Type 2 Diabetes Health Equity Audit in the Basque Public Healthcare Service

1. Type 2 Diabetes Health Equity Audit in the
Basque
Public Healthcare Service (Spain)
Amaia Bacigalupe. Department of Sociology 2. University of the
Basque Country. Spain
Santiago Esnaola. Department of Health. Basque Government.
Spain
amaia.bacigalupe@ehu.eus

2. Introduction
• The main determinants of health and health inequalities are
outside the healthcare services (Dahlgren and Whitehead, WHO,
2011)
• Some studies have also stressed that the health services can play an
important role in reducing or increasing health inequalities
• That´s exactly what we wanted to study, using a pathology, such as
type 2 diabetes, where great inequalities have been described in
terms of prevalence and incidence at least in most Western
societies.
Research question
Can health services reduce social inequalities in type 2 diabetes,
regarding its main results (good metabolic control and complications
associated with the disease)?

3. Results
• Great socioeconomic inequalities exist in DM2, as well as in its
main risk factors
Obesity Hypertension Smoking

4. Results
• Health Services act more intensively on the diabetic population of
lower socioeconomic groups or, at least, no inequalities are produced
Lack of test of
glycated hemoglobine
Referrals to
specialists

5. Results
• Despite an adequate management by healthcare services,
significant inequalities in DM2 related results persist
Poor metabolic control
Complications

6. Conclusion
Even if public funded and universally accessible health
services, such as the Basque Health Service, can
deliver a “pro poor” healthcare, inequalities in health
will remain or even worsen, unless other
determinants of health, outside the health system,
are seriously tackled.
Thanks!
amaia.bacigalupe@ehu.es

7. Introduction
• The main determinants of health and health inequalities are
outside the healthcare services (Dahlgren and Whitehead, WHO,
2011)
• Some studies have also stressed that the health services can play an
important role in reducing or increasing health inequalities.
• That´s exactly what we wanted to study, using a pathology, such as
type 2 diabetes, where great inequalities have been described in
terms of prevalence and incidence at least in all Western societies.
Research question
Can health services reduce social inequalities in diabetes,
regarding its main results (good metabolic control and lack of
complications associated with the disease)?

8. Results: can be summarized in three main
messages
• Great socioeconomic inequalities exist in DM2, as well as
in its main risk factors (obesity, hypertension and smoking)
• Health Services act more intensively on the diabetic
population of lower socioeconomic groups, doing more
glycated hemoglobine tests) or at least no inequalities are
seen among groups (as in referrals to specialists)
• Despite an adequate management by health services,
significant socioeconomic inequalities in DM2 related
results persist (mainly, complications and poor metabolic
control)
• Conclusion: Even if public funded and universally
accessible health services, such as the Basque Health
Service, can deliver a “pro poor” healthcare, inequalities in
health will remain or even worsen, unless other
determinants of health, outside the health system, are
seriously tackled.