SOCIAL DETERMINANTS OF HEALTH AND HEALTH INEQUALITIES: DIFFERENCES BETWEEN URBAN AND RURAL AREAS

Year 2021, Volume: 17 Issue: 2, 151 - 166, 22.11.2021

Alpaslan Türkkan Kayıhan Pala

Abstract

Health disparities between urban and rural areas in Turkey have not been fully known yet, which remained under-researched in the relevant literature. To investigate the distribution of health and its social determinants, including demographics, socio-economic characteristics, and behavioral factors in the rural and urban population, who live in Turkey. In this study, we used cross-sectional data, namely the Nilüfer Social Determinants of Health Survey 2014. The findings showed that 799 of the houses (79.3%) and 79.9% of the respondents (2481 people) were in the city. In this study, 20.1% of the respondents (n=624) were reported to live in 208 (20.7%) of the houses that were located in the rural area. The socioeconomic indicators (education, employment status, household appliances, car ownership, household income, income status and money-saving) explored in this study were correlated with the health indicators (p<0.01). Socioeconomic indicators were strongly associated with health in both rural and urban area. The residential area was an important determinant of health. Our study, however, has revealed that socioeconomic factors are highly likely to determine the health status of people more than urban-rural settings. Thus, the higher the socioeconomic status is the better the health indicators are.

Keywords

Social determinants of health, Urban health, Socioeconomic factors, Chronic disease, Injuries.

References

• Aguilar-Palacio, I., Carrera-Lasfuentes, P., Sánchez-Recio, R., Alonso, J.P., Rabanaque, M.J. (2018). Recession, employment and self-rated health: a study on the gender gap. Public Health, 154, 44-50.
• Braveman, P., Gottlieb, L. (2014). The Social Determinants of Health: It’s Time to Consider the Causes of the Causes. Public Health Rep,129, 19-31.
• Chen, H., Liu, Y., Zhu. Z., Li, Z. (2017). Does where you live matter to your health? Investigating factors that influence the self-rated health of urban and rural Chinese residents: Evidence drawn from Chinese General Social Survey data. Health Qual Life Outcomes, 15(1), 1-12.
• Cislaghi, B., Cislaghi, C. (2019). Self-rated health as a valid indicator for health-equity analyses: evidence from the Italian health interview survey. BMC Public Health, 19(1),1-14.
• Dorjdagva, J., Batbaatar, E., Dorjsuren, B., Kauhanen, J. (2015). Explaining differences in education-related inequalities in health between urban and rural areas in Mongolia. IntJ Equity Health, 14(1), 1-13.
• Duboz, P., Boëtsch, G., Gueye, L., Macia, E. (2017) Self-rated health in Senegal: A comparison between urban and rural areas. PLoS One, 12(9),1-17.
• Grady, M., Goldblatt, P. (Ed.). (2012). Addressing the Social Determinants of Health: The Urban Dimension and the Role of Local Government. Copenhagen: WHO Regional Office for Europe.
• Irwin, A., Scali, E. (2010). Action on the Social Determinants of Health: Learning from Previous Experiences. Geneva:World Health Organization.
• Kien, V. D., Van Minh, H., Giang, K. B., Dao, A., Weinehall, L., Eriksson, M., Ng, N. (2017). Socioeconomic inequalities in self-reported chronic non-communicable diseases in urban Hanoi, Vietnam. Glob Public Health, 12(12),1522-1537.
• Laaksonen, M., Rahkonen, O., Martikainen, P., Lahelma, E. (2005). Socioeconomic position and self-rated health: The contribution of childhood socioeconomic circumstances, adult socioeconomic status, and material resources. Am J Public Health, 95(8),1403-1409.
• Lago, S., Cantarero, D., Rivera, B., Pascual, M., Blázquez-Fernández, C., Casal, B., Reyes, F. (2018). Socioeconomic status, health inequalities and non-communicable diseases: a systematic review. J Public Hea, 26(1),1-14.
• Lankila, T., Näyhä, S., Rautio, A., Nordström, T., Koiranen, M., Taanila, A., Rusanen, J. (2012). Self-reported health in urban-rural continuum: A grid-based analysis of Northern Finland Birth Cohort 1966. Int J Public Health, 57(3), 525-533.
• Levira, F., Todd G. (2017). Urban Health in Tanzania: Questioning the Urban Advantage. J Urban Heal, 94(3), 437-449.
• Mackenbach, J., Stirbu, I., Roskam, A., JR., Schaap, M. M., Menvielle, G., Leinsalu, M., Kunst, A. E. (2008). Socioeconomic Inequalities in Health in 22 European Countries. N Engl J Med, 358(12), 2468-2481.
• Nilüfer Kaymakamlığı. (2017). İdari Durum. Retrieved from http://www.nilufer.gov.tr/idari-durum.
• Nummela, O.P., Sulander, T.T., Heinonen, H.S., Uutela, A.K. (2007). Self-rated health and indicators of SES among the ageing in three types of communities. Scand J Public Health, 35(1), 39-47.
• Ompad, D. C., Galea, S., Caiaffa, W.T., Vlahov, D. (2007). Social determinants of the health of urban populations: Methodologic considerations. J Urban Heal, 84, 42-53.
• Pinillos-Franco, S., Kawachi, I. (2018). The relationship between social capital and self-rated health: A gendered analysis of 17 European countries. Soc Sci Med, 219, 30-35.
• Sommer, I., Griebler, U., Mahlknecht, P., Thaler, K., Bouskill, K., Gartlehner, G., & Mendis, S. (2015). Socioeconomic inequalities in non-communicable diseases and their risk factors: An overview of systematic reviews. BMC Public Health, 15(1),1-12.
• Turkish Statistical Institute. (2019). Labour Force Statistics. Retrieved from http://www.turkstat.gov.tr/PreHaberBultenleri.do?id=30689.
• Wilkinson, R., Marmot, M. (2003). Social Determinants of Health: The Solid Facts (2nd ed.). Copenhagen: WHO Regional Office for Europe. World Health Organization Commission on Social Determinants of Health. (2008). Closing the Gap in a Generation. Geneva: World Health Organization.
• World Health Organization. (2013a). Health 2020 A European Policy Framework and Strategy for the 21st Century. Copenhagen: WHO Regional Office for Europe.
• World Health Organization. (2013b). Handbook on Health Inequality Monitoring. Luxembourg: World Health Organization.
• World Health Organization. (2013c). The Economics of Social Determinants of Health and Health Inequalities - A Resource Book. Luxembourg: World Health Organization.