Geographical inequality in health: results from a population-based health survey

BACKGROUND: The greatest public health concern is social inequality in health, which also includes a geographic dimension. Residents of less resourceful areas are often disproportionately exposed to health risks, and the negative health effects of both low social position and unhealthy surroundings can exacerbate each other. This study aims to explore the relationship between sociodemographic characteristics of local areas, health behavior and mental health. METHODS: The study used self-reported data from the ‘How are you? 2021’ health survey conducted in the Central Denmark Region (N = 33,925), and parish-level data from Statistics Denmark. Latent Profile Analysis was used to group parishes into five socio-geographic groups based on social composition, where deprived areas were characterized by low income, high unemployment, and low education. Health behavior and mental health were compared across socio-geographic groups using linear regression, contrasts and linear hypothesis tests. RESULTS: Citizens in less resourceful areas exhibit higher prevalence rates of daily smoking, physical inactivity, unhealthy diet, and obesity, alongside higher levels of perceived stress and depressive symptoms, as compared to citizens in more affluent areas. However, a higher proportion of individuals in affluent areas exceeded the Danish Health Authority's low-risk recommendations for alcohol consumption. CONCLUSIONS: The health outcomes of citizens living in less resourceful areas are inferior to those of citizens in more affluent areas. Residents in less resourceful areas exhibit poorer health outcomes across health behaviors and mental health. Based on the study's findings, implementing health promotion initiatives at the local level and addressing the underlying social inequality through structural efforts are necessary. This could potentially help to reduce the disparities in health outcomes in citizens in less resourceful areas compared to those in more affluent areas. KEY MESSAGES: • Health outcomes of citizens in less resourceful areas are inferior to those living in affluent areas. • Local health promotion initiatives and structural efforts addressing social inequality is needed.