A holistic model of health inequalities in the regions of the Czech Republic

What are the spatial factors influencing health inequalities within a socio-economically homogeneous country?

Dana Hübelová, Alice Kozumplíková, and colleagues from Mendel University in Brno investigate health disparities across different regions of the Czech Republic. The team explore how economic conditions, social care access, and regional characteristics impact health, and why urban areas don’t always have better health indicators than rural regions.

Read the original research: doi.org/10.1186/s12939-023-01996-2


Image Credit: Adobe Stock / Kinga




Hello and welcome to Research Pod! Thank you for listening and joining us today.


In this episode we look at the work of Dana Hübelová, Lenka Janošíková, Alice Kozumplíková and Beatrice-Elena Chromková of Mendel University in Brno, Czech republic, who investigate health inequalities within the Czech republic and how spatial factors are related to population health issues.

The Czech Republic is socio-economically and ethnically homogeneous, yet despite this apparent uniformity, there is some variance within the country.  Different regions, with their distinctive historical and geographical traits, are associated with different impacts in public health status of their residents.   While Prague residents are economically the best off,  the most educated, and have access to affordable social care, they are often dissatisfied with their health status.   Similarly those living near big cities such as Brno are educated, employed, and economically secure, but with less social and health infrastructure, and those living in the mountains and forests on the Czech-Polish border may be cut off from this infrastructure but are the most satisfied with their health.

Although spatial disparities in health inequality determinants have diminished over the past two decades, many Czech health status markers haven’t seen improvement for population health indicators. And subjective quality of life aligns only partially with health determinants and health status for many Czech people.  Unlike trends observed in other European countries, Czech people living in urban areas don’t consistently exhibit better health than their rural counterparts across all measures, but there is nuance which has been captured by recent research.

Dana Hübelová, Lenka Janošíková, Alice Kozumplíková and Beatrice-Elena Chromková of Mendel University in Brno, Czech republic, suggest that while Czech health inequalities showed recent improvement, the disparities in public health have remained largely unchanged over time.  Their research was funded by the Technology Agency of the Czech Republic and focuses on health inequalities in population health, building on previous research to create and extensive set of data and visualisations which are now available online and continuously updated.   The results can be used as a tool for creation of policies and health reports to be used not only for improving public health but also in political realms, as there are many dimensions to health including medicine, sociology, economic, geography, and environmental science.

There are persistent health disparities in regions of the European Union, both between central areas and more remote regions, and among socially, economically, and ethnically disadvantaged groups.  Health inequalities are caused by a multitude of factors, and spatial differentiation is observable and linked to specificities of context. Unlike many other European regions, Czechia exhibits relative homogeneity in terms of demographics, social structure, economy, and ethnicity. Additionally, the proportion of individuals living below the poverty line is one of the lowest in the EU. In contrast to findings in studies conducted in other European countries, the assumption that urban areas outperform rural areas does not hold true in the Czech Republic.

Specific historical and geographical factors shape the Czech regions, such as the impact of post-Second World War settlement in the Czech borderlands and the presence of both external and internal rural peripheries, as well as urban fringe zones.  Research indicates variations in quality of life with cities and small towns demonstrating better standard of life than the distant peripheral countryside.  Rural areas in Czechia have undergone a decline in agriculture without viable replacement by other economic activities.  Resultant challenges such as migration-induced depopulation and ageing, alongside declining economic, social, and cultural activities cause enduring health inequalities.  When scrutinizing health discrepancies, it’s important to account for the specificities of the Czech context as these spatial issues have measurable impacts on population health.

In assessing these relatively small spatio-temporal variances, which show determinants of health inequalities and their correlation with indicators of health status, the researchers used government indexes.  These are publicly available records of surveys examining health status and health inequality, as well as data from interviews about subjective quality of life.  Indices represent a mathematical amalgamation of variables, capturing various dimensions of health. A higher index value indicates better health in the region.  These composite indicators facilitate the interpretation of extensive data matrices, showing nuance in these objective measures of Czech people’s health.

As well as these surveys, there have been interview based studies of how Czech people perceive their health.  The subjective quality of life numerical values were derived from processing interview data to create a numbers based approach.   For this project, the researchers sourced data from the Czech Household Panel Survey project, which employs a sample survey based on two-stage stratified random sampling. This project repeatedly interviewed a randomly selected sample of households residing in the Czech Republic.

Together, these three data sources enabled the researchers to examine spatial correlations between determinants of health inequalities and subjective assessments of quality of life, as well as between indicators of health status and subjective assessments of quality of life.  These population health measures were mapped onto regions within Czechia. They were therefore able to assess health inequality, health status, and subjective quality of life, seeing how these different measures of health are affected by the region people live within the Czech Republic to show how public health is impacted by spatial issues.

The index of determinants of health inequalities displayed improvement.  However, the health status index deteriorated slightly.

In the southwest to northeast region of Bohemia, especially the urbanised western periphery districts, the changes in the health status index consistently showed positive trends. The districts in the hinterland of the capital city of Prague and the southeastern districts of the South Moravian Region exhibited the most favourable changes.

The Czech-Moravian border districts, however, were characterised by an improvement in the index of determinants of health inequalities alongside slight deterioration in the health status index. Moreover, Moravian districts in the eastern part of the country, consisting of border districts with Slovakia, experienced a marginal increase in the index of determinants of health inequalities coupled with a decline in health status indicators.

The spatial distribution of subjective quality of life in the Czech Republic reveals districts where there is a high, favourable, value of the determinants of health inequalities index, yet a low, negative value of the subjective quality of life index. Conversely, there are districts with a low, negative value of the determinants of health inequalities index but a high, positive value of the subjective assessment of quality of life index. Additionally, there is regional variation observed in the relationship between the health status index and the subjective quality of life index.

Assessing the influence of the geographic environment on health inequalities poses challenges due to the multitude of determinants exhibiting spatial characteristics. However, the geographical context holds promise for understanding health disparities and population health status. As distance from the central areas increases, a decline in the standard of living, quality of life, population decline, and worsening economic and social conditions is observed with knock on impacts for health.

The researchers found lots of contradictions in the health status of Czech people. Despite some progress in improving health equality, there are still gaps between different areas of the Czech republic. Overall, the nation’s health is declining slightly. They also discovered that people’s quality of life doesn’t always match up with traditional health measures. Some places have big health differences even though people feel content, and in other places, health is getting worse even though things seem good economically.

Health inequalities exhibit spatial patterns and demonstrate consistent trends over time, indicating they are not randomly distributed.  Unlike findings in other European countries, Czech residents of cities do not always have better health conditions than those in rural areas due to the homogeneity of the Czech republic.  Typically, Czech regions with more pronounced disparities are often situated in peripheral areas.   Although these inequalities have decreased over the last 20 years, the health status indicators have not improved.  And health determinants and status are only partially correspondent to subjective quality of life.  However, there is considerable nuance demonstrated within this and different regions of Czechia are associated with health effects captured in this research.  Understanding and evaluation health disparities in the Czech context shows how spatial factors are important in differentiation of population health in the Czech republic.

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