Health inequalities

The higher the household income, the higher life expectancy at birth. During the period 2011-2014, life expectancy of people in the highest income group was around 84 years. Among the group with the lowest income this was around 77 years, a difference of 7 years. This is true for both men and women, although women in all income groups have a slightly higher life expectancy at birth than men (not shown in figure). In all income groups life expectancy increased between 2004 and 2014. The absolute differences in life expectancy between income groups remained virtually the same during this period. Another commonly used indicator for socio-economic health inequalities is educational level. During the period 2011-2014 the difference in life expectancy between low-educated and high-educated people was over six years (not shown in graph).

It is not certain how the increase in life expectancy will develop in the future for different socio-economic groups. The educational level of the Dutch population is expected to increase over the next few decades. As a consequence the composition of the group of low-educated people will change, which may possibly result in a concentration of risk factors for poorer health in this group. Yet, the increase in educational level could also result in the group of better educated people becoming more heterogeneous as regards the risk factors for health. It is uncertain what the consequences of this will be for differences in life expectancy between low-educated and high-educated people.

Low-educated people feel less healthy than high- educated people. The Trend Scenario shows that the percentage of low-educated people aged 25 years and over who feel healthy will decrease in the future, whereas this percentage will remain reasonably stable for high-educated people. The percentage of low-educated women who feel healthy will fall by more than the percentage of low-educated men (not shown in graph). Approximately 80 percent of the total population felt healthy in 2015 and will do so in 2040 (not shown in graph either).

Over the last few years, the proportion of self-employed people and flex-workers (employees not on a permanent contract) in the labour force has risen, and the proportion of employees on a permanent contract has fallen. Flex-workers slightly more often judge their health to be less good and/or are slightly less often satisfied with their life than employees on a permanent contract. This is the case above all among the group of flex-workers with a lower than average income. This income group is also larger among flex-workers than among the self-employed and people on a permanent contract. The health and life satisfaction perceived by the self-employed is comparable to that of permanent employees. Evidently, flex-workers and the self-employed often experience greater job insecurity than permanent employees. This insecurity is more likely to affect flex-workers and thus their wellbeing

It is uncertain how the relationship between health, life satisfaction, income and type of employment contract will develop in the future. This will depend in part on how the flexibilisation of the labour market will develop over the next 25 years.

In the Trend Scenario, overweight increases in all educational groups in the period up to 2040. In the future, the proportion of people aged 25 years and over who are overweight (Body Mass Index (BMI) higher than 25) will remain the greatest among low-educated people. However, the differences in the proportion of those overweight between educational groups will be smaller compared with the current difference in the proportion of those overweight. There may be a ceiling effect for low-educated people (see graph). This projection is based on the historical trend from 1990 to 2015 in the occurrence of overweight. In this period the percentage of adults who are overweight rose, but over the last few years the trend has become slightly less clear. From 2010, there appeared to be a stabilisation in the increase of those overweight in the total population, but from 2014 the percentage of adults who were overweight again appeared to increase slightly (not shown in graph).

The Trend Scenario shows that the percentage of people who smoke will fall in the future among both high-educated and low-educated people aged 25 years and over. Most of these people are daily smokers, but they also include people who smoke occasionally. The percentage of daily smokers will also fall in all educational groups (not shown in graph). This decrease will be the greatest among high-educated people. By implication, the differences in smoking levels between high-educated and low-educated people will increase in the future. In 2015, 17 percent of high-educated people smoked occasionally, and in 2040 this will be 7 percent (a decrease of 10 percentage points). For low-educated people, the proportion of occasional smokers will fall from 27 percent to 19 percent (a decrease of 8 percentage points). In 2040, the percentage of smokers among low-educated people will therefore almost triple the percentage among high-educated people. Among the entire population, the percentage of smokers will fall in the Trend Scenario from 25 percent in 2015 to 14 percent in 2040 (not shown in graph).

Virtually everywhere in the Netherlands the European Standards for air quality are now being met. Nevertheless, there are still negative effects on health caused by air pollution components such as particulate matter (PM10, PM2.5, PM0.1), NO2 and soot. For instance, with the current concentrations particulate matter (PM10) reduces life expectancy by on average nine months and NO2 by four months. The concentration of PM10 was reasonably uniformly distributed over the Netherlands in 2015, with a few locally elevated levels. High local particulate matter concentrations can be related to local activities such as the storage and transhipment of dry bulk goods in the ports, and by poultry stalls and fertiliser emissions in the agricultural sector as well as by the incineration of biomass such as wood, or by intensive traffic. In the future, the air will become cleaner and the concentrations of PM10, PM2.5, NO2 and soot will fall. Nevertheless, regional variations will remain as a result of local conditions such as agricultural activities, traffic, households or industry and local incidents.