type 2 diabetes health equity audit in the basque public healthcare service
TRANSCRIPT
Type 2 Diabetes Health Equity Audit in the Basque
Public Healthcare Service (Spain)
Amaia Bacigalupe. Department of Sociology 2. University of the Basque Country. Spain
Santiago Esnaola. Department of Health. Basque Government. Spain
Introduction • The main determinants of health and health inequalities are outside
the healthcare services (Dahlgren and Whitehead, WHO, 2011)• Some studies have also stressed that the health services can play an
important role in reducing or increasing health inequalities• That´s exactly what we wanted to study, using a pathology, such as
type 2 diabetes, where great inequalities have been described in terms of prevalence and incidence at least in most Western societies.
Research question
Can health services reduce social inequalities in type 2 diabetes, regarding its main results (good metabolic control and complications
associated with the disease)?
Results• Great socioeconomic inequalities exist in DM2, as well as in its main risk
factors
Obesity Hypertension Smoking
Results• Health Services act more intensively on the diabetic population of lower
socioeconomic groups or, at least, no inequalities are produced
Lack of test of glycated hemoglobine
Referrals to specialists
Results• Despite an adequate management by healthcare services,
significant inequalities in DM2 related results persist
Poor metabolic control
Complications
Conclusion
Even if public funded and universally accessible health services, such as the Basque Health Service, can deliver
a “pro poor” healthcare, inequalities in health will remain or even worsen, unless other determinants of
health, outside the health system, are seriously tackled.
Introduction • The main determinants of health and health inequalities are outside
the healthcare services (Dahlgren and Whitehead, WHO, 2011)• Some studies have also stressed that the health services can play an
important role in reducing or increasing health inequalities.• That´s exactly what we wanted to study, using a pathology, such as
type 2 diabetes, where great inequalities have been described in terms of prevalence and incidence at least in all Western societies.
Research question
Can health services reduce social inequalities in diabetes, regarding its main results (good metabolic control and lack of
complications associated with the disease)?
Results: can be summarized in three main messages
• Great socioeconomic inequalities exist in DM2, as well as in its main risk factors (obesity, hypertension and smoking)
• Health Services act more intensively on the diabetic population of lower socioeconomic groups, doing more glycated hemoglobine tests) or at least no inequalities are seen among groups (as in referrals to specialists)
• Despite an adequate management by health services, significant socioeconomic inequalities in DM2 related results persist (mainly, complications and poor metabolic control)
• Conclusion: Even if public funded and universally accessible health services, such as the Basque Health Service, can deliver a “pro poor” healthcare, inequalities in health will remain or even worsen, unless other determinants of health, outside the health system, are seriously tackled.