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In this study, we test the assumption that sociocultural differences in use of health services will only occur below a certain level of illness severity. Data are derived from the Curaçao Health Study (n = 2248). Subjects' educational level and degree of proto-professionalization are used as indicators of their sociocultural background. Differences in the likelihood of seeking professional care for several common health problems are analyzed, and are compared with the help-seeking behavior for chronic disorders. As hypothesized, higher educated and proto-professionalized people are less likely to seek care for everyday symptoms. In addition, proto-professionalization is accompanied by a greater likelihood of using over the counter medication. Increasing empowerment of patients appears to lead to increased self care for everyday symptoms. When conditions reach a more serious stage, the differences in help-seeking behavior disappear: for most of the chronic conditions studied, the higher educated and more proto-professionalized individuals are just as likely to seek professional treatment as the less advantaged groups. However, there is a difference as to the type of professional consulted for chronic health problems. Proto-professionalized individuals more often receive specialist treatment, probably because they are better equipped to persuade GPs to refer. The adverse side of patient empowerment may be increasing consumerism: a situation in which patient demands, not medical necessity, determine the care delivered.

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OBJECTIVE: The aim of the article is to report the prevalence of obesity, abdominal fatness and waist circumference in different socioeconomic classes in Curaçao. DESIGN: In 1993/1994 a health interview survey (the Curaçao Health Study) was carried out among a random sample (n = 2248, response rate = 85%) of the adult non-institutionalized population of Curaçao. METHODS: We analyzed the association between obesity (BMI > or = 30), abdominal fatness (waist hip ratio (WHR) > or = 0.95 for men, WHR > or = 0.80 for women) waist circumference (WC > or = 100 cm for men, WC > or = 91 cm for women) and socioeconomic status (SES) by age adjusted logistic regressions, for men and women separately. RESULTS: The prevalence of obesity was about 27%: 36% of the women and 19% of the men were obese. An at risk WHR was reported among 62.2% of the women and among 20.4% of the men. A WC above the cut-off point was reported for 44.3% women and 25.3% men. Compared to women of higher SES, the lower SES women have a two to three times higher risk of a BMI, WHR or WC exceeding the cut-off points. Among men, no statistically significant difference between an increased BMI, WHR or WC and SES factors was found. The overlap between the three measures is large, about 56% of the women scored similarly on all three measurements. Among men the overlap is even greater (73%). CONCLUSIONS: The prevalence of obesity in Curaçao is alarming. Low SES women are at the greatest risk of an increased BMI, WHR or WC. The obesity figures can be placed between industrialized societies and less modernized cultures. Action and additional research on the prevention of obesity in Curaçao are deemed necessary. The cut-off points in our study for WC in the non-white population are preliminary and need to be elucidated further.

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The aim of this study is to examine whether there is socioeconomic equity in health care utilization in Curaçao, Netherlands Antilles. We explore how educational level is related to utilization of GPs, specialists, hospitals; dentists and physiotherapists, taking into account the effects of sex, age and inequalities in health. The study also examines whether these relationships vary according to the unit of analysis: probability (or incidence) of services use versus overall volume of contacts. The data were derived from the Curaçao Health Study, a health interview survey among a random sample (N = 2248) of the non-institutionalized population aged 18 and over. The results indicate that there is socioeconomic inequity in the probability of health care utilization in Curaçao. People with a higher educational level are more likely to consult a specialist, dentist or physiotherapist, and are also more likely to be hospitalized. This is not only the case when the mediating effects of socioeconomic inequalities in health (need) are taken into account, but also before adjustment for health inequalities. In other words: there appears to be both vertical inequity (i.e. greater needs for services are not met by greater use) and horizontal inequity (i.e. similar needs for care are not met by similar levels of services use). The observed inequalities in use of specialists and hospitals contrast with findings from international research. The volume of health services use (i.e. the numbers of consultations) appears to be hardly connected with a person's position in the SES hierarchy; only dental services are used more extensively by higher educated individuals.

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This study examines whether there is socioeconomic equity in health care utilization in Curacao. We explore how education level is related to utilization of various health services, taking into account the effects of sex, age, and inequalities in health. The study also examines whether these relationships vary according to the unit of analysis; probability (or incidence) of services use versus overall volume contacts. The data was derived from the "Curacao health study", a health interview survey among a random sample (n=2248) of the non-institutionalized population 18 years and over. The results indiacte that there is socio-economic inequalities in health (need for care) is taken into account. In other words: greater need for services are not met by greater use (vertical equity) and similar needs for care are not met by similar levels of service use (horizontal inequity). The volume of use (i.e. the number of consultations with a care provider, once a person has entered the health care system) appears to be fairly equitable. The observed inequalities in probability of specialist and health utilization contrast with findings from international research. The outcomes of this study underline the importance of health care reforms in order to attain more equitatble access to health care. (AU)

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The aim of this paper is to report the prevalence of obesity and abdominal fatness in different socioeconomic classes in Curacao. In 1993/1994 a health interview survey (the Curacao Health Study) was carried out among a random sample (n = 2248, response rate = 85 percent) of the adult non-institutionalized population of Curacao. We analyzed the association between body mass index (BMI) and socioeconomic status (SES) as well as the relationship between waist-hip ratio (WHR) and SES by logistic regression models for men and women separately. The overall prevalence of obesity among women peaked at age 46 to 55 years (OR 4.195 percent CI 2.6 - 6.6) and between 56 to 65 (OR 1.7 95 percent CI 1.0 - 3.1) years in men. Women of lower SES are approximately twice as much at risk of being obesed compared to women of higher SES (OR 2.4 95 percent CI 1.7 - 3.4) for the low SES group. The percentage of participants with an at risk WHR (cut off point 0.80 for women and 0.95 for men) is more than three times higher among women than among men (62.2 percent versus 20.4 percent). WHR increased significantly with age among both genders. Compared to women of higher SES, the lower SES women have a three times higher risk of a WHR exceeding th cut off point (OR 3.0 95 percent CI 2.0 - 4.5). The overall prevalence of obesity was much higher than in Spain, Brazil and the Netherlands. The high prevalence of obesity in Curacao justifies action and research on the prevention of obesity in Curacao. (AU)

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