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Background The unemployed have lower work ability and poorer health than the employed. This situation deteriorates when unemployment continues. The long-term unemployed often have co-morbidities and face many other challenges. This increases the need for a multidimensional assessment of work ability and functioning in different service settings. In this study, we describe the development and analyse the content validity of the Abilitator, a self-report questionnaire on work ability and functioning for those in a weak labour market position. Methods The Abilitator was developed in 2014–2017. Its construct was assessed by members of academic expert panels (n = 30), practical expert panels of professionals (n = 700) and target group clients (n = 28). The structure and the content of the questionnaire was co-developed in 29 workshops and adjusted twice based on the expert panels’ feedback. The Abilitator was also implemented among target group clients (n = 3360) in different services and projects. During its development the Abilitator was linked to the International Classification of Functioning, Disability and Health (ICF). The content validation process followed the guidelines recommended by the Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) panel. Results The construct of the Abilitator combines the multidimensional and biopsychosocial models of work ability and functioning. It also includes aspects of social inclusion and employability. It evaluates social, psychological, cognitive and physical functioning, and the ability to cope with everyday life. The content of these concepts was validated by the academic and practical expert panels. The Abilitator’s 79 ICF codes covered 57% of the Generic, 77% of the Brief Vocational Rehabilitation, and 8% of the Minimal Environmental ICF Core Sets. When compared with the Work Ability Index (WAI) and the World Health Organization Disability Assessment Schedule (WHODAS 2.0), the direct equivalences of the ICF codes were 36 and 44%, respectively. Conclusion The Abilitator sufficiently comprehensively covers the relevant aspects to enable the assessment of the overall work ability and functioning of the population in a weak labour market position.

BackgroundNeighbourhood safety has repeatedly been shown to be associated with the health and well-being of the residents. Criminality is often seen as one of the key factors affecting neighbourhood safety. However, the relationship between crime, fear of crime and feelings of safety remains underexplored.MethodsData on socio-demographic, health and safety perceptions was extracted from the Maastricht municipality survey (the Netherlands) (n = 9656 adults) and merged with data on official neighbourhood crime rates from the Police Registry. Pearson correlation coefficients and multilevel logistic regression models were computed to assess the association between aspects of objective and perceived criminality, individuals’ feelings of safety and health.ResultsThe correlation between the police recorded crime and residents’ perceptions of the neighbourhood crime rates was weak (0.14–0.38), with the exception of violent crime (0.59), which indicates that other factors contribute to the perceptions of safety. In turn, the perception of higher rates of violent crime and more nuisance (on the scale 0–10) but not other types of crime or nuisance was positively associated with feeling unsafe (OR 1.27 [1.22;1.32] and 1.39 [1.33;1.46], respectively). Lower general feelings of safety at both the individual and neighbourhood level were consistently associated with worse self-rated health. Among different indicators of safety, the general feelings of safety had the most pronounced association with health, while subjective or objective measures of crime showed limited to no direct relationship with health.ConclusionsPublic health policies targeting safety as a social determinant of health should consider prioritizing areas of violent crime and nuisance to improve general feelings of safety. Further research is needed to understand which factors aside from criminality are driving residents’ feelings of safety.

Objectives: This study compared 15 countries for multiplicative effects of gender by education and by income on self-rated health of individuals with chronic medical conditions. Methods: We analyzed data from the Research on Early Life and Aging Trends and Effects (RELATE) Study. Participants were sampled from 15 countries including Argentina, Barbados, Brazil, Chile, Cuba, Costa Rica, China, India, Ghana, Russia, Puerto Rico, South Africa, Mexico, Uruguay, and the United States. The analytical sample was limited to individuals with at least one chronic medical condition. The main outcome of interest was self-rated health (SRH). Country-specific logistic regressions were used for data analysis. We ran separate models with gender × education and gender × income interactions. Results: In Ghana, Uruguay, and India, gender moderated the effects of socioeconomic status (SES) on SRH. In Ghana and Uruguay, education and in Mexico and India, income had a stronger effect on SRH for women than men. Conclusions: Countries vary in gender differences in vulnerability to SES indicators on SRH of patients with chronic medical conditions. Women are more vulnerable than men to the effect of low SES on SRH in Ghana, Uruguay, Mexico, and India.

