Atlas of Health Inequalities in Europe User Manual
Contents
1. Crude death rate total All causes of death A00 Y89 less than 15 years males Crude death rate total All causes of death A00 Y89 less than 15 years both Y Hospitalisations Standardized hospitalisation rate c0000 All causes A00 Z99 excluding V W X tandardized hospitalisation rate cOO0e All causes A00 Z99 excluding V W X 3q 4q M Sol Title Buttons Map Bar Chart Legend Pie Chart Spine Chart The components and the navigation in this type of Atlas are similar to the ones described before However you will find two new components of dynamic report in this atlas the Pie and Spine Charts 5 2 Pie Chart The pie chart shows the proportion of regions and their value ranges in each quintile class Moving the mouse pointer over the chart will display the value in each class In the illustration below Figure 27b it displays 4 7 5 3 18 5 This means that the Health Inequalities in Europe Interactive Atlas User Manual 35 WHO EC Equity in Health Project value of the selected slice of pie ranges from 4 7 to 5 3 which is 18 5 of the total regions You can define the number of classes from Legend Options Figure 27 Pie chart a in 4 7 5 3 18 508 4 7 5 3 18 59 You can click on the slice Figure 27c to select the regions Clicking on the slice instantly shades the Map according to the legend colour as well as displays the values of selected slice2. 2 Child health atlases by socio economic variable In each of these categories six atlases one for each of the following socioeconomic indicators are available 1 Income of households Disposable income net uses Purchasing power standard based on final consumption per inhabitant PPS are country averages 2 Percentage of population by highest level of education attained Pre primary primary and lower secondary education levels 0 2 ISCED 1997 Both sexes Between 25 and 64 years 3 Percentage of population by highest level of education attained Tertiary education levels 5 6 ISCED 1997 Both sexes Between 25 and 64 years 4 Unemployment rates by sex and age 25 years and over Both sexes 5 Long term unemployment 12 months and more Long term unemployment rate on total unemployment 6 Infant mortality rate as an indirect measure of overall human development The full list of indicators in the social health inequalities atlases related to avoidable mortality and child health is provided in Annex 3b and 3c ISCED refers to International Standard Classification of Education For further information see http www unesco org education information nfsunesco doc isced 1997 htm Alternatively you will find the complete report at http www uis unesco org TEMPLATE pdf isced ISCED_A pdf Health Inequalities in Europe Interactive Atlas User Manual 25 WHO EC Equity in Health Project 4 2 Getting Start
3. Purchasing power standard based on final consumption per inhabitant Long term unemployment 12 months and more Long term unemployment rate on total unemployment Infant mortality rate 2 Health System Resources a Hospital beds HP 1 by region Available beds in hospitals HP 1 per 100 000 inhabitants Health personnel by region Physicians or doctors per 100 000 inhabitants Health personnel by region Nurses and midwives per 100 000 inhabitants 3 Mortality a Standardized death rate Amenable causes of death 02 11 17 18 27 34 36 38 39 43 50 and 54 Less than 65 years females b Life expectancy at birth males c Life expectancy at birth both sexes d Standardized death rate All causes of death all ages females e Standardized death rate All causes of death all ages males f Standardized death rate All causes of death all ages both sexes g Life expectancy at birth females h Standardized death rate Amenable causes of death 02 11 17 27 34 36 38 39 43 and 54 Less than 65 years males i Standardized death rate Amenable causes of death 02 11 17 18 27 34 36 38 39 43 50 and 54 Less than 65 years both sexes j Crude death rate total All causes of death A00 Y89 less than 15 years females k Crude death rate total All causes of death A00 Y89 less than 15 years both sexes l Crude death ra
4. expectancy gt gt At birth Both sexes Note that the Map appearance will not change but there will be changes in the values of the Legend and Tables and scale of the bar Chart showing negative values Figure 22 In addition you will see that the average difference of Group 5 in relation to Group 1 is 5 6 years as mentioned above but there are regions in Group 5 that are farther below down to 9 9 years indicating the presence of important life Health Inequalities in Europe Interactive Atlas User Manual 28 WHO EC Equity in Health Project expectancy inequalities within quintile groups Likewise there are a few regions that are 2 years above Group 1 average Figure 22 Example with absolute health indicator differences between socioeconomic groups Area Target Difference Life Expectancy gt gt At birth both sexes tay Sane rumonr Data Filter 2 Regions Value Group 29 Q c 2x4 Q AT11 Burgenlan 1 1 QidoccL2 TE E j Q AT12 Niederdsterreic 9 BH 1 1 0 3 3 D Q AT13 Wien 1 2 B 0 2 0 5 a Q AT21 K rnten 0 1 Moe 25 DA AT22 No Data 4 QA AT31 O National Borders P J 2 ze Q AT32 Salzbur O Rectangle oc P 3 A AT33 Tir z Q AT34 3 Q Be R gion de Bruxelles Ca 3 Q BE21 Prov Antwerpen 4 Q BE22 Prov Limburg B Name Group 1 least depri Q BE23 Prov Oost Vlaanderen Group 2 Q BE24
5. all ages males s of death all ages both sexes m co o Io m Eo fees De causes of death 02 11 17 27 34 36 3 m J causes of death 02 11 17 27 34 36 38 3 NO04 Agder J E z Er N C ow Oo wo Oo ul MU t oo w woo N or NON oh u nable causes of death 02 11 17 18 27 34 36 3 auses of death A00 Y89 less than 15 years causes of death 400 Y83 less than 15 years males NOO4 ul m o uN auses of death A00 Y89 less than years ot ion rate c0000 All causes A00 Z99 excluding V W X 7 z o o E no n u zo mE mom ion rate cOO0e All causes A00 Z99 excluding V W X Soll a tu Wow d d d Ww I a v Li n 2 UE o W ig n Holding Ctrl key and clicking on geographic area regions in the map will allow you to select and compare 2 regions You can instantly observe the changes in the Bar chart pie chart as well as in Spine chart Health Inequalities in Europe Interactive Atlas User Manual 38 WHO EC Equity in Health Project Dynamic Linkages There are dynamic linkages or brushing between the components in Regional Profile Comparison atlas This means that if you select any value in one component for example in a map all other components will be updated 5 4 New Buttons in Regional Profile Comparison Atlas In addition to the above mentioned features you will find two more buttons in this atl
6. 13 580 8 5 Q BG31 Severozapaden No Data N 15 012 8 17 044 12 888 9 13 320 8 i DU Veep Vem Un uU IX UN a 2 ta 3 3 3 12 987 4 5 Q BG32 Severen tsentralen No Data N o Data o Data 4 BG33 Severoiztochen No Data No Data o Data 5 Q BG34 Yugoiztochen No Data N Disposable income net uses Purchasing power standard based on final consumption per inhabitant Please do not or use these materials without written consent of WHO Title Buttons Legend Map Tables Context Menu Bar Chart Socioeconomic variable The atlas of social health inequalities has the same global features as described in earlier sections Part II of this manual In this new report you will also see a bar Chart and two data Tables which will be explained further in the coming sections Health Inequalities in Europe Interactive Atlas User Manual 26 WHO EC Equity in Health Project 43 Barchart Q You will see the ranked bar chart shaded according to the legend that 1s by the selected indicator Moving the mouse pointer over the bar chart displays comparison values for the selected regions Figure 20 Figure 20 Ranked Bar Chart NOO04 Agder og Rogaland 30 8 With the mouse pointer over the bar chart clicking on any bar chart will automatically highlight the data in the Table and its geographic location in the Map for selected bars You can select single or multiple bars by holding Ctrl key and
7. By default the first indicator available in the Data or Filter buttons described below is shown When another one of the list 1s selected it changes accordingly 2 2 Buttons When clicking on a Data or Filter button a drop down menu in list form is displayed The arrow signs indicate further sub division of the list and clicking on them will open each list which may be on Data Indicators or Filter regions To collapse or close the subdivision list click on this arrow sign again A click on the or signs at the bottom of the window will expand or collapse the whole list Moreover by clicking on an indicator or region in the list modifies the report display Only one variable may be displayed in a map at a time with up to two maps depending on the type of Atlas By clicking on the Help button it will display a webpage showing handy tips on using the Report Once the help window is opened you can click on the section of your interest to jump directly to it 2 3 Legend The Legend provides information about the way the data values from an indicator are organized or classified Try moving your mouse over the data and maps and click on some of the buttons You can toggle your contextual geographies by clicking the checkboxes in the legend as well as toggle the data and filter menu Once you load the Atlas Map Figure 2 Legend properties the legend is displayed below ru 4 Regions the Data and Filter button
