Regional inequalities in self-reported conditions and non-communicable diseases in European countries: Findings from the European Social Survey (2014) special module on the social determinants of health

Background: Within the European Union (EU), substantial efforts are being made to achieve economic and social
cohesion, and the reduction of health inequalities between EU regions is integral to this process. This paper is the
first to examine how self-reported conditions and non-communicable diseases (NCDs) vary spatially between and
within countries. Methods: Using 2014 European Social Survey (ESS) data from 20 countries, this paper examines
how regional inequalities in self-reported conditions and NCDs vary for men and women in 174 regions (levels 1
and 2 Nomenclature of Statistical Territorial Units, ‘NUTS’). We document absolute and relative inequalities across
Europe in the prevalence of eight conditions: general health, overweight/obesity, mental health, heart or circulation
problems, high blood pressure, back, neck, muscular or joint pain, diabetes and cancer. Results: There is
considerable inequality in self-reported conditions and NCDs between the regions of Europe, with rates highest in
the regions of continental Europe, some Scandinavian regions and parts of the UK and lowest around regions
bordering the Alps, in Ireland and France. However, for mental health and cancer, rates are highest in regions of
Eastern European and lowest in some Nordic regions, Ireland and isolated regions in continental Europe. There are
also widespread and consistent absolute and relative regional inequalities in all conditions within countries. These
are largest in France, Germany and the UK, and smallest in Denmark, Sweden and Norway. There were higher
inequalities amongst women. Conclusion: Using newly available harmonized morbidity data from across Europe,
this paper shows that there are considerable regional inequalities within and between European countries in the
distribution of self-reported conditions and NCDs.