“The increase in life expectancy has traditionally been a good resume of a population’s state of health. But the profile of diseases has changed: now there is a great prevalence of specific disorders that are not life-threatening yet are very incapacitating,” points out Unai Martín. In other words, life expectancy is no longer the only indicator to be taken into consideration: for example, it is not possible to speak of wellbeing if one lives longer but if one is ill or dependent during that extra time. This sociologist of the University of the Basque Country (UPV/EHU) says it is more realistic to ask: how many years can we expect to live free of incapacity and/or in good health? He has studied how the population in the Basque Autonomous Community (BAC) has evolved, and what its current state is in this respect. His thesis is entitled: Salud y desigualdades sociales en salud en la C.A. del País Vasco en el cambio de siglo: una visión desde las esperanzas de salud (Health and social inequalities in health in the Basque Autonomous Community in the new century: a vision from the health expectancy perspective).
In actual fact, it is a matter of integrating the mortality rate and health quality into a single index. To do this, Martín has in this research consulted three sources of data focussing on the BAC: data on death (1989-2008); population censuses (1991, 1996, 2001 and 2006); and the last four health surveys (1992, 1997, 2002 and 2007) conducted by the BAC Government.
Progress is slowing down
As the thesis explains, the evolution in the state of health of the Basque population has been positive until now. However, the most recent data indicate that this evolution has slowed down. Martín warns that it is necessary to be on the alert in this respect: “In the data in the BAC, in the first three periods studied, there is a compression of morbidity and the years of life gained are accompanied by better health. But in the last period one is beginning to see that life expectancy is increasing at the expense of an increase in incapacity. The state of health does not improve as much as it used to, and signs that it could start to deteriorate are seen.”
In connection with this, the researcher points out that it is important to focus collective effort to ensure that the fall in mortality continues to be accompanied by an improvement in the population’s health, and not at the expense of an expansion in chronic diseases or incapacities.
Mitigating this potential problem requires changes in the allocation of resources and the prioritizing of services, among other things. For example, Martín points out that the Strategy for addressing the Chronicity challenge in the BAC (started by the BAC Government in 2010) constitutes an advance in this respect, although it is not sufficient. “The significance of chronic diseases has forced the redirecting of healthcare systems, and in this respect, the chronicity strategy is ground breaking. But the cutting of chronic diseases not only takes place because the healthcare system adapts. It is a plan with a highly biomedical vision, and which fails to deal with other kinds of factors like those linked to conditions of life which have a lot to do with improving the health of the population,” he points out.
Great social inequality
In actual fact, if the level of education or the social class themselves are already determining life expectancy, Martín explains that the influence of conditions of life is even greater when the indicator proposed is applied: “With these measures that take mortality as well as health into consideration, the inequalities are even greater.” The data gathered in this research show, for example, that a newborn boy belonging to the 20% most deprived neighbourhoods in the BAC can expect to live in good health 6.4 years less than one born in the 20% of areas of least deprivation. A difference which in the case of newborn girls amounts to 7.4 years. Likewise, by the time a man who has not been educated or who has only been through elementary education reaches the age of 20, he can expect to live 10.9 years less in good health than a man who has been through university; in the case of women, that difference is 9.4 years.
In other words, the data indicate than a fall in the social scale means not only living fewer years but also living fewer years in good health.
Unai Martín-Roncero (Llodio, Basque Country, 1980) is a graduate in Sociology. He wrote up his thesis under the supervision of Begoña Arregi-Gorospe, tenured lecturer in the Department of Sociology II of the UPV/EHU’s Faculty of Social Sciences and Communication. Right now Martín works in this department and that is where he did his thesis. Part of the thesis was also done while he was collaborating with the Department of Health and Consumer Affairs of the BAC Government and with the Basque Foundation for Healthcare Innovation and Research.