Strukturelle und verhaltensbezogene determinanten gesundheitlicher ungleichheit

The relative importance of structural and behavioural determinants of health inequalities was analysed, based on data from the 3. National Health Survey of the DHP-Study and taking into account the fact that behavioural factors are often based on structural factors. When structural and behavioural determinants are analysed separately, their contribution to the explanation of health inequalities is of similar magnitude. There are large gender differences concerning the magnitude of the overall explanation of health inequalities: For men, 30-40% of the health inequalities can be explained by the structural and behavioural determinants, and for women, the percentage is only 5-20%. Including structural and behavioural determinants in one single model shows that a considerable part of health inequalities can be explained by their overlap. This overlap can be defined as the indirect effect of structural factors, i.e. structural factors having an effect on behavioural factors that in turn effect health inequalities. When the overlap is included, the total effect of structural factors on health inequalities is much larger than the effect of behavioural factors. The results support the assumptions that health relevant behaviour is at least partly determined by structural factors, and that, therefore, the reduction of health inequalities can hardly be achieved by interventions aiming exclusively at behavioural factors. It is concluded that structural factors have the greatest potential for reducing health inequalities.