The role of individual characteristics and municipalities in social inequalities in perceived health (Italy, 2010–2012) : a multilevel study

Backgrounds The empirical evidence shows discordant results regarding the role of local contexts on individual health. This article considers the role of the municipal socio-economic contexts on self-rated health in Italy, taking into account some individual variables. Methods Multilevel model software (MlwiN) is used to fit multilevel linear regression models of perceived health. Individual data are from the Italian surveys on BAspects of Daily Life^ 2010, 2011 and 2012, collected by the Italian National Institute of Statistics (Istat). In addition, municipality-level social, demographic and economic characteristics are from the 2011 Census and the database BAtlas of Italian Municipalities^ (Istat). Results The main findings of this study confirm that, controlling for age and gender at the individual level, poor health is influenced by socio-economic positions: lower education, not working or looking for employment and disadvantaged family social class predict higher perceived health. The individual level explains the 70.1% heterogeneity in self-assessed health, the family level 25.6% and the municipality level only 4.3%. The additional influence of the socio-economic context is, conversely, of little substantive importance. Conclusions Finally, by showing that variability in health relates mainly to individual characteristics, this study suggests that intervention to mitigate social inequalities in health should focus on structural factors, such as education and the labour market.