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Tobacco may explain some of the differences in health inequalities between North and South Europe


Educational differences in smoking: international comparison

Smoking may explain some of the differences in health inequalities between Northern and Southern European countries, indicates research in this week's issue of the BMJ. But, says the research, the North / South gap is likely to close, while the health gap between the rich and the poor will widen further as a result of smoking.

A pan-European team of researchers led by Mackenbach of the Erasmus University, Rotterdam, in the Netherlands, compared the socioeconomic differences in smoking patterns across 12 European countries. Health survey data were analysed for the years 1986 to 1990, and separately for men and women and the age groups 20 to 44 and 45 to 74. Educational level was chosen to indicate socioeconomic status.

Smoking rates were highest among younger people with low levels of education in most countries. There was a distinctive North / South pattern. Higher rates of smoking were found among women with low levels of education in the UK, Norway, and Sweden; higher rates were found in well educated women in southern European countries. The same was true for older men, although to a lesser extent, but not for younger men.

The differences in smoking patterns, say the authors, are likely to be related to the stage countries have reached in the "smoking epidemic" - with the more affluent starting and giving up smoking first. These patterns are also likely to be partly responsible for the high rates of death and disease from heart disease seen among the less well off in Northern European countries compared with their peers in the South. But on the basis of current trends, the South will catch up. And, worryingly, say the authors, these patterns suggest that the health gaps from diseases associated with smoking between the rich and poor will continue to grow. Governments wanting to tackle the social inequalities in health need to think about antismoking policies that are less intellectually demanding, conclude the authors.



Professor Johan Mackenbach, Dept Public Health, Erasmus University, Rotterdam, The Netherlands

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