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Health systems in transition
Portugal
9
Box 1.1
Health inequalities
In 2012, Portugal was among the most unequal countries in the EU, recording the fourth highest
Gini coefficient for disposable household income (0.34) (European Commission, 2015). Likewise,
Portugal also registers high health inequalities in the EU context (Mackenbach et al, 2008). Despite
intense criticism in several international reports and scientific articles (WHO Regional Office for
Europe 2010a; 2010b; Bago d’Uva, 2010), there is no new evidence since then that the objective of
reducing health inequalities has been achieved.
As noted before, there are significant differences between men and women regarding mortality and
morbidity. On average, women live longer than men, but they are also disproportionally affected
by musculoskeletal disorders, depression and obesity. Women are also more likely to take sick
leave and report chronic back pain (Perelman, Fernandes &Mateus, 2012). According to the latest
National Health Survey, in 2014 men recorded higher standardized mortality rates than women,
and latest data also suggest higher rates of smoking and other risk factors (INE/INSA, 2016).
Besides, other studies have shown that African immigrants have higher AIDS and cardiovascular
mortality than citizens born in Portugal, having higher mortality associated with socio-
environmental factors (Harding et al., 2008; Williamson et al., 2009). Additionally, a number of
studies reported that lower education is strongly associated with worse health condition (Bastos
et al., 2013; Santos et al., 2014). Education was also found to be strongly associated with chronic
back pain (with less educated individuals being more likely to suffer chronic back pain) (Azevedo
et al., 2012) and functional limitations (Eikemo et al., 2008). Deprivation and financial constraints
were also found to be associated with poorer health outcomes (Alves et al., 2012).
Despite the limited availability of demographic data, the existing evidence suggests that the most
vulnerable groups in Portugal include the elderly and children in poverty, poor people living
in rural areas, ethnic minorities, migrants, and the long-term unemployed (Crisp et al., 2014).
These groups are more likely to suffer from poor health and experience long periods of poverty,
unemployment and social exclusion (Crisp et al., 2014). There are also significant differences in
wealth and health indicators between the great metropolitan areas of Lisbon and Oporto and the
interior regions. Many of those living in rural areas still live in relative poverty and have barriers
(particularly geographic distance) to access quality health services (Crisp et al., 2014).
Infant mortality in Portugal is below the EU average (3.7/100 000 live
births in 2012) and was recorded as 2.9 deaths per 100 000 live births in 2014
(Table 1.3). Overall, maternal and child health indicators in Portugal are similar
or better than the EU average. The adolescent fertility rate in Portugal has been
decreasing over the past decades, as a result of better health promotion and
education, from 21.0 in 1995 to 10.3 births per 1000 women aged 15–19 years in
2014, remaining slightly lower than the EU average of 11 births per 1000 women
in 2014 (World Bank, 2016).
According to the Global Burden of Disease study (IHME, 2016),
noncommunicable diseases accounted for 85.9% of the burden of disease
in Portugal (measured by disability-adjusted life years (DALYs)) in 2015.
This is in line with other European countries, where noncommunicable