8. Prov Vlaams Brabant Group 3 Q BE25 Prov West Vlaanderen Q BE31 Prov Brabant Wallon Q BE32 j Q BE33 Pro Q BE34 Q BESS j Q G31 Severoza Q BG32 Severen tsentralen Group 4 Group 5 most depr DOR Bo B PP oQ FN ON WO FP BP BP YP BP GGG H Disposable income net uses Purchasing power standard based on final consumption per inhabitant Please do not quote or use these materials without written consent of WHO 1 1 on fo FN O ND PF O0 1 m Differences between socioeconomic groups can also be displayed as ratios This time the example involves avoidable mortality e g certain preventable causes of deaths occurring before the age of 65 years of age for both sexes and all causes combined The report Title should look like this Area Target Ratio Amenable mortality Both sexes 0 64y gt gt gt Amenable causes of death 02 11 17 18 27 34 36 38 39 43 50 and 54 The resulting Legend shows the quintile classification scheme with a large range of values starting at 63 1 and ending at 408 6 Health Inequalities in Europe Interactive Atlas User Manual 29 WHO EC Equity in Health Project Figure 23 These values mean that there are regions where the amenable mortality rate is as low as two thirds as that of the target Group 1 average or four times higher than the target Moreover the socioeconomic group figures in the Table and the b
9. or doctors Per 100 000 inhabitants AT21 K rnten or doctors Per 100 000 inhabitants AT31 do idwives Per 100 000 inhabitants AT21 K rnten dwi o o idwives Per 100 000 inhabitants AT31 AT21 K rnten kad to co o AT31 4 7 5 3 18 5 ife expectancy at birth males AT21 K rnten J Ma to PU co oo o oo Q0 N N irth males AT31 at birth both sexes AT21 K rnten at birth both sexes AT31 E o io co W m 5 3 Spine Chart Spine Chart gives you at a glance an assessment of cross indicator area profiles as shown below Health Inequalities in Europe Interactive Atlas User Manual 36 WHO EC Equity in Health Project Figure 29 Spine chart Indicator Performance Y Socio economic indicators Income of households Disposable income net uses Purchasing power standard amp T21 K rnten Income of households Disposable income net uses Purchasing power standard amp T31 Ober J gt J t Percentage of population by highest level of education attained Pre primary prima AT21 K rnten Percentage of population by highest level of education attained Pre primary prima AT31 Ober J UJ UJ UJ b u uu w Percentage of population by highest level of education attained Tertiary education amp T21 K rnten r t om uo 0 MJ J n A J MJ J J L I J Percentage of population by highest level o
10. plot it will display the name e g FR3 Nord Pas de Calais and values for each indicator x 13 513 4 y 74 of the selected geographic region In addition you will find statistical information about the scatter plot which 1s displayed as the title of the graph in the example Pearson s correlation coefficient r 0 74 r squared 0 55 and the regression equation y 0 0x 69 24 If needed you can select more than one value or region in the scatter plot For this you need to do the following e Put the mouse cursor over the scatter plot e Click the left mouse button hold and the drag mouse pointer over the values that you would like to select as shown in Figure 17 a The selected values will be instantly highlighted If you want to select individual values click on the value then hold down Ctrl Key and keep on clicking the values that you want to select Moreover if you want to select values from different locations of the scatter plot you can do that too Repeat Health Inequalities in Europe Interactive Atlas User Manual 21 WHO EC Equity in Health Project the steps mentioned for Figure 17 a then hold down Ctrl Key and select the values by holding and dragging mouse pointer as shown in Figure 17 b Figure 17 Selection of values in a scatter plot uation y 0 00x 69 24 66 64 6000 10000 14000 18000 22000 26000 30000 34000 38000 2000 6000 10000 14000 18000 22000 26000 30000 34000 38000 8000 12000 16000 2000
11. rate both sexes all ages Standardized death rate females 0 64 years Standardized death rate males 0 64 years Standardized death rate both sexes 0 64 years Standardized hospitalisation rate ameanable causes females 0 74 y y amp Standardized hospitalisation rate ameanable causes males 0 74 oO wz 1 Standardized hospitalisation rate ameanable causes both sexes 0 74 y 4l p Standardized hospitalisation rate ameanable causes females 45 74 y p Standardized hospitalisation rate ameanable causes males 45 74 y Clicking on the themes such as ife expectancy will display all the sub groups available for the atlas shown in Figure 6 You can do the same with other themes to see the available indicators Life expectancy At birth both sexes Figure 6 Indicators descriptive and correlation w Life expectancy analysis atlas 1 At birth females i i E CRC Clicking on the notes icon next to the 4 At birth both sexes teer demde indicator name will link to the metadata and 3 4 At age 5 males At age 5 both sexes display additional summary information on 4 At age 25 females Epa eee eerie data geographical and Statistical 5 At age 25 both sexes 5 At age 65 females 4 At age 65 males distribution quality and availability of indicator selected shown in Figure 7 For illustration purposes we wi
12. 0 24000 28000 32000 36000 4000 8000 12000 16000 20000 24000 28000 32000 36000 es PPS based on final consumption per inhabitant d income net uses PPS based on final consumption per inhabitant Income gt gt Disposable household income net uses Once you select the values from the scatter plot the regions in data Tables as well as in the Map will instantly be highlighted Figure 18 10000 14000 18000 22000 26000 30000 34000 38000 32000 36000 8000 12000 16000 20000 24000 28000 ome gt gt Disposable household income net us s PPS based on final consumption per inhabitant Health Inequalities in Europe Interactive Atlas User Manual 22 WHO EC Equity in Health Project Part IV Atlas of Social Health Inequalities The reports of the social health inequalities atlases include a single Map Table and Chart providing a multi faceted view of a specific composite indicator They allow further exploring social health inequality patterns e g as expressed by health outcome indicators while taking into account different socioeconomic status perspectives e g income education and employment Furthermore these maps allow visualization of the difference between the variable for a region or group of regions and a target value 1 e that of the most favourable situation which may be considered an attainable horizon 4 1 Calculation of Composite Indicators To determine inequalities in health status and res
13. 1 2 Q BE23 Prov Oost Vlaanderen 82 5 25 557 6 ples Burgaais d 83 3 Q BE24 Prov Vlaams Brabant 83 5 30 121 3 i Ad Q BE2S Prov West Vlaanderen 83 4 26 622 1 Q BE31 Prov Brabant Wallon 82 9 28 380 1 Q BE32 Prov Hainaut 80 8 18 932 Q BE33 Prov Li ge 81 2 21 126 3 Te i y mee E ME Q BE34 Prov Luxembourg B 81 7 19 685 8 Pda n mises id fogadministrative boundaries When selecting one sub region or country note that the legend applies only to the selected areas it is modified accordingly Selection of Geographic Areas Click the name of the geographic regions to select the area A selected geographic area will be shaded Alternatively moving the mouse cursor over a region in a map window displays its name and clicking on it will select and change temporarily its colour orange by default The selected region 1s also shown in the table with shaded colour The table display may be adjusted for different column width and order o Hold your mouse pointer over the divider between column s headers and lateral arrows will appear Click and drag the divider to adjust the column width Q Click a column header to sort the tables in ascending A or descending W order You can sort columns with names text as well as data numbers Magnifying Geographical Area Click on the magnifying glass icon displayed on the left side of geographic area to zoom to the selected area in the map e Clickin
14. 3 QI QI 3 IQR outlier the value lies 3 0 times inter quartile range below first quartile Q1 1 5 IQR suspected outlier the value lies 1 5 times inter quartile range below first quartile Q3 1 5 IQR suspected outlier the value lies between 1 5 times and 3 0 times the inter quartile range above third quartile Q3 3 IQR outlier the value lies more than 3 0 times inter quartile range above third quartile Mean mean value SD Standard Deviation Health Inequalities in Europe Interactive Atlas User Manual 13 WHO EC Equity in Health Project Included in the summary you will find a box plot Figure 8 further describing the statistical distribution of the indicator The box plot shows the position of 7 of 10 descriptive statements mentioned above Figure 8 Box plot explanation E cM Max 80 20 Q3 78 50 Median 77 40 Q1 75 70 Ww N I 8 Suspected outliers QI 3 IQR lt x lt QI 1 5 IQR or Q14 1 5 IQR lt lt es x Q343 IQR N e g Mazowieckie PL12 2 71 40 Wielkopolskie PL41 71 40 Eszak Magyarorsz ag HU31 8 67 60 O Outliers Q1 3 IQR lt x gt Q3 3 IQR E g Outliers are Estonia EE 67 20 Latvia LV 65 80 Lithuania LT 64 80 Min 64 80 In the example above the box plot does not have the values that are greater than Q3 1 5 IQR or Q1 3 IQR In addition you will see a bar diagram with colour codes adja
