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Leaving no one behind: intersectional health system equity in Sweden

Research project Swedish healthcare is not universally provided on equal terms across gender, education, income, country of origin, sexual orientation, or disability.

Research and monitoring of care tend to analyse inequities one by one, there is scarce evidence on who, where and how the combination of these inequities create particularly vulnerable groups and pressing inequities in the Swedish health system.

Head of project

Per Gustafsson
Associate professor
E-mail
Email

Project overview

Project period:

2021-01-01 2024-12-31

Participating departments and units at Umeå University

Department of Epidemiology and Global Health

External partners

The Public Health Agency of Sweden

Research area

Public health and health care science

Project description

Purpose
The project will use population-based survey and register data in Sweden 2001-2020 and apply an intersectional equity framework to respond to the following research questions:

  1. For whom do inequities arise in the Swedish health system? - Which population groups are furthest left behind?

  2. Where in the Swedish health system do inequities arise? - Which aspect and level of the health system functions more or less inequitably?

  3. How do inequities arise in health system utilization? - What are the health system barriers and social processes underpinning the inequities?

Description

Achieving an equitable health system is an important accelerator for equitable population health, leaving no one behind. But who are the ones left furthest behind in the Swedish health system; in which parts of the health system do inequities arise; and what are the barriers to equity?

A critique emerging in recent years within epidemiology poses that health inequities conventionally are understood and studied in a too simplified way; for example, as a separate health gap first between women and men, second between educational groups, and third between native- and foreign-born.

An intersectionality framework, in contrast, involves taking into account multiple social groupings are intertwined and combine into complex inequities in health and healthcare. The present project will use an intersectional equity framework that emphasizes the interrelations between multiple inequities, to examine inequities in health system utilization and outcomes across three levels – a) preventive policy; b) primary health care; and c) secondary (hospital-based) care - in Sweden 2001-2020. 

The specific research questions are:
1. For whom do inequities arise in the Swedish health system? - Which population groups are furthest left behind?

2. Where in the Swedish health system do inequities arise? - Which aspect and level of the health system functions more or less inequitably?

3. How do inequities arise in health system utilization? - What are the health system barriers and social processes underpinning the inequities?

The project will use population data in Sweden 2001-2020 to examine multiple combinations of dimensions of inequity as expressed within the health system use and outcomes, using novel statistical methods.

The project team includes both researchers at Umeå University as well at collaborators at the Public Health Agency of Sweden, facilitating dissemination of findings and translation to national-level public health policy.