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McCallum A.K.,Directorate of Public Health and Health Policy | Manderbacka K.,Finnish National Institute for Health and Welfare | Arffman M.,Finnish National Institute for Health and Welfare | Leyland A.H.,MRC CSO Social and Public Health science Unit | And 2 more authors.
BMC Health Services Research | Year: 2013

Background: Finland decentralised its universal healthcare system and introduced market reforms in the 1990s. Despite a commitment to equity, previous studies have identified persistent socio-economic inequities in healthcare, with patterns of service use that are more pro-rich than in most other European countries. To examine whether similar socio-economic patterning existed for mortality amenable to intervention in primary or specialist care, we investigated trends in amenable mortality by income group from 1992-2003. Methods. We analysed trends in all cause, total disease and mortality amenable to health care using individual level data from the National Causes of Death Register for those aged 25 to 74 years in 1992-2003. These data were linked to sociodemographic data for 1990-2002 from population registers using unique personal identifiers. We examined trends in causes of death amenable to intervention in primary or specialist healthcare by income quintiles. Results: Between 1992 and 2003, amenable mortality fell from 93 to 64 per 100,000 in men and 74 to 54 per 100,000 in women, an average annual decrease in amenable mortality of 3.6% and 3.1% respectively. Over this period, all cause mortality declined less, by 2.8% in men and 2.5% in women. By 2002-2003, amenable mortality among men in the highest income group had halved, but the socioeconomic gradient had increased as amenable mortality reduced at a significantly slower rate for men and women in the lowest income quintile. Compared to men and women in the highest income quintile, the risk ratio for mortality amenable to primary care had increased to 14.0 and 20.5 respectively, and to 8.8 and 9.36 for mortality amenable to specialist care. Conclusions: Our findings demonstrate an increasing socioeconomic gradient in mortality amenable to intervention in primary and specialist care. This is consistent with the existing evidence of inequity in healthcare use in Finland and provides supporting evidence of changes in the socioeconomic gradient in health service use and in important outcomes. The potential adverse effect of healthcare reform on timely access to effective care for people on low incomes provides a plausible explanation that deserves further attention. © 2013 McCallum et al.; licensee BioMed Central Ltd.

Sim J.A.,Directorate of Public Health and Health Policy | Ulanika A.A.,Directorate of Public Health and Health Policy | Katikireddi S.V.,Directorate of Public Health and Health Policy | Gorman D.,Directorate of Public Health and Health Policy
Public Health | Year: 2011

Objectives: Pregnancy has been identified as a risk factor for complications from pandemic H1N1 influenza, and pregnant women were identified as a target group for vaccination in the UK in the 2009 pandemic. Poland took a more conservative approach, and did not offer vaccination to pregnant women. Poland accounts for the largest wave of recent migrants to the UK, many of whom are in their reproductive years and continue to participate actively in Polish healthcare systems after migration. The authors speculated that different national responses may shape differences in approaches to the vaccine between Scottish and Polish women. This study therefore aimed to assess how pregnant Polish migrants to Scotland weighed up the risks and benefits of the vaccine for pandemic H1N1 influenza in comparison with their Scottish counterparts. Study design: A qualitative interview-based study comparing the views of Scottish and Polish pregnant women on H1N1 vaccination was carried out in 'real time' during the first 2 weeks of the vaccination programme in November 2009. Methods: One-to-one interviews were conducted with 10 women (five Polish and five Scottish) in their native language. Interviews were transcribed, translated, coded and analysed for differences and similarities in decision-making processes between the two groups. Results: Contrary to expectations, Scottish and Polish women drew on a strikingly similar set of considerations in deciding whether or not to accept the vaccine, with individual women reaching different conclusions. Almost all of the women adopted a critical stance towards the vaccine. While most women understood that pregnancy was a risk factor for complications from influenza, their primary concern was protecting family health overall and their fetus in particular. Deciding whether or not to accept the vaccine was difficult for women. Some identified a contradiction between the culture of caution which characterizes pregnancy-related advice, and the fact that they were being urged to accept what was perceived as a relatively untested vaccine. Their health histories, individual constitutions, and whether their everyday routines exposed them to sources of infection combined to establish their perceived 'candidacy' for contracting infection. Neither Scottish nor Polish women felt that 'official' information addressed their concerns in sufficient detail, and almost all of the women sought information from a variety of sources. Polish women found it more difficult to access information and advice from the National Health Service than their Scottish counterparts. For most respondents, deciding whether or not to accept the vaccine was an attenuated process, culminating for many in choosing the 'least worst' option in the context of competing risks. Conclusions: To the authors' knowledge, this is the first study to assess perceptions of H1N1 immunization risk in pregnant women in 'real time'. It highlights the important unmet needs for information that women need to be able to make informed vaccination choices, and the challenges of producing such information in a context of uncertainty. This is of particular relevance as many countries, including the UK, are actively reviewing their plans for vaccination programmes during pregnancy. © 2011 The Royal Society for Public Health.

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