15. FN QN WO FP BP BP HR HR HR HR HR HH Prov Namur No Data Severozapaden 288 2 Severen tsentralen 242 3 Severoiztochen 287 4 C E2 C252 E22 E Ex L2 E2 C2 E C2 E C2 E23 C2 EZ L2 Ex L2 T3 C2 Yuaniztachen 282 5 Disposable income net uses Purchasing power standard based on final consumption per inhabitant Please do not quote or use these materials without written consent of WHO In the next example we use a filter to compare the EU 15 and the EU 12 countries Where do regional health inequalities appear to be more important Review Figure 24 and Figure 25 below to analyse the results Figure 24 Example with relative health indicator differences between socioeconomic groups with filter applied to EU 15 countries Area Target Ratio Amenable Mortality Both sexes 0 64 y gt gt Amenable causes of death 02 11 17 18 27 34 36 38 39 43 50 and 54 gt gt Filter EU 15 or 12 gt gt EU 15 L Regions Name Value Group 63 6 83 0 Burgenland No Data 83 1 95 3 M 95 4 108 0 B 108 1 123 7 B 123 8 252 6 No Data O National Borders O Rectangle Nieder sterreich 102 1 Wien 122 8 Karnten No Data Steiermark 95 5 Ober sterreich 95 3 Salzburg No Data Tirol 82 7 Vorarlberg No Data R gion de Bruxelles C No Data 1 at X 3E 1 1 nF 1 1 3 Name A Indi Prov Antwerpen 104 1 2 Group 1 least dep
16. Filter Button a Zz WN World Health Organization a Ze Regional Office For Europe Name Map 1 UKK2 Dorset and Somerse t 17 072 UKK3 Cornwall and Isles of Scilly 15 135 6 UKK4 15 772 3 UKL1 Wes ales and The Valleys 14 637 1 UKL2 East Wales 15 502 UKM Scotland 15 776 6 elation coefficient r 0 73 gt gt r squared 0 53 gt gt Regression Equation y 0 00x 73 65 2000 6000 10000 14000 18000 22000 26000 30000 34000 38000 4000 s000 12000 16000 20000 24000 28000 32000 36000 Income gt gt Disposable household income net uses PPS based on final consumption per inhabitant You may be further interested in analysing the situation of only a single country or a group of countries to allow this you need filter tools The Filter button lists available filters or subset selection possibilities and their values follow the example below Figure 11 Filter explorer correlation map atlas y ELI ELI Hon ELI Click to toggle the filter menu 7 EU 13 or 12 EU 12 EU 15 Mon EU p Country Click on the Filter button to display the list in Figure 11 To select the geographic regions of the 12 newer EU Member States since 2004 or 2007 choose EU 12 EU 15 or 12 EU 12 Once the filter is applied the Title will show its name e g Life expectancy gt gt At birth both sexes Filter EU 15 or 12 EU 12 and the Map will a
17. The main objective of this user manual is to facilitate the effective utilization of the interactive atlas to describe and analyse statistical data and information relevant to equity in health 1 3 Intended User of the Manual This manual is targeting public health professionals policy makers and researchers to facilitate health situation analysis and does not intent to be a substitute for the detailed development and generic user manual of the underlying InstantAtlas software which is available through the Help button 1 4 System Requirements The interactive maps are created using InstantAtlas from Geowise To view the interactive atlases you need Adobe Flash add on to your Internet browser and PDF reader to view documents in PDF format The best way to check Adobe Flash add on to your browser is by clicking on the link for atlas from the menu After clicking on the atlas link if you do not get an atlas appearing then the most likely cause of the problem is that you do not have the Adobe Flash Player Ver 8 or higher installed You can test your browser support for Flash add on by clicking on the Adobe Flash version test page http kb2 adobe com cps 155 tn_15507 html If you need to install the free Adobe Flash Player plug in then you can download it from the Adobe web site http get adobe com flashplayer You can download and install free Adobe Reader from http get adobe com reader If you have any problems doing this pl
18. WORLD HEALTH ORGANIZATION REGIONAL OFFICE FOR EUROPE ORGANISATION MONDIALE DE LA SANT BUREAU REGIONAL DE L EUROPE WELTGESUNDHEITSORGANISATION BCEMHPHAS OPI AHH3AIIHMSA 3 IPABOOXPAHEHHA REGIONALB RO F R EUROPA EBPOIIEHCKOE PETHOHAJIbHOE BIOPO Technical meeting to review the project Inequalities in health System Performance and their Social Determinants in Europe Tools for Assessment and Information Sharing a joint WHO European Commission Action 2006WHO03 WHO Regional Office for Europe Copenhagen 12 August 2010 18 19 August 2010 Atlas of Health Inequalities in Europe User Manual Technical document Equity in Health Inequalities in Health System Performance and Their Social Determinants in Europe Tools for Assessment and Information Sharing Atlas of Health Inequalities in Europe User Manual 3 Fl y mil H lu hil JT Gal li ise WORLD HEALTH ORGANIZATION Regional Office for Europe August 2010 Please do not quote or use these materials without written consent of WHO Revised draft 12 August 2010 Contents Part Fo Introduction 5 eI Dd e need anda eoe eoa oa eve a eo gen neo d oo oda aono eae aae Ri 1 Del C onte xtor the Manua ees ibo o te b batte adeo tosta dee ibis l 1 2 Primary Purpose of the Manual sees 4 1 5 Intended User or the MaImual aueiieo Ee pon Reed od En tes doen a eure 4 1 47 System Regue Wc HS ncs i
19. analysis of good policy examples across Europe and an assessment of their applicability to various contexts but also to making the information available in a form that supports systematic uptake and application of the learning know how However routine information required to monitor and assess health inequalities such as social determinants of health intermediate health determinants population health outcomes and on the associations and pathways that explain those variations is rarely available in a user friendly way for decision makers In response WHO Regional Office for Europe WHO Europe and the European Union DG SANCO formed a partnership in 2007 to develop the project Inequalities in Health system Performance and their Social Determinants in Europe Tools for Assessment and Information Sharing with special focus on the EU and EFTA EEA countries within a broader WHO European Region framework a joint WHO European Commission action 2006WHO03 One of the main goals of the project is to improve availability of and access to evidence on inequalities in health system performance including quality of care and the structural determinants of such inequalities across countries and regions in Europe In general the project is looking at the distribution and association of social health determinants and health outcomes indicators and takes the pragmatic view of maximizing the use of publicly accessible Eurostat data by sub natio
20. ap In this example for the top map choose the per capita disposable household income adjusted for purchase parity and for the bottom one the life expectancy at birth for both sexes combined colour has been changed from the default to allow improved comparisons As shown below in Figure 10 you will be able to see the regional distribution of both indicators side by side and also notice how the data are correlated Geographical patterns show that the 20 richest regions highlighted in orange tend to be in the centre and northern areas while life expectancy increases towards the south east however given the number of regions and colours it is difficult to determine how they are related in the Map The Health Inequalities in Europe Interactive Atlas User Manual 15 WHO EC Equity in Health Project correlation chart of the atlas on the lower right corner of the report provides such information The scatter plot shows a strong positive relationship Pearson s correlation coefficient r 0 73 which is nonlinear the slope is steep initially and Starts to wane after 10 000 Figure 10 Correlation use of two maps Income gt gt Disposable household income net uses PPS based on final consumption per inhabitant Data 2 Regions 3 146 0 9 897 2 9 897 3 13 288 1 W 13 288 2 14 999 6 W 14 999 7 16 648 1 W 16 648 2 35 833 5 No Data both sexes WHO EURO ExXELIROSTAT fohadministrativelboundaries 3 3
21. ar Chart show a non monotonic distribution of target ratios which are skewed towards the highest values in Group 5 The average value for Group 5 223 4 indicates that amenable mortality is more than 100 higher or two fold than in Group 1 Health Inequalities in Europe Interactive Atlas User Manual 30 WHO EC Equity in Health Project Figure 23 Example with relative health indicator differences between socioeconomic groups Area Target Ratio Amenable Mortality Both sexes 0 64 y gt gt Amenable causes of death 02 11 17 18 27 34 36 38 39 43 50 and 54 L Regions x Name Value Group Burgenland No Data 63 1 83 8 83 9 100 2 M 100 3 116 6 B 116 7 161 3 B 161 4 408 6 No Data Nieder sterreich 102 1 Wien 122 8 K rnten No Data Steiermark 95 5 Ober sterreich 95 3 O National Borders O Rectangle Salzburg No Data Tirol 82 7 Vorarlberg No Data R gion de Bruxelles Ca No Data Prov Antwerpen 104 1 Prov Limburg B 101 7 Name A Indi Group 1 least depri 100 Prov Oost Vlaanderen 107 4 Group 2 Prov Vlaams Brabant 98 4 Group 3 Prov West Vlaanderen 102 1 Group 4 Prov Brabant Wallon No Data Group 5 most depr Prov Hainaut No Data Copyright WHO EURO EUROSTAT for adtnifistrative boundaries v Prov Li ge No Data Prov Luxembourg B No Data a A B B o RB WO
