The objectives of this study are to describe, for European countries, variations among political traditions in the magnitude of inequalities in self-perceived health by educational level and to determine whether these variations change when contextual welfare state, labor market, wealth, and income inequality variables are taken into account. In this cross-sectional study, the authors look at the population aged 25 to 64 in 13 European countries. Individual data were obtained from the Health Interview Surveys of each country. Educational-level inequalities in self-perceived health exist in all countries and in all political traditions, among both women and men. When countries are grouped by political tradition, social democratic countries are found to have the lowest educational-level inequalities.
Get full access to this article
View all access options for this article.
References
1.
NavarroV.Politics and health outcomes. Lancet368:1033–1037, 2006.
2.
BorrellC.Politics and health (editorial). J. Epidemiol. Community Health61(8):658–659, 2007.
3.
ChungH., and MuntanerC.Welfare state matters: A typological multilevel analysis of wealthy countries. Health Policy80(2):328–339, 2007.
4.
ChungH., and MuntanerC.Political and welfare state determinants of infant and child health indicators: An analysis of wealthy countries. Soc. Sci. Med.63(3): 829–842, 2006.
5.
CoburnD.Beyond the income inequality hypothesis: Class, neo-liberalism, and health inequalities. Soc. Sci. Med.58(1):41–56, 2004.
6.
RaphaelD., and BryantT.The welfare state as a determinant of women's health: Support for women's quality of life in Canada and four comparison nations. Health Policy68:63–79, 2004.
7.
NavarroV.The importance of the political and the social in explaining mortality differentials among the countries of the OECD, 1950–1998. Int. J. Health. Serv.33(3):419–494, 2003.
8.
DahlE.Welfare state regimes and health inequalities. In Social Inequalities in Health: New Evidence and Policy Implications, ed. SiegristJ. and MarmotM., pp. 193–222. Oxford University Press, Oxford, 2006.
9.
MuntanerC.Social class inequalities in health: Does welfare state regime matter? In Staying Alive: Critical Perspectives on Health, Illness and Health Care, ed. RaphaelD.BryantT., and RiouxM., pp. 139–158. Canadian Scholars' Press, Toronto, 2006.
10.
EspeltA.Inequalities in health by social class dimensions in European countries of different political traditions. Int. J. Epidemiol.37(5):1095–1105, 2008.
11.
LundbergO.Commentary: Politics and public health—some conceptual considerations concerning welfare state characteristics and public health outcomes. Int. J. Epidemiol.37(5):1105–1108, 2008.
12.
EspeltA.Answer to the commentary: Politics and public health—some conceptual considerations concerning welfare state characteristics and public health outcomes. Int. J. Epidemiol., January 8, 2009 [Epub ahead of print].
13.
MackenbachJ. P.European Union Working Group on Socioeconomic Inequalities in Health: Socioeconomic inequalities in health in 22 European countries. N. Engl. J. Med.358(23):2468–2481, 2008.
14.
IdlerE. L., and BenyaminiY.Self-rated health and mortality: A review of twenty-seven community studies. J. Health Soc. Behav.38:21–37, 1997.
15.
BlakelyT. A.What is the lag time between income inequality and health status?J. Epidemiol. Community Health54(4):318–319, 2000.
16.
HuberE.RaginC., and StephensJ.Comparative Welfare States Data Set.Northwestern University and University of North Carolina, Chapel Hill, 1997.
17.
NavarroV.SchmittJ., and AstudilloJ.Is globalisation undermining the welfare state. Camb. J. Econ.28:133–152, 2004.
18.
KunkelS. R., and AtchleyR. C.Why gender matters: Being female is not the same as not being male. Am. J. Prev. Med.12:294–296, 1996.
19.
SchiaffinoA.[Odds ratio or prevalence ratio? Their use in cross-sectional studies.]Gac. Sanit.17:70–74, 2003.
20.
MackenbachJ. P., and KunstA. E.Measuring the magnitude of socio-economic inequalities in health: An overview of available measures illustrated with two examples from Europe. Soc. Sci. Med.44:757–771, 1997.
21.
SimonJ. G.How is your health in general? A qualitative study on self-assessed health. Eur. J. Public Health15(2):200–208, 2005.
22.
MackenbachJ. P.Socioeconomic inequalities in morbidity and mortality in western Europe. The EU Working Group on Socioeconomic Inequalities in Health. Lancet349:1655–1659, 1997.
23.
KunstA. E.Trends in socioeconomic inequalities in self-assessed health in 10 European countries. Int. J. Epidemiol.34(2):295–305, 2005.
24.
HuberE., and StephensJ.Development and Crisis of the Welfare State, p. 90. University of Chicago Press, Chicago, 2001.
25.
EikemoT. A.Health inequalities according to educational level in different welfare regimes: A comparison of 23 European countries. Sociol. Health Illn.30(4): 565–582, 2008.
26.
NavarroV., and QuirogaA. [Welfare state policies for equity.] In Informe de la Sociedad Española de Salud Pública y Administración Sanitaria (SESPAS) 2004: La salud pública desde la perspectiva de género y clase social, ed. BorrellC.García-CalventeM. M., and Martí-BoscàJ. V.. Gac Sanit.18(Suppl. 1):147–157, 2004.
27.
HadleyJ.Sicker and poorer. The consequences of being uninsured: A review of the research on the relationship between health insurance, medical care use, health, work, income. Med. Care Res. Rev.60 (Suppl.):3–75S, 2003.
28.
LasserK. E.HimmelsteinD. U., and WoolhandlerS.Access to care, health status, and health disparities in the United States and Canada: Results of a cross-national population-based survey. Am. J. Public Health96(7):1300–1307, 2006.
29.
LynchJ. W.Income inequality and mortality: Importance to health of individual income, psychosocial environment, or material conditions. BMJ320: 1200–1204, 2000.
30.
WilkinsonR. G., and PickettK. E.Income inequality and population health: A review and explanation of the evidence. Soc. Sci. Med.62(7):1768–1784, 2006.
31.
ArtazcozL.Women, family demands and health: The importance of employment status and socio-economic position. Soc. Sci. Med.59(2):263–274, 2004.
32.
BorrellC.Social class and self-reported health status among men and women: What is the role of work organisation, household material standards and household labor?Soc. Sci. Med.58(10):1869–1887, 2004.
