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10 The LSE companion to health policy

European level, neither the European Community Household Panel Survey (ECHP)
nor the European Union Survey of Income and Leaving Conditions (EU- SILC) include
objective measures, only self- reports. Only the Survey of Health, Ageing and Retirement
in Europe (SHARE) and the forthcoming European Health Interview Survey include
objective (e.g. walking speed, grip strength) and quasi- objective (e.g. activities of daily
living, symptoms) measures of health. At national level, only few countries include
objective measures, such as Finland (blood tests and anthropometric tests FINRISK),
Germany (anthropometric measures National Health Interview and Examination
Survey; urine and blood samples German Health Survey for Children and Adolescents)
and the UK English Longitudinal Study of Ageing (ELSA) and Health Survey of
England (HSE).
Together with their limited availability, biomarkers may still be subject to bias and
are not included in longitudinal data. The main methodological challenge lies with the
standardisation of data collection, as variations may arise from diferent methods of
collection. For example, a persons blood pressure may vary according to the time of
day it is taken. In fact, information on the details of objective health data collection is
not often provided. This measurement error is particularly problematic if it is correlated
with sociodemographic characteristics, hence biasing estimates of social inequalities.
Collecting biological data also tends to reduce survey response rates, which limits the
sample size and their representativeness (Masseria et al., 2007). The limitation of biologi-
cal markers to cross- sectional data is an important disadvantage since longitudinal data
allow the exploration of the dynamic relationship between health, socioeconomic status
and access to health care (Hernndez- Quevedo et al., 2008).
4.2 Measuring the Socioeconomic Gradient
Box 1.2 describes diferent potential sources of a socioeconomic gradient that might
well difer across the individuals life cycle (e.g. those early in the cycle rely more on
their wealth than on income). Normally, studies employ a measure of income but fail to
account for measures of wealth in computing the socioeconomic position ranking to then
estimate a concentration index. Normally, income data employed are current income,
although a few studies have managed to disentangle the efect of permanent income.
Similarly, in measuring the efect of wealth, diferent sources of wealth such as savings
and housing wealth traditionally exert diferent efects in that some are more liquid and
easy to transform into income. Finally, other important factors that are associated with
income and not all studies control for are knowledge and social environment.
4.3 Data Sets
The main data sets analysed to measure equity in health at the European level are the
Statistics on Income and Living Conditions (EU- SILC) and the European Community
Household Panel (ECHP), both provided by Eurostat, which are general socioeconomic
data sets that favour cross- country analysis, together with health national surveys
such as the British Household Panel Survey. The World Health Survey also includes
a self- reported measure of health and health in eight domains, such as mobility, self-
care, pain and discomfort, cognition, interpersonal activities, vision, sleep and energy,
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