22. as Clicking on the button will display data Table instead of the Map Figure 31 You can sort columns by clicking the header Data for each geographic region is linked to notes for each map feature Re clicking on Lo Table will hide the Table and show the default thematic Map Figure 31 Table button function a Default report displaying Map b Report after clicking on table button Socio economic indicators Infant mortality rate Socio economic indicators Infant mortality rate Data j Filter Name A Indicator 9 UKI1 Inner London 5 9 amp UKI2 Outer London T Q UKJ1 Berkshire Bucks a 4 6 Lr S Q UKJ2 Surrey East and 4 4 3 Q UKI3 Hampshire and Isl 4 5 Q uia4 Kent 3 9 3 Q UKK1 Gloucestershire 4 8 A Q UKK2 Dorset and Somer 4 1 D Q UKK3 Cornwall and Isles 4 2 3 Q UKK4 Devon 5 1 3 Q UKL1 West Wales and T 4 8 3 QA UKL2 East Wales 6 3 amp UKM Scotland 5 7 Y Health System Resource Hospital beds HP 1 by regi 26 Hospital beds HP 1 by regi 25 Health personnel by region Health personnel by region 14 Health personnel by region 8 Health personnel by region 2 Y Mortality Finally although it is not implemented yet the Atlas allows to show time trends of selected indicators when the Time button is clicked replacing the bar Chart with quintile distribution of indicators Please note that the time button 1s cur
23. cent to the box plot this is the legend for the thematic map showing indicator value ranges Outliers and suspected outliers in this context refers to data that are showing extreme values according to a given expected distribution and not that the data are false or poor quality Health Inequalities in Europe Interactive Atlas User Manual 14 WHO EC Equity in Health Project Data availability in the form of a histogram by Figure 9 Time histogram yearly periods is also shown in the summary 100 page Figure 9 80 In the given time histogram 60 of regions have data life expectancy at birth for males available for the year 2007 around 40 for 2006 and lt 1 for 2003 60 40 Likewise click on the notes icon for other indicators e g Income GDP at current 20 market prices EUR inhabitant and see the one page summary as explained earlier try to c 2003 2006 2007 interpret the box plot and time histogram year Annex 3 of this manual lists all indicators in the atlas system 3 2 The Use of Two Maps and Correlation of Indicators As indicated before you are able to visualize two different indicators and how they relate to each other in the descriptive and correlation analysis atlas The value of the indicator selected from Data Button top will be displayed in the Map on the top whereas values of the selected indicator from Data Button bottom will display on the bottom M
24. clicking on desired bars 4 4 Data Tables Name Value Group In the columns of Table you will see 5 Q Huss D l Alfald 73 4 5 4 Q 1601 Border Midlands and Western 8 79 6 4 Name of geographic location Value and Q 1602 Southern and Eastern 74 3 A 15 Iceland 81 5 Mo Data Group Here value represents the selected 4 sc piemonte 812 2 amp amp ITC valle d Aosta Vall e d Aoste 81 2 E indicator e g life expectancy at birth both e 5 mez ugura 16 a2 i 5 C tea Schedis sexes whereas group refers to quintiles of the socioeconomic indicator in which this region falls This provides a first glance on whether the regions with the highest life expectancy or other indicator as selected are also the ones with the least deprived socioeconomic condition following the example the 20 highest values of disposable income Name 4 Indicator There will be another smaller Table 6 Group 1 least deprived 20 8 em 4 below the legend where you will see Group Group 3 QO 7 Name and Indicator value columns along Group 4 73 3 Group 5 mast deprived 75 21 With colour codes for groups Here the groups are presented from least deprived to most deprived quintiles Thus Group 1 refers to the top 20 of the population who Health Inequalities in Europe Interactive Atlas User Manual 27 WHO EC Equity in Health Project are least deprived or better off based on the socioec
25. e and Correlation Analysis Atlas The descriptive and correlation analysis atlas allows the visualization of one or two variables in maps at a time together with a correlation analysis In addition the comparison of regions is also possible After clicking on the link available for this type of atlas an active window will open in a new browser page as shown in Figure 4 The default view displays the regional distribution of female life expectancy at birth you will be able to change the indicator as you wish Figure 4 Descriptive and correlation analysis atlas report World Health Organization Regional Office for Europe Life expectancy gt gt At birth females Q AT11 Burgenlan Q AT12 Nieder sterreic Q AT13 Wien Q AT21 K rnten Q AT22 Stei Q AT31 er sterreic t WHO EURO EUROSTAT for administrative boundaries 78 80 tel P Life expectancy gt gt At birth females S WHOJEURO EUROSTAT for administrative boundaries 3 1 Data Button Once you click on it the Data button lists the available themes Figure 5 e g Life expectancy Standardized death rates by sex and age group and Indicators e g At birth Females Clicking on the indicator will load new data Figure 5 Data button window descriptive and correlation analysis atlas Life expectancy gt Standardized death rate females all ages amp Standardized death rate males all ages p Standardized death
26. e atlas system will instantly produce a scatter plot showing indicator values on each axis Figure 16 In the example given below you can see the data from Data button on top Income gt gt Disposable household income net uses PPS based on final consumption per inhabitant is displayed in X axis where as data from Data button at the bottom Life expectancy At birth males 1s displayed in Y axis Health Inequalities in Europe Interactive Atlas User Manual 20 WHO EC Equity in Health Project Figure 16 Scatter plot explanation Income Disposable household income net uses PPS based on final consumption per inhabitant Data Filter j Correlation coefficient r 0 74 gt gt 0 55 gt gt Regression Equation y 0 00x 69 24 2 7 Regions WM 13 288 2 14 999 6 M 14 999 7 16 648 1 la 16 648 2 35 833 5 Ho Data v O Countries 7 L Rectangle ui w m E x t oOo 4J d Life expectancy At birth males Data J e v Regions expectancy gt gt Life 2000 6000 10000 14000 18000 22000 26000 30000 34000 38000 4000 8000 12000 16000 20000 24000 28000 32000 36000 7 Rectangle Income gt gt Disposable household income net uses PPS based on final consumption per inhabitant The above graph shows the positive association between life expectancy male and disposable household income If you do point the mouse over the dots of the scatter
27. ease read the Help associated with this page Health Inequalities in Europe Interactive Atlas User Manual 4 WHO EC Equity in Health Project Please be patient Loading and re loading after changes can take a few moments and it is not always obvious that the tool is still active We would welcome any comments and suggestions about these Interactive Atlases Please address them to Division of Information Evidence Research and Innovation HIUData 9 euro who int Health Inequalities in Europe Interactive Atlas User Manual 5 WHO EC Equity in Health Project Part II Basic Features of the Atlases When you open any Interactive Atlas available at WHO Europe e g the Descriptive and Correlation Analysis Atlas Map the interface looks similar to the image displayed below with different windows and functions components Figure 1 The full page is also referred to as the Report Figure 1 Correlation atlas map window RS w H h Organization 1 Regional Office for Europe Life expectancy gt gt At birth 1 t WHO EURO EUROSTAT for administrative boundaries 78 80 e d Life expectancy gt gt At birth females S WHOJEURO EUROSTAT for administrative boundaries This interface shows the following elements o Title Q Buttons Common atlas visualization 9 Map Graph Legend windows and function o Map components Data Table Q Chart 2 1 Title This element shows the selected displayed indicator
28. ed with Atlases of Social Health Inequalities Once you click the link to open the dynamic reports for selected indicator of either Amenable Mortality Atlases or Child Health Atlases different components will appear as shown in Figure 19 The indicator selected by default in either atlas is the socioeconomic variable used for grouping regions into quintiles Figure 19 Social Health Inequality Atlas Socio economic indicator Disposable income net uses Purchasing y based on final consumption per inhabitant Disposable income net uses Purchasing y power standard based on final consumption per inhabitant MURIS CUROPE Value Group DA AT11 17 587 9 3 A AT12 rreic 18 256 4 D Q AT13 Wien 18 792 2 5 Q AT21 K rnten 17 064 7 3 Q AT22 Steiermark 17 021 5 Clear Selection D Q Ar21 S ic TGB Filter Selection M Q AT32 Salzburg 18 426 Clear Filter 5 Q AT33 Tiro 18 092 3 Reset Layout 5 A AT34 18 628 6 D Q BE1 R gion de Bruxelles Ca Print Preview D Q BE21 Prov Antwerpen Export M Q BE22 About InstantAtlas Q BE23 Q BE24 Pro 5 Q BE25 Pro Nest Vlaanderen m 10 a m itale 14 201 9 15 584 6 gt i D Uu f 14 419 4 15 830 3 18 069 1 Settings About Adobe Flash Player 10 a rs an 3 Q BE31 Oo rabant Wallon al D 5 Q ges2 H c EC Copyright WHO ERO 6 EUROSTAT focadilinigietivecboundarits h Q BE33 amp BE34 Pro uxembourg B 5 Q BE35 Prov Namur
