Health disparities in adults

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Increase in differences by education, income and age over the past ten years   

In general, Utrecht residents are healthy. However, there are also major differences between groups in health and factors that influence health. Differences between groups increase over the years, or negatively decrease, based on education, income and age. More specifically, there are several more negative changes over time among: 

• Utrecht residents who have difficulty making ends meet compared with Utrecht residents who have no difficulty making ends meet. 
• Utrecht residents with senior secondary vocational, senior general secondary or pre-university education as their most recent education and Utrecht residents with primary education or pre-vocational secondary education as their most recent education (particularly up to and including 2016) compared with Utrecht residents with a university of applied sciences or a university degree. 
• Young adults aged 18 to 24 compared with other age groups (particularly between 2020 and 2022). 

Percentage of Utrecht residents with good perceived health based on income 

Negative changes in quality of life and social environment 

There are changes in differences for almost all groups on a number of health themes and factors that influence health. Particularly in the areas of quality of life and social environment. The differences between several groups in the city are increasing or decreasing in a negative way. In terms of work situation, the differences between several groups are actually becoming smaller (positive change). 

Utrecht residents with the greatest risk of being disadvantaged compared with other groups 

• Utrecht residents who have difficulty making ends meet 
• Utrecht residents with primary education or pre-vocational secondary education as their most recent education 
• Utrecht residents who live alone 
• First-generation migrants 

The current study shows that the chances of good health in Utrecht are not equal. Health differences by education, income and age remain big and are sometimes increasing. This also applies to differences in factors that influence health. This study confirms that unequal investment is necessary for equal opportunities for a healthy life, see the current coalition agreement Investing in Utrecht (in Dutch):

Choosing equal opportunities, affordable housing and climate.

Which groups of Utrecht residents have a greater risk of health disadvantages? 

The current study shows that it remains important to focus on the well-known groups: 

• Residents who have difficulty making ends meet. This is particularly urgent, since the number of Utrecht residents struggling to make ends meet is increasing. 
• Residents with primary education or pre-vocational secondary education as their last education. 

Two new groups of Utrecht residents are at risk of belonging to the groups with the greatest health inequalities: 

• Utrecht residents with senior secondary vocational, senior general secondary or pre-university education as their last education 
• Young adults (18 to 24 year olds)  

Both groups have a stronger negative development for health and factors that influence health than the other groups. These groups require attention when it comes to unequal investment for equal opportunities. It is important to recognise that not all Utrecht residents in these groups have health problems. Conversely, some of the other Utrecht residents also have health problems. Although the risk is less likely, Utrecht residents with a university of applied sciences or a university degree or Utrecht residents who can make ends meet may also have health problems. 

Work integrally and across domains to reduce health differences 

This study confirms the importance of an integrated and cross-domain approach for reducing health differences. There are major differences in many domains in Utrecht. For example, the current publication shows an increase in differences in the social environment for almost all groups in recent years. It also shows that health differences between people who are struggling and who are not struggling to make ends meet are increasing . These results are in line with other studies in Utrecht. The integrated, cross-domain approach is also recommended by the Social and Economic Council of the Netherlands. 

Positive developments in health differences 

There are also positive developments:  

• The disadvantage of Utrecht residents with primary education or pre-vocational secondary education in physical health and factors that influence health does not appear to be increasing since 2016. 
• First-generation migrants still have a major health disadvantage, but the differences are decreasing for the themes work and income status. 
• With regard to the theme of work, differences have become smaller not only in terms of migration background, but also in terms of education and making ends meet. This is encouraging because it is a factor that ensures social security, one of the main causes of health differences. 

Future developments are uncertain 

Lastly, remember that this publication focuses on trends over approximately the last ten years. We have seen quite a few changes in health in the last few years. Evidence shows that all kinds of social changes influence this, such as the COVID-19 pandemic, inflation, wars and the climate crisis. This makes predicting how differences in health and factors that influence health will develop particularly complex. 

This publication describes the differences in Utrecht and the changes in differences over the past ten years for the themes in the Utrecht Health Model. We divide these into:  

• Health; such as perceived health, control over your life, mental health and physical health. 
• Factors that influence health; such as lifestyle, social and physical environment, safety, health care, work and income situation and education and skills.  

Changes in health differences and factors that influence health have been examined by gender, education, type of household, making ends meet, age and migration background. Also, we highlight some themes where several negative or positive changes in differences are visible.