This paper develops a method to model the effect of income on self-reported health at the individual level. The model is estimated using the meta-analytic data of 68 studies from 13 countries, and is used to test two hypotheses. The first hypothesis is that income affects health at the individual level. If this is the case, the incidence of poor health will differ across people from different income groups. The second hypothesis is that income differentials are associated with differential vulnerability to poor health. If so, the influence of income on health outcomes will differ across members of different income groups in different countries.The collected data are best described by a log-linear relationship between income and self-reported health. The empirical results confirm both hypotheses. We have found that (a) income inequality affects health at the individual level; (b) the level of self-reported poor health in the bottom deciles of the income distribution increases with the level of inequality in the country's income distribution; and (c) the relative income hypothesis has a stronger explanatory power for our results than the absolute income hypothesis. These results confirm the idea that for comparisons at the individual level, relative income matters more than absolute income. These findings have important policy implications.

Contains fulltext : 90131.pdf (Publisher’s version ) (Closed access) Objective To assess the value of self-rated health assessments by examining the association between education and self-rated poor health. Methods We used the globally representative population-based sample from the 2002 World Health Survey, composed of 219 713 men and women aged 25 and over in 69 countries, to examine the association between education and self-rated poor health. In a binary regression model with a logit link function, we used self-rated poor health as the binary dependent variable, and age, sex and education as the independent variables. Findings Globally, there was an inverse association between years of schooling and self-rated poor health (odds ratio, OR: 0.929; 95% confidence interval, CI: 0.926–0.933). Compared with the individuals in the highest quintile of years of schooling, those in the lowest quintile were twice as likely to report poor health (OR: 2.292; 95% CI: 2.165–2.426). We found a dose–response relationship between quintiles of years of schooling and the ORs for reporting poor health. This association was consistent among men and women; low-, middle- and high-income countries; and regions. Conclusion Our findings suggest that self-reports of health may be useful for epidemiological investigations within countries, even in low-income settings.

The aim was to describe health literacy among the older population of Kosovo, an Albanian speaking post-war country in the Western Balkans, in the context of self-perceived health status and self-reported chronic morbidity. A cross-sectional study was conducted in Kosovo in 2011 including 1753 individuals aged a parts per thousand yen65 years (886 men, 867 women; mean age 73.4 +/- 6.3 years; response rate: 77%). Participants were asked to assess, on a scale from 1 to 5, their level of difficulty with regard to access, understanding, appraisal and application of health information. Sub-scale scores and an overall health literacy score were calculated for each participant. Information on self-perceived health status, presence and number of chronic diseases and socioeconomic characteristics was also collected. Mean values of the overall health literacy score and all sub-scale scores (access, understanding, appraisal and application) were lower among older people who reported a poorer health status or at least one chronic condition compared with individuals who perceived their health status as good or had no chronic conditions (p

OBJECTIVES: To compare self-reported disability and performance-based limitation and their association in elderly men from three European countries. DESIGN: Cross-sectional data from a cohort study collected around 1990. SETTING: Three cohorts from Finland, the Netherlands, and Italy. PARTICIPANTS: One thousand one hundred sixty-one men aged 70 and older. MEASUREMENTS: Disability and functional limitation were measured in a standardized way in three countries. Self-reported disability was estimated by questionnaire, assessing three domains of activities of daily living: instrumental activities of daily living, mobility, and activities of daily living (score 0-3). Functional limitation was measured by performance tests (score 0-16), with 0 indicated the healthiest score. RESULTS: Self-reported disability and performance-based limitation scores differed between countries. Mean self-reported disability score was worse in Italy (0.72) and the Netherlands (0.70) than in Finland (0.54). Italian men scored worst on the performance-based tests (mean 4.80 vs 4.04 for Finland and 3.74 for the Netherlands). Differences in self-reported disability remained after adjusting for performance scores: Dutch men reported more disabilities (odds ratio (OR) = 1.66, 95% confidence interval (CI) = 1.23-2.25) than men in Finland (reference group) and Italy (OR = 1.08, 95% CI = 0.77-1.53). Self-reported disability was positively associated with performance-based score (OR = 1.28, 95% CI = 1.21-1.35) and did not differ between countries. CONCLUSION: Cross-cultural variation was noted in self-reported disability adjusted for performance score. These differences may be due to sociocultural and physical environmental factors. Self-reported disability was consistently associated with performance-based limitation in Finland, the Netherlands, and Italy.