29. f education attained Tertiary education AT31 Ober Unemployment rates by sex and age 25 years and over Both sexes AT21 K rnten Unemployment rates by sex and age 25 years and over Both sexes AT31 Ober J a oo Long term unemployment 12 months and more Long term unemployment rate o AT21 K rnten 4 un Long term unemployment 12 months and more Long term unemployment rate o AT31 Ober Infant mortality rate AT21 K rnten J N m re Li m J Infant mortality rate AT31 Ober Y Health System Resources Hospital beds HP 1 by region Available beds in hospitals HP 1 Per 100 000 i Karnten Hospital beds HP 1 by region Available beds in hospitals HP 1 Per 100 000 i Ober Health personnel by region Physicians or doctors Per 100 000 inhabitants Karnten Health personnel by region Physicians or doctors Per 100 000 inhabitants Ober Health personnel by region Nurses and midwives Per 100 000 inhabitants AT21 K rnten Health personnel by region Nurses and midwives Per 100 000 inhabitants Obers Y Mortality Life expectancy at birth females Karnten a Life expectancy at birth females Ober e Life expectancy at birth males K rnten Life expectancy at birth males Obere Ww Life expectancy at birth both sexes K rnten o oo oo oo o o LJ WJ WJ Life expectancy at birth bot
30. for Indicator e g PWA for absolute absolute relative relative education Population population population 6 population quintile mortality rate quintile inequality inequality inequality inequality B C D E F G H J L M N Most adv 1 Region 1 4 952 100 6 3796 97 27 2 Region 2 4 648 000 12 36 Q1 99 6196 3 Region3 6 222 300 20 3796 102 46 4 Region 4 4 598 888 111 54 5 Region 5 4 700 109 112 8496 6 Region 6 9 023 315 114 1396 7 Region 7 3 921 040 116 8696 8 Region 8 4 648 000 119 7196 9 Region 9 6 348 000 112 8496 10 Region 10 5 722 300 65 37 117 38 11 Region 11 6 598 888 73 86 Q4 123 86 12Region 12 6 010 109 81 6096 127 8876 13 Region 13 86 74 21 92 129 57 14 Region 14 92 72 Q5 32 51 126 33 15 Region 15 100 00 39 57 129 05 Total Most deprived 77 689 683 100 00 Abbreviations used Calculations SES Socio Economic Status SES indicator PWA for quintile H A1 G1 A2 G2 A3 G3 49 0 PWA Population Weighted Average Indicator PWA for quintile J G1 11 G2 12 G3 13 77 1 Health Inequalities in Europe Interactive Atlas User Manual 24 WHO EC Equity in Health Project Given the diverse and large number of variables available to allow for more specific analyses the atlases of social health inequalities are grouped into thematic categories by either health outcomes or population groups Below are the two examples prepared for the project 1 Avoidable mortality atlases by socio economic variable and
31. g on Notes icon will automatically display the portrait a brief profile of the respective region Figure 15 Health Inequalities in Europe Interactive Atlas User Manual 19 WHO EC Equity in Health Project The link redirects to the webpage of the selected region that is provided by Eurostat This webpage provides further information on geography and history population employment etc of this selected region Figure 15 Portrait of the regions EE Burgenland v Go NUTS 3 Geography and history Population Employment Economy Environment Education health and culture Burgenland More extensive time series which may go back as far as 1970 more detailed statistics than those given in this web site population detailed results of the Community labour force survey economic accounts aggregates detailed breakdown of agricultural production data on the HE af agricultural holdings etc are all available in the l MewcCronos Full details of these national regional breakdowns including lists of level 2 and level 3 regions and the appropriate maps may be consulted on the RAMON server of Eurostat as well eurepa eu int commy eurostat ramoen nuts splaeh regions html The above example shows the portrait of the NUTS 2 region Burgenland in Austria 3 5 Additional Functions in the Scatter Plot As shown before once you choose a couple of indicators and apply a filter 1f any th
32. gt EU 12 Help Data Filter Map 1 Map 2 10 916 1 8 593 1 7 955 8 7 190 3 7 749 5 7 822 4 uation y 0 00x 71 27 8000 10000 net uses PPS based on final consu If you change the filter to EU 15 you will find the dynamic reports as shown in Figure 13 In this case the distribution is different showing some clustering of regions of EU 15 countries the correlation coefficient changes to 0 28 indicating weaker positive linear association Health Inequalities in Europe Interactive Atlas User Manual 17 WHO EC Equity in Health Project Figure 13 Correlation map atlas with filter EU 15 Y World Health ganization Regional Office fur Europe Income gt gt Disposable household income net uses PPS based on final consumption per inhabitant gt gt Filter EU 15 or 12 gt gt EU 15 Map 1 i S m a 17 587 9 2 Regions urgenlan j 7 081 5 12 473 0 a 4 ieder sterreic 18 256 4 12 473 1 14 245 8 e ien 18 792 2 M 14 245 9 15 640 9 L rnten 17 064 7 M 15 641 0 17 072 0 i ES i 17 021 5 la 17 072 1 22 1027 us Ty er sterreic 17 687 No Data 3 Ee tri orrelation coefficient r 0 28 gt gt r squared 0 08 gt gt Regression Equation y 0 00x 78 41 ountries i E x a v e e o a A c a m X 74 6000 8000 10000 12000 14000 16000 18000 20000 22000 24000 26000 Income Disposable household
33. h sexes Ober In the spine chart you will see the indicators geographic area and value of the respective indicator along with a comparison chart For illustration purposes if we take one indicator e g life expectancy at birth females you will see the following e Indicator Life expectancy at birth females e Area AT 21 K rnten e Value 83 7 years e Comparison 7 NW e Legend ig 24 sq d E So B In the above comparison chart you will see 5 quintiles each shown with respective colours which can be seen in the legend at the bottom of the Spine Chart window Note that depending on the type of indicator the sequence of colours changes although for same indicators such as health care resources available the optimal may not be found at one of the end points of the interval Putting the mouse pointer over the graph will display the quintile information e g 5q 75 8 80 6 The values 75 8 and 86 shown in the graph represent minimum and maximum figures for the indicator female life expectancy at birth respectively and represents the background against which a region is compared Health Inequalities in Europe Interactive Atlas User Manual 37 WHO EC Equity in Health Project The bar in the middle of the spine chart represents the value for the region AT 21 i e 83 7 years This region is relatively well positioned since its value is above 60 of all other regions light green If used systemat
34. he data e Atlases of social inequalities allow visualization of differences in composite social health inequality indicators between the target value and the value in a region or group of regions The target value is the population weighted average of the most advantaged quintile of the region Differences between this target and the individual region are shown as absolute differences area target differences or as relative differences area target ratios e Regional Profile Comparison atlas allows quick comparison of several key indicators between a limited numbers of regions These atlases have different indicators according to their themes The detailed list of NUTS level 2 regions is available in Annex 2 whereas the list of indicators can be found in Annex 3 An additional annex also provides information on sources of data and metadata Annex 1 This manual explains different available Atlases The interactive map of selected health related indicators 1s available for sub national level NUTS level 2 and covers the following dimensions e Structural determinants e g disposable income GDP e Intermediary determinants e g health care resources such as physicians or hospital beds e Health outcomes e g mortality and hospitalization rates and e Statistical associations between above categories Health Inequalities in Europe Interactive Atlas User Manual 3 WHO EC Equity in Health Project 1 2 Primary Purpose of the Manual
35. ically this tool can be used to identify priority regions where many conditions or indicators of diverse health dimensions are in the red zone suggesting more unfavourable situations Scroll the vertical bar if not all the indicators can be viewed within the spine chart dimensions Update Map and Charts Clicking on a given indicator in the Spine Chart window will instantly update the displays on the Map bar and pie Charts Area Profile If you want to see the situation of a particular geographic area regarding all available indicators just select the area from the map Figure 30 and the spine chart will display the profile of the selected area Figure 30 Area profile N004 Agder og Rogaland Socio economic indicators Infant mortality rate t eg Percentage of population by highest level of education attaine Percentage of population by highest level of education attain Unemployment rates by sex and age 25 years and over oth s s Long term unemployment 12 months and more Long term un Infant mortality rate Y Health System Resources Hospital beds HP 1 by region Available beds in hospitals HP 1 Per 100 000 i Health personnel by region Physicians or doctors Per 100 000 inhabitants Health personnel by region Nurses and midwives Per 100 000 inhabitants Y Mortality Life expectancy at bi Life expectancy at birt W oO D w N s of death all ages females ses of death
