Uno sguardo alla salute dei toscani: differenze sociali e territoriali attraverso l’indagine “Condizioni di salute e ricorso ai servizi sanitari” - 2005

Questa ricerca è stata realizzata nell’ambito del Progetto Finanziato dalla Regione Toscana – Settore Sistema Statistico. Abstract. The White Paper for Health of European Commission has recently reaffirmed the necessity to adopt a multidimensional and integrated approach in the field of health. Such an approach is needed for the understanding and the monitoring of how to produce a “population ageing in good health”, from both an individual and a collective point of view. This objective refers to a view of health and of its determinants that encompasses all the daily life domains. This study about different aspects of inequalities in health and its socioeconomic correlates in Tuscany gets into this framework. The possibility of a detailed analysis is provided by the Italian interview survey on Health Conditions and Recourse to Health Services, carried out by Istat in 2004-2005. Thanks to an agreement among Istat, Regional Authorities and the Department of Health, this survey can take advantage of large sample size that allows us to analyse the data at a sub-national level. Particularly, the sample design defines the so-called large areas, which identify geographical aggregates of particular interest for the health policies at local level from the points of view of administration, management and policies. Tuscany region is splitted in 4 large areas: the city of Florence; the rest of the province of Florence together with the provinces of Pistoia and Prato; the provinces of Siena, Arezzo and Grosseto; and finally the provinces of Massa Carrara, Lucca, Livorno e Pisa. Bearing in mind that in Italy the competences on health care are delegated to a regional level, the knowledge of health and socioeconomic features of an area and of its population is necessary in order to monitor possible discrepancies between need of health and resources of health system. Thanks to the richness of information provided by the survey, health of individuals is here investigated and evaluated from a multidimensional perspective and considering several aspects. Chapter 1 focuses on subjective health perception, on the presence of chronic diseases and of disabilities, evaluating socioeconomic and territorial inequalities in these domains. In Chapter 2 we consider the main risk factors relied to individual lifestyles (weight, physical activity and smoking), with a specific focus on young population, while in Chapter 3 we analyse the consumption of drugs and non-conventional cures, and the recourse to diagnostic tests and check-up. The recourse to health services, general practitioner and specialist visits, and hospital recovery represent the topics faced in Chapter 4. We consider, again in an intra-regional comparative perspective, the access and the payment of these services, besides the opinion and the satisfaction of Tuscany population about them. Chapter 5 deals with “women health”, investigating the recourse to screening programs about the feminine cancers and the reproductive health, with regard to the phases of pregnancy, childbirth and feeding. We conclude in Chapter 6 with a comprehensive analysis, which aims to highlight potential associations between health conditions and socioeconomic status. Availability of socio-demographic characteristics of respondents, namely sex, age, marital status, relationship networks and education, besides the subjective evaluation of their socioeconomic situation and the reported housing conditions, enables an analysis of associations among health, environment and individual features. In this way, we are able to depict elements of inequalities that survive both at large area territorial level, and among social groups. To summarise, the descriptive analyses show a relation between socioeconomic inequalities and health inequalities in Tuscany. For all the health indicators investigated we observe that people in lower socio-economic conditions are more exposed to bad health. Health inequalities are due also to disparities in the distribution of risk factors and in the use of screening programs. We found that people in disadvantaged socioeconomic conditions are more likely to adhere to unhealthy or health-damaging behaviours, do not always use the existing health facilities in an optimal way, as well as the prevention and screening protocols. From a territorial point of view, it clearly emerges a certain degree of intra-regional heterogeneity, both for the socioeconomic status, for the different dimensions that compose the concept of health and for the recourse to health services. We remark also the persistence of gender imbalances, whose intensity may differ depending on the health indicator considered. An interesting finding for Tuscany is that, notwithstanding some social and intra-regional differences, this region is above the national average for the diffusion and the utilization of public regional screening programs about the feminine cancers. Finally, the relation between health status, demographic and socioeconomic characteristics is confirmed also by multivariate logistic regression models applied on Tuscany population aged 50 and more, given the prevalence of bad health status in this age. For all the indicators – self-rated health, presence of multiple chronic diseases and presence of disabilities – our analysis confirms that, also in Tuscany, the risk of bad health conditions is higher for women and it worsens with the increasing of age. Furthermore, we find that each component of the socioeconomic condition – educational level, economic satisfaction and housing assets – is strongly correlated with the individual health indicators. Particularly, for the self-rated health the association with the evaluation of economic situation changes in relation to the large area of residence. Finally, as for the relationships networks available to individuals, this indicator shows a higher risk of bad health for people who cannot rely on help in case of need, or, for the disabilities indicator, also for people who do not live with their partner. These results in terms of association between health status, recourse to health services and individual socioeconomic conditions aim at contributing to the knowledge of social and territorial inequalities of health in Tuscany. This knowledge represents an essential starting point for specific policy interventions, indispensable to remove the observed inequalities and to sustain a population that, given the ageing perspectives, will show raising needs in the field of health.