Demographic and socio-economic factors are important determinants of health.   In general, people who are economically more disadvantaged also face the double jeopardy of being:

• subject to higher exposures to environmental pollutants and other hazards (the so-called problem of environmental injustice or inequity), because of being involved in more hazardous occupations and because of where they live;
• to have less healthy lifestyles, due to poor diet, poor housing and lack of educational opportunities or access to social care and health services.  

These factors in turn contribute to noticeable gradients in mortality and morbidity by socio-economic status.

 

Indicators of socio-economic status

For these reasons, socio-eonomic status (SES) is often seen as an indicator of both vulnerability and susceptibility to environmental effects on health, and efforts are often made to take account of SES both in epidemiological studies and in environmental health impact assessment.  The indicators used vary, in part because of cultural differences between different countries, but in part also because of differences in data availability. Common measures include indicators of income or wealth, education and occupation, or some aggregation of these and other variables in the form of an index of deprivation.  Some countries now have relatively well established indexes of this sort, usually based on census data or other routine statistics.  Examples include the (somewhat different) indices used across the United Kingdom.  Care is of course needed in using measures of SES in environmental health impact studies for two crucial reasons:

1. SES in itself is not a direct cause of differences in health, but rather an indirect determinant, which operates through factors such as diet and lifestyle;
2. SES tends to be associated both both levels of exposure (vulnerability) and degree of susceptibility, so confounding may occur in relationships between SES and health; it is important neither to dilute or remove the influence of the environment, by controlling for SES, nor to inflate possible health impacts by double-counting the joint effects of socio-economic status and environmental factors. 

Sources of data on socio-economic status

A common European index of deprivation has not been developed.  Information on socio-economic characteristics is available, however, from Eurostat - the statistical office of the European Union, which is tasked with providing statistics at European level that enable comparisons between countries and regions.  Eurostat’s main role is to collect statistics supplied by Member States, and consolidate these using a harmonised methodology.   This is facilitated by the NUTS (Nationales Unites Territoriales Statistiques) system, a standard hierarchy of administrative regions established in Europe.   Member States are subdivided into three levels with 1 to 3 representing country, province/state and county/department areas, respectively.   It is statistics for these top levels that are available through Eurostat, many of which are crucial for informing decisions and evaluation at European level. 

Eurostat provides statistics on a wide range of socio-economic themes.  Amongst these, those most of relevance for the derivation of measures of SES relate to health, education, labour, income, living conditions, social protection, crime and culture, all available via the Eurostat Population and social conditions theme http://epp.eurostat.ec.europa.eu/portal/page/portal/statistics/themes.    For the most part, these data are available at NUTS 2 or NUTs 3 level.

National statistical offices also serve a vital role in providing socio-economic statistics and indicators.   Many of these are available for relatively small administrative areas (e.g. communes or census tracts), enabling them to be used for sub-national, city or small area assessments.  If available, statistics for LAUs can usually be obtained from the National statistics offices; links to these websites can be found via the Eurostat portal:  http://epp.eurostat.ec.europa.eu/portal/page/portal/links/national_statistical_offices.