Background The purpose of this study was to assess potential differences in the predictive ability of self-assessed health for mortality between educational groups, and to find explanations for any of these educational differences.Methods We used data from the longitudinal GLOBE study, with a 13-year mortality follow-up. Analyses were performed for people aged between 25-74 years at baseline (n = 16 722). The associations of self-assessed health with mortality were estimated with Cox regression analyses, and the resulting hazard ratios were used as indicators of the 'predictive ability' of self-assessed health for mortality. Differences between educational levels were estimated by including an interaction term of education with self-assessed health in regression models with mortality as the outcome. The analyses were subsequently adjusted for: life threatening chronic conditions, non-life threatening conditions, stressors and health behaviour, to test the contribution of these factors to the predictive ability of self-assessed health.Results Results indicated that the predictive ability of self-assessed health for mortality was greater in men with tertiary education as compared with the lowest educated men. No differences were observed in women. None of the four health aspects accounted for the educational difference in men.Conclusions Because differences in the predictive ability for mortality were limited to the extreme educational groups in men, educational differences in self-assessed health that are reported in numerous studies should not be expected to seriously overestimate educational differences in 'objective' health status.

FP is funded by the Chief Scientist Office of the Scottish Executive Health Department Background: Scotland's overall health record is comparatively poor for a Western European country, particularly amongst people of working age. A number of previous studies have explored why this might be the case by comparing mortality in Scotland with England and Wales. A study in the 1980s showed that the higher prevalence of deprivation in Scotland accounted for Scotland's excess mortality risk. However, more recent studies suggest that deprivation now explains less of this excess. This has led to the suggestion that there is a yet unidentified "Scottish effect" contributing to Scotland's mortality excess. Recent research has also suggested that there could be an unidentified effect influencing Scotland's higher rate of heart disease. This paper explores whether there is also an unexplained Scottish excess, relative to England, in self reports of poor health. Methods: Data came from the individual Sample of Anonymised Records, a 3% random sample of the 2001 UK census. Using logistic regression models, self reports of health (limiting illness and general health) from the working age populations (aged 25 to 64) of Scotland and England were compared. Account was taken of people's country of birth. Stratified analysis by employment status allowed further exploration of Scotland's excess. Results: People born and living in Scotland reported higher levels of poor general health and limiting illness compared to people born and living in England. Adjustment for socioeconomic position and employment status largely explained the higher rates. In the stratified analysis a Scottish excess was seen only amongst the economically inactive born and living in Scotland. For those in employment, people born and living in Scotland actually had slightly lower odds of reporting poor general health and limiting illness than people born and living in England. Conclusion: This analysis suggests that higher rates of poor self reported health in Scotland can be explained by differences in employment and socioeconomic position and so there is unlikely to be an unidentified "Scottish effect" for self reports of health. Scotland's excess of poor general health and limiting illness amongst the economically inactive is probably attributable to its economic and employment history. Publisher PDF

Background Research and policy related to reducing health inequalities has progressed separately within Ireland and Northern Ireland. This paper describes the first exploration of the socio-economic influences on health on the island of Ireland since 1922. Methods Postal survey. Results The response rate was 52%; 11,870 respondents. Men reported more long-standing illness (LLTI) or poor general health (PGH); depression was more common amongst women. Socio-economic gradients in health were evident in both jurisdictions, with the effects of household income being particularly marked. Overall, morbidity levels were significantly better in Ireland than in Northern Ireland: adjusted odds ratio Of 0.79 (95% Cl 0.71- 0.88) for LLTI; 0.64 (0.57 - 0.72) for PGH; 0.90 (0.82 - 0.99) for depression. Conclusions There is evidence of strong and similar socio-economic gradients in health throughout the island of Ireland. This would suggest joint policy approaches or at least further comparative evaluation of the initiatives in each jurisdiction.