In Germany and other European countries, inequalities in health are growing. However, the underlying mechanisms which mediate the association between socio-economic disadvantage and health have not yet been fully understood. Existing explanatory models often fail to acknowledge the role of contextual variables located at the level of regions, counties and neighborhoods (as compared to factors at individual level); in addition, they tend to put too little emphasis on the temporal dimension of the association of low socioeconomic status and poor health. During the ZiF-workshop the need for modifying existing explanatory models of the association between place, time and health was discussed in an interdisciplinary approach. Experts from the fields of geography, statistics, epidemiology and sociology collaborated, in addition to experts from the fields of health sciences/medicine. Theoretical models on space, place and health were covered, as well as empirical findings of research on spatial determinants of health, statistical methods and data in research on contextual factors and implications for health services. This workshop brought together over thirty researchers from different disciplines coming from France, Great Britain, the Netherlands, Sweden, Austria and Germany.
Jens S. Dangschat (Vienna University of Technology) introduced the topic of the workshop in his presentation on 'Social inequality and space'. Jamie Pearce (University of Edinburgh) focused on 'Theorising space, place and health inequalities during a period of austerity'. Eva Kibele (University of Groningen) covered 'Regional mortality differences in Germany: spatial patterns, temporal trends, and contextual determinants' and Juan Merlo (Lund University, Malmö) 'Bringing the individual back to small-area variation studies'.
In the section on statistical methods, Barbara Hoffmann (Heinrich Heine University, Düsseldorf) looked at 'Environmental equity: a multilevel study design to identify social groups with a high exposure to environmental hazards-traffic, noise and particulate matter', and Alastair H. Leyland (Social and Public Health Sciences Unit, Glasgow) spoke on 'Multilevel modelling as a tool to assess area-based inequalities in health'. Jan Goebel (German Institute for Economic Research (DIW), Berlin) presented the 'Analytical potentials of the Socio-Economic Panel (SOEP) to study health inequalities with respect to space and time', Basile Chaix (Medical Faculty of Paris) covered 'Incorporating mobility in neighborhood and health studies through surveys of regular destinations and GPS tracking (the RECORD Study)'. Jürgen Schweikart (University of Applied Sciences, Berlin) showed 'Geographical methods illustrated by the accessibility of outpatient care in Berlin'. Jörg Betzin (National Association of Statutory Health Insurance Funds (GKV-Spitzenverband), Berlin) presented 'Structural equation models to analyze the relationship between regional indicators and health care servicing', and Thomas Kneib from Georg-August-University in Göttingen 'Structured Additive Regression Models'.
Implications for Health Services were addressed by Peter Schröder-Bäck and Greg Stapleton (Maastricht University) in their presentation on 'Ethical issues related to regional differences in primary care', as well as by Frauke Kupfernagel and Thomas Uhlemann (National Association of Statutory Health Insurance Funds (GKV-Spitzenverband), Berlin) in a presentation on 'Regional planning of primary care with respect to regional health disparities'. Finally, Peter P. Groenewegen et al. (Netherlands Institute for Health Services Research in Utrecht) presented a European comparison on 'Strength of primary care and health outcomes for chronically ill people'.
The discussions showed that a good cooperation between the different disciplines is essential to analyse and reduce inequalities in health. It helps to link theoretical models of health inequalities with empirical findings, to apply the latest and most powerful statistical and geographical methods, and to match the interests and questions of health service stakeholders and public health researchers.
Jörg Betzin (Berlin, GER), Verena Bohn (Bielefeld, GER), Gabriele Bolte (München, GER), Jürgen Breckenkamp (Bielefeld, GER), Christoph Buck (Bremen, GER), Basile Chaix (Paris, FRA), Thomas Classen (Bielefeld, GER), Jens S. Dangschat (Wien, AUT), Jan Goebel (Berlin, GER), Peter P. Groenewegen (Utrecht, NED), Barbara Hoffmann (Düsseldorf, GER), Eva Kibele (Groningen, NED), Thomas Kneib (Göttingen, GER), Daniela Koller (Bremen, GER), Frauke Kupfernagel (Berlin, GER), Alastair H. Leyland (Glasgow, GBR), Werner Maier (Neuherberg, GER), Juan Merlo (Malmö, SWE), Friedrich Meschede (Bielefeld, GER), Jamie Pearce (Edinburgh, GBR), Anna Rieger (München, GER), Odile Sauzet (Bielefeld, GER), Sven Schneider (Mannheim, GER), Peter Schröder-Bäck (Maastricht, NED), Jürgen Schweikart (Berlin, GER)