36. ietokrzyskie PL33 70 70 Slaskie PL22 70 60 Zachodniopomorskie PL42 70 60 Kujawsko Pomorskie PL61 70 60 Lubuskie PL43 70 40 Dolnoslaskie PL51 70 40 Centru RO12 70 30 Lubelskie PL31 70 20 V chodn Slovensko SK04 70 10 Nyugat Dun nt l HU22 70 00 Yugozapaden BG41 70 00 Yuzhen tsentralen BG42 70 00 Warminsko Mazurskie PL62 70 00 Regiao Aut noma da Madeira PT PT3 69 90 Stredn Slovensko SK03 69 80 Sud Vest Oltenia RO41 69 80 Nord Est RO21 69 70 Severen tsentralen BG32 69 50 Sud Muntenia RO31 69 50 K z p Dun nt l HU21 69 40 Sud Est RO22 69 40 Vest RO42 69 40 Severoiztochen BG33 69 20 Nord Vest RO11 69 20 D l Alfold HU33 69 10 D l Dunantul HU23 69 00 Yugoiztochen BG34 68 90 Severozapaden BG31 68 60 L dzkie PL11 68 50 szak Alfold HU32 68 40 Eszak Magyarorsz g HU31 67 60 FR94 CENE FR93 FR92 2 LS FR91 IS PT3 oo a Map b Boxplot c Data availability Data Quality Checks preliminary data Indicator name in the database 1last reg mlifexp lifexp yO m In the above figure the table summarizes the descriptive statistics about the indicator N number of regions with available data Min minimum value Max maximum value Median median value QI first quartile cuts off lowest 25 of data Q3 third quartile cuts off lowest 75 of data IQR Inter Quartile Range Q
37. income net uses PPS based on final consumption per inhabitant WHO EURO GEUROSTAT fof administrative boundaries 3 4 Data Tables Once you select an indicator from the Data Button the data Tables will display the name of the geographic regions selected indicator values according to either map 1 or 2 and Notes and Magnifying glass icons Once you select and apply a filter e g selecting AT by clicking on a region in the data Tables e g AT11 Burgenland the geographical area AT11 Burgenland will be automatically highlighted Placing your mouse pointer over the geographical area will display the name of region along with its selected indicator value Figure 14 one for each map If needed vertical scroll bars are also available if data can not be viewed within the table dimensions Health Inequalities in Europe Interactive Atlas User Manual 18 WHO EC Equity in Health Project Figure 14 Data table Descriptive and correlation analysis atlas Map 1 2 Ra 2 z m 5 Q AT11 Burgenland 83 3 20 528 2 T Q AT12 Nieder sterreich 82 7 23 9m ala 3 A AT13 Wien 83 3 52 41 076 7 n O AT21 K rnten 83 7 25 361 8 Q AT22 Steiermark 83 6 25 712 3 Q AT31 Ober sterreich 83 3 28 361 2 Q Q AT32 Salzburg 84 1 33 007 5 j Q AT33 Tirol 84 30 794 4 Q AT34 Vorarlberg 84 31 176 2 Q BEl R gion de Bruxelles Capi 81 6 57 242 3 Q BE21 Prov Antwerpen 82 6 34 061 9 Q BE22 Prov Limburg B 83 2 23 18
38. l window display where elements are dynamically interrelated e g if a region or group of regions is selected in a map chart table or legend they are shown with a distinct colour in each of the window components Health Inequalities in Europe Interactive Atlas User Manual 41 WHO EC Equity in Health Project Figure 33 Print preview window Print Preview x Print Preview Print full screen Print full screen rint As Vector supports transparency Table Scatter Plot Print As Bitmap best quality Legend o MEE Map Show Buttons s Show Images Show Images Show Background O Show Background Print Close Print Close J Export Options Export Options X This option allows you to export the Full Screen Table Scatter Export fullscreen Y Plot Legend or Map to JPEG or PNG format You can find the a Save As JPEG exported object with the given filename in the location you have chosen on your local external hard drive Export Close i For further explanations on terminology see for example the list of Key Terms from Whitehead M amp Dahlgren G Levelling up part 1 a discussion paper on concepts and principles for tackling social inequalities in health WHO 2006 Health Inequalities in Europe Interactive Atlas User Manual 42 WHO EC Equity in Health Project
39. led thematic shading By default region values are classified into quintiles as described above Change the classification and colour properties in the Legend and see the difference The Nomenclature of Territorial Units for Statistics or Nomenclature of Units for Territorial Statistics NUTS after the French nomenclature d unit s territoriales statistiques is a geocode standard for referencing the subdivisions of countries for statistical purposes The standard is developed and regulated by the European Union and thus only covers the member states of the EU in detail Source http en wikipedia org wiki Nomenclature of Territorial Units for Statistics accessed 4 August 2010 Health Inequalities in Europe Interactive Atlas User Manual 8 WHO EC Equity in Health Project Figure 3 Map showing European project geographic areas full view WHO EURO EUROSTAT for administrative boundaries Also if you move the cursor over the regions in the Map in any of the Atlases you will read their country and region code name and value of the selected indicator If you know a region but do not know where it 1s you may scroll the table and moving the cursor over the name will show the specific location highlighting the region Sometimes visualization of certain areas in a full Map is difficult and you may want to see more details You can achieve that by using the zooming tool which is located on the top left corner of the Map Click
40. ll be taking one indicator life expectancy at birth among males and discuss in the following sections The display shows a regional distribution with longer life expectancy in certain northern and south eastern areas and in the south of the United Kingdom To highlight them move the cursor over the highest value in the legend or click on the colour box this action may be cancelled by clicking again Now clicking on the notes icon for life expectancy At birth Males will display a PDF formatted one page summary about the selected indicator as shown in Figure 7 the file opens in an external window for which you need Acrobat Reader or relevant programme to open PDF files The one page summary e g life expectancy at birth for males shows additional statistical information about the data distribution and availability Health Inequalities in Europe Interactive Atlas User Manual 12 WHO EC Equity in Health Project Figure 7 Summary information WHO EURO Equity in Health Project February 8 2010 Life expectancy at birth males LN Min ax sias qr 35 GR or Sgn GT Legh Q5 LIQ Qs S IQR Mean 8D 275 6180 80 20 Tad 76 28 17623 Outliers are Estonia EE 67 20 Latvia LV 65 80 Lithuania LT 64 80 Suspected outliers are Mazowieckie PL12 71 40 Wielkopolskie PL41 71 40 K z p Magyarorsz g HU1 71 30 Podlaskie PL34 71 00 Zapadn Slovensko SK02 70 90 Bucuresti Ilfov RO32 70 80 Sw
41. lso display data for the selected geographic regions Health Inequalities in Europe Interactive Atlas User Manual 16 WHO EC Equity in Health Project If you apply the filter at another level selecting an individual country e g Austria AT the view will zoom in and display the data for this country only You can eliminate the filter and return to the original status by clicking on Remove Filter How does the filter work Once you apply the filter to the data the dynamic report will instantly select and display the specific values in the Map Data Tables and Charts Try to apply some filters on the data to observe how dynamic reports display new values Figure 10 shows the atlas map without filter there 1s a positive relationship between life expectancy at birth both sexes and disposable income per capita When you apply the filter EU 15 or 12 EU 12 the dynamic reports look like Figure 12 while the correlation coefficient is still positive but the relationship is weaker r 0 56 In addition there are large regional differences in life expectancy of nearly 8 years while income varies by nearly 9 000 indicating important disparities among regions of EU 12 countries Figure 12 Correlation atlas map with EU 12 filter Ce y World Health Organization Regional Office for Europe Income gt gt Disposable household income net uses PPS based on final consumption per inhabitant gt gt Filter EU 15 or 12 gt
42. nal geographic units and defined population groups The project aims to improve insight into the regional dimension of social inequalities in health across counties regions in addition to the country dimension In this way the power of international comparisons at the country level is enhanced by comparisons at the regional level Studies have also indicated that patterns and trends of regional socioeconomic development differ at times very considerably from those at the country level In addition the project intends to increase awareness and responsibility to tackle the health implications of inequalities in policies at different levels In particular it aims to increase the engagement of the public and the media in the dialogue with health policy A third objective of the project 1s to provide a feasible model of regular monitoring and assessment of the magnitude of social inequalities in health and the impact of the relevant policies interventions and services To meet those purposes several interactive atlases have been developed with publicly available data from Eurostat databases more details on the process and creation of a new database is given in a separate document The geographical unit of analysis has been mostly the second level national administrative territorial units also know as NUTS2 or regions except in circumstances where no health outcome data were available at such level in which cases NUTS or national level da
