versus full-day energy expenditure: a cross-sectional study of sedentarism in a Portuguese urban population. BMC Public Health. 2005;5(1):16.PubMedCentralCrossRefPubMed
59.
Moreira PA, Padrão PD. Educational and economic determinants of food intake in Portuguese adults: a cross-sectional survey. BMC Public Health. 2004;4(1):58.PubMedCentralCrossRefPubMed
60.
Oliveira IT. Fecundidade e educação. Revista de Estudos Demográficos. 2007;40:5–19.
61.
Davis EM, Zyzanski SJ, Olson CM, Stange KC, Horwitz RI. Racial, ethnic, and socioeconomic differences in the incidence of obesity related to childbirth. Am J Public Health. 2009;99(2):294.PubMedCentralCrossRefPubMed
62.
Kunst AE, Bos V, Lahelma E, Bartley M, Lissau I, Regidor E, et al. Trends in socioeconomic inequalities in self-assessed health in 10 European countries. Int J Epidemiol. 2005;34(2):295–305.CrossRefPubMed
63.
Huisman M, Van Lenthe F, Mackenbach J. The predictive ability of self-assessed health for mortality in different educational groups. Int J Epidemiol. 2007;36(6):1207–13.CrossRefPubMed
64.
Oksuzyan A, Juel K, Vaupel JW, Christensen K. Men: good health and high mortality. Sex differences in health and aging. Aging Clin Exp Res. 2008;20(2):91–102.PubMedCentralCrossRefPubMed
65.
McDonough P, Walters V. Gender and health: reassessing patterns and explanations. Soc Sci Med. 2001;52(4):547–59.CrossRefPubMed
66.
Macintyre S, Hunt K, Sweeting H. Gender differences in health: are things really as simple as they seem? Soc Sci Med. 1996;42(4):617–24.CrossRefPubMed
67.
Rieker PP, Bird CE. Rethinking gender differences in health: why we need to integrate social and biological perspectives. J Gerontol Ser B Psychol Sci Soc Sci. 2005;60(Special Issue 2):S40–S7.CrossRef
68.
Eurostat. Migrants in Europe. Belgium: A statistical portrait of the first and second generation; 2011.
69.
70.
71.
72.
Direção-Geral da Saúde. A Saúde dos Portugueses. Perspetiva 2015 Lisbon: Direção-Geral da Saúde. 2015.
73.
Marmot M. Health inequalities in the EU. Final report of a consortium. Health inequalities in the EU Final report of a consortium. 2013.
74.
Direcção-Geral da Saúde. Plano Nacional de Saúde: Revisão e Extensão a 2020. Lisbon: Direcção-Geral da Saúde; 2015.
75.
Smith KE, Eltanani MK. What kinds of policies to reduce health inequalities in the UK do researchers support? Journal of Public Health. 2015;37(1):6–17.PubMedCentralCrossRefPubMed
76.
Metadata
Title
Connecting the dots on health inequalities – a systematic review on the social determinants of health in Portugal
Authors
Inês Campos-Matos
Giuliano Russo
Julian Perelman
Publication date
01-12-2016
Publisher
BioMed Central
Published in
International Journal for Equity in Health / Issue 1/2016
Electronic ISSN: 1475-9276
DOI
https://doi.org/10.1186/s12939-016-0314-z

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