43. on Zoom In Zoom Out or Zoom Full icons to change the zoom to geographic features 1n the Map Note that this procedure will not change the legend as when doing a selection see Section 3 3 on Filter button below 2 5 Tables Once you select an indicator from the Data button the data Tables will display the name of the geographical regions selected indicator values according to either Maps 1 or 2 and Notes _ and Magnifying glass icons 2 6 Charts Charts allow further analysis of information from selected indicators either in the form of a scatter plot a bar graph a pie chart or a spine graph The first of two variables 1s used in the descriptive and correlation analysis atlas the second displays Health Inequalities in Europe Interactive Atlas User Manual 9 WHO EC Equity in Health Project health data by socioeconomic group in the atlases of social health inequalities and the second third and fourth show indicator grouping distributions in the Regional Profile Comparison atlas They will be described in more detail in the context of the respective atlas section For other generic window functions that modify the appearance of Legend Map Table or Chart components that allow further filtering or printing or exporting the report outputs please see Part VI on page 40 of this manual Health Inequalities in Europe Interactive Atlas User Manual 10 WHO EC Equity in Health Project Part III Descriptiv
44. on the Spine Chart Figure 28 Features in the slice Indicator Area Socio economic indicators ncome of households Disposable income net uses Purchasing power standard AT21 K rnten n a a o a 3 vu 3 n nm ncome of households Disposable income net uses Purchasing power standard AT31 Ober rcentage of population by highest level of education attained Pre primary prima AT21 K rnten 0 Ww Ww ercentage of population by highest level of education attained Pre primary prima AT31 Ober Percentage of population by highest level of education attained Tertiary education AT21 K rnten ercentage of population by highest level of education attained Tertiary education AT31 t A D N oO MN b QU U U NM M ou uu o nemployment rates by sex and age 25 years and over Both sexes AT21 K rnten nemployment rates by sex and age 25 years and over Both sexes AT31 Ober uu uw U ong term unemployment 12 months and more Long term unemployment rate o AT21 K rnten E ul N N e e N w ng term unemployment 12 months and more Long term unemployment rate o AT31 r AT21 AT31 er Hospital beds HP 1 by region Available beds in hospitals HP 1 Per 100 000 i AT21 K rnten o o e a Hospital beds HP 1 by region Available beds in hospitals HP 1 Per 100 000 i AT31 Health personnel by region Physicians
45. onal Borders O Rectangle Q BG32 Severen tsentralen 242 3 Mo Data Q BG33 Severoiztochen 287 4 No Data Q BG34 Yugoiztochen 282 5 No Data Q BG41 Yugozapaden 252 2 No Data Q BG42 Yuzhen tsentralen 285 4 No Data Q CY Cyprus 97 No Data Q cz01 Praha 126 7 Q CZ02 Stredn Cechy No Data Q cz03 Jihoz pad 159 1 Q CZ04 Severoz pad 197 8 Q CZ05 Severov chod 142 4 Q cz06 Jihov chod 155 6 Q 207 Stredn Morava 176 5 Name A Indi Group 1 least depri 100 Group 2 100 5 2 L Es E E E T E E E E Se Group 3 102 5 Q cz08 Moravskoslezsko 191 2 4 5 5 5 5 5 5 5 Q EE Estonia 274 2 E 4 5 5 5 5 5 5 5 Group 4 108 3 Group 5 most depr 223 4 Q HU1 K z p Magyarorszag 248 4 Copyright WHO EURO EUROSTAT for adtniniztrative boundaries Q HU21 K z p Dun nt l 288 9 Q HU22 Nyugat Dun nt l 244 5 Q HU23 D l Dun nt l 258 1 Q HU31 szak Magvarorsz g 314 9 Q HU32 szak Alf ld 306 3 rar wre E v L3 E E Q Hu33 D l Alf ld 265 8 329 4 Disposable income net uses Purchasing power standard based on final consumption per inhabitant Please do not quote or use these materials without written consent of WHO In a second example try using other mortality indicators e g by specific causes such as tuberculosis or Ischaemic hear
46. onomic variable chosen e g disposable income of households The value in the indicator column e g 80 8 for Group 1 shows the population weighted average life expectancy at birth both sexes for the respective groups quintiles In this case the least deprived group has on average a 5 6 years longer life expectancy compared to the most deprived group whose average is 75 2 years You can highlight the socioeconomic group thresholds by clicking on the group name This will draw a cut off line in the bar chart In the illustration below Figure 21 you can see a cut off line in the bar chart when Group 4 is selected Figure 21 Socioeconomic group average threshold for the selected indicator Name A Indicator G1 Group 1 least deprived 80 8 G2 Group 2 80 9 G3 Group 3 80 G4 Group 4 79 9 B G5 Group 5 most deprived 75 2 To facilitate the interpretation of health differences between socioeconomic groups the atlas also includes absolute and relative differences between the value in a region or group of regions and a target value that is defined as the average in the most favourable quintile The indicators of absolute or relative differences are referred to as Area Target Difference or Area Target Ratio respectively To continue with the example on life expectancy for both sexes you need to use the Data button and select the indicator the Title should now look like this Area Target Difference Life
47. ources due to socioeconomic inequalities composite indicators of social health inequalities are calculated according to the following algorithm 1 First the regions are sorted according to the socioeconomic indicator value from the most advantaged to the most deprived regions 2 Regions are grouped into five groups taking into account population size of each region resulting in 5 groups of regions with approximately the same population size 3 Population weighted averages are calculated for the socioeconomic status indicator and all other indicators of interest for each group quintile of regions 4 The population weighted average of the most advantaged Q1 group of regions is used as benchmark target value 5 For each region the absolute difference between the value of the indicator in the region and the target Area Target Difference and the relative difference between the regional value and target Area Target Ratio in are calculated Similarly quintile target difference and quintile target ratio are also computed The calculation of composite indicators is illustrated below in Table 1 Table 1 Example of calculation of composite indicators Socio economic status Area Target Quintile Target Area Target Quintile SES indicator e g Cumul 9 Weight within quintile SES indicator Indicator difference difference ratio Target ratio population with high of total of total of quintile PWA
48. rently not in use as the Atlases 1n their current version have no time series available Health Inequalities in Europe Interactive Atlas User Manual 39 WHO EC Equity in Health Project Part VI Additional Generic Features in the Atlases There are additional generic window functions to modify the properties in the Atlases Every time you move the cursor over the upper right corner of a Legend Map Table or Chart window you will see the following toolbar O with drag resize and close functions These allow changing their position and appearance 6 1 Dragging Windows By clicking and holding on Drag icon you can drag move Legend Map Tables or Charts windows at your desired location 6 2 Resizing Window Maximize and Restore You can maximize the Legend Map Tables or Charts windows by clicking on Maximize icon O You may also change the window to a desired size by moving the cursor to a side or corner and dragging the arrows in the appropriate direction Moreover you can restore the respective window by clicking on the Restore ul Down icon which 1s displayed when moving the cursor to the top right corner of a maximized window 6 3 Closing Windows To allow further organization of the report you can even close the Legend Map Tables or Charts windows by clicking on Close icon If you wish to re open a closed window you can choose Reset Layout from Context Menu see below 6 4 All components are vis
49. ri 100 Prov Limburg B 101 2 3 Group 2 100 5 1 3 1 4 4 4 4 1 i Z 1 Group 3 12 5 Prov Oost Vlaanderen 107 4 Prov Vlaams Brabant 98 4 Prov West Vlaanderen 102 1 Group 4 i08 3 y Group 5 most depr 223 4 Prov Brabant Wallon No Data Prov Hainaut No Data Copyright WHO EURO EUROSTAT for adtnifistrative boundaries lt a Prov Li ge No Data Proy Luxembourg B No Data Prov Namur No Data Stuttgart 84 1 Karlsruhe 100 3 Ia C Es L2 E2 D Ex L2 E L2 E2 L2 EX L2 EX D EX L2 E D2 E33 D7 Freiburg T ihinaen Disposable income net uses Purchasing power standard based on final consumption per inhabitant Please do not quote or use these materials without written consent of WHO Health Inequalities in Europe Interactive Atlas User Manual 31 WHO EC Equity in Health Project Figure 25 Example with relative health indicator differences between socioeconomic groups with filter applied to EU 12 countries Area Target Ratio Amenable Mortality Both sexes 0 64 y gt gt Amenable causes of death 02 11 17 18 27 34 36 38 39 43 50 and 54 gt gt Filter EU 15 or12 gt gt EU 12 2 Regions Click to toggle the filter menu hal Name Value Group 97 0 162 4 d Q BG31 Severozapaden 288 2 No Data 162 5 191 2 g f M 191 3 248 4 NW 248 5 306 3 WM 306 4 408 6 No Data O Nati
50. s Figure 2 You can change the Legend Settings Border Color E legend settings by clicking on s Transparency the Legend Setting icon Data Palette O Countries H w L Rectangle Reverse Palette bd Health Inequalities in Europe Interactive Atlas User Manual 7 WHO EC Equity in Health Project The legend settings will allow you to do the following e Change the border colour of the geographic regions e Adjust map layer transparency point symbol sizes when available e Choose colour palettes reverse the palette e Apply a continuous or a divergent shading scheme e Increase decrease the number of classes e Choose data classifiers default is quintile 5 by default for ease of interpretation but equal interval natural break continuous and standard deviation are also available However these other classifiers are not used in the subsequent analyses in this project Once you change these settings the colour of map and legend changes instantly The boxes Ll or LI refer either to the country boundaries or rectangle highlighting the overseas departments and territories of France Checking on them will show these features while they disappear when un checked 2 4 Map The Atlas Map window shows the geographic areas e g the regions of countries which are based mostly on NUTS level 2 classification The Map also displays shades of colours representing values from selected indicators this 1s cal
51. sis oc eene iate oco ie nts usns ose MEUM Ie RtIL EIUS 4 Part II Basic Features in the Atlases eee e eee eee eee eee ee eee eee eee eee ettet eoe 6 PM NEED 6 2D BONS eee E E m EE 7 PASO US x c 7 DA UNA e ETERNI LR 8 De ME EU Sh sats EE E AE PE Ae dam este ve san c 9 PA VERE 9 Part III Descriptive and Correlation Analysis Atlas 11 Sek DoD I M caved boreal thins 1 3 2 The Use of Two Maps and Correlation of Indicators 15 319 JEUIOC TD UELO Blend bison sies dd uc om ibn ti ame oe e 16 CPR Die a S A E N A Mu ce Pre ty eter E ate cs Mead T EAE o 18 3 5 Additional Functions in the Scatter Plot eeeeeesseeeeeeees 20 Part IV Atlas of Social Health Inequalities eee eee eee 23 4 1 Calculation of Composite Indicators ccccccccccccsssseseeeeeceeceaeeeeseeeceeeeeeeeaeeeees 23 4 2 Getting Started with Atlases of Social Health Inequalities 26 d B aee N a EE mm 27 A Data TIDES m T 24 Part V Regional Profile Comparison Atlas eee ecce ee eee e e eene 33 5 1 Getting Started with Regional Profile Comparison Atlas 39 20 PIC C db ett eee ne RAE Pere near eee Tre E S pont OE MM Dit ubt 35 SENS o E 112 1a ERR eran VAE EE EN E m 36 5 4 New But
52. t disease and select a filter to analyse the situation in the EU 12 countries or in Germany What can you conclude about health inequalities in these areas Health Inequalities in Europe Interactive Atlas User Manual 32 WHO EC Equity in Health Project Part V Regional Profile Comparison Atlas Regional Profile Comparison Atlas allows quick comparison of several key indicators in a selected region with respect to the whole NUTS2 regions distribution or between two selected regions and the regional average In other words it gives you a cross sectional view across multiple indicators for any two regions The indicator values are standardized so that they can also be presented consistently within a spine chart The indicators are grouped into logical categories Given that the interest 1s to provide fast access to data to compare regional health systems this atlas only includes a selected number of variables under the following categories 1 Socio Economic Indicators f Unemployment rates by sex and age 25 years and over Both sexes Percentage of population by highest level of education attained Pre primary primary and lower secondary education levels 0 2 ISCED 1997 Both sexes Between 25 and 64 years Percentage of population by highest level of education attained Tertiary education levels 5 6 ISCED 1997 Both sexes Between 25 and 64 years Income of households Disposable income net uses
53. ta were used The variables displayed in these atlases cover demographic social economic health status and health system resources categories including more than 890 individual indicators In total there are 281 geographical regions that allow comparisons for different country subgroups e g EU vs Non EU countries or for regions within individual countries The use of atlases and maps has been increasing in the public health field Interactive functions clickable maps charts and tables among other features provide user friendly tools that make it easier to understand public health data In this regards the Atlas of health inequalities in Europe presented here represents a tool for assessment Health Inequalities in Europe Interactive Atlas User Manual 2 WHO EC Equity in Health Project of the relative importance of health system and the social determinants on health outcomes It is also an information sharing tool explaining regional gradients of social inequalities in health The following interactive atlases haven been developed for the project e Descriptive and correlation analysis atlas that allows a quick visualization and analysis of one or two variables in separate maps Their association 1s further described and analysed in a graph This atlas provides the opportunity for exploring distributions and identifying patterns of health indicators Links to additional resources allow further analysis for the interpretation of t
54. te total All causes of death AOO Y89 less than 15 years males 4 Hospitalisations a Standardized hospitalisation rate c0000 All causes A00 Z99 excluding V W X and Y codes less than 75 years both sexes b Standardized hospitalisation rate c000e All causes A00 Z99 excluding V W X and Y codes excluding healthy newborn babies Z38 less than 75 years both sexes For detailed description of the indicators please see Annex 3d Health Inequalities in Europe Interactive Atlas User Manual 34 WHO EC Equity in Health Project 5 1 Getting Started with Regional Profile Comparison Atlas Once you open the Regional Profile Comparison Atlas you will see the dynamic report window as shown below in Figure 26 Figure 26 Regional Profile Comparison atlas Socio economic indicators Income of households I income net uses Purchasing power standard based on dg consumption per inhabitant ata Filter y region Available beds in hospitals HP 1 Per 100 000 i ici tors Per 100 000 inhabitants Nurses and midwives Per 100 000 inhabitants causes of death 02 11 17 18 27 34 36 3 ath all ages females ath all ages males ath all ages both sexes causes of death 02 11 17 27 34 36 38 3 ndardized death rate Amenable causes of death 02 11 17 18 27 34 36 3 Crude death rate total All causes of death A00 Y895 less than 15 years femal
55. tons in Regional Profile Comparison Atlas sssee 39 Part VI Additional Generic Features in the Atlases 40 OE Jraseme WIDOOWS redcoon pape auod osco pa Crise E ple be PN Sa E RE ROREE 40 6 2 Resizing Window Maximize and Restore eeseeeeeeeeeeeeeeee 40 0o Clos ME Windows rires ea A N TA Aa 40 OR ME Giro rE Naess AE EETA ESA AE E EE E E REE 4 Health Inequalities in Europe Interactive Atlas User Manual i WHO EC Equity in Health Project Part I Introduction I 1 Context of the Manual Inequalities 1 in health are increasing in Europe They exist between population groups within the same country and between countries across the European region These inequalities lead to increased vulnerabilities in populations as well as increased differences in health behaviours and outcomes between population groups whether measured by education income or employment At the same time there is a trend in a number of countries to devolve more responsibility for health systems to the regional level As a result there 1s increased demand by policy makers for knowledge on the options for addressing socially determined health inequalities In particular how health system policies and their outcomes in various settings impact on inequalities and actions that can be taken to improve health equity This requires not only the systematic collection and
56. ualized in the original way as when the atlas was loaded for the first time Health Inequalities in Europe Interactive Atlas User Manual 40 WHO EC Equity in Health Project 6 4 Context Menu When you click with the mouse right button Figure 32 Context menu anywhere over the Legend Map Tables Charts Clear Selection Scatter Plot Pie Bar Spine Chart or in the Dynamic Filter Selection Clear Filter Report a Context Menu will appear as shown in Reset Layout Figure 32 This menu allows you to do the following Print Preview Export e Clear a selection About InstantAtias e Filter based on the active selection Settings e Remove a filter About Adobe Flash Player 10 e Reset the report layout e Print report e Export the report Reset Layout You can choose this option to bring back all active windows to their original state dynamic report with Legend Map Tables and Charts Filter a Selection After applying a selection in a window Legend Map Table or Chart by clicking on Filter Selection you can further display regions using same classification criteria e g quintile to the selected group Where as clicking on Clear Filter clears all the filters applied Print Preview This allows you to print Tables Charts Legend Map or even Full Screen You can print the object as vector or bitmap Figure 33 In addition you can include buttons images or background A dynamic report is the overal
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