Commentary:
Politics and public health—some conceptual considerations concerning welfare state characteristics and public health outcomes
Stockholm University/Karolinska Institutet,
International Journal of Epidemiology – May 8, 2008
Available online at: http://ije.oxfordjournals.org/cgi/content/full/dyn078v1?etoc
“…..Espelt et al. have published a paper1 on differences between European welfare states and how these differences are linked to health inequalities among the older part of the population. Although many comparative studies of international variations in health inequalities have drawn conclusions about the pros and cons of different welfare state set-ups, the issue has not been properly studied. Partly, this could be due to the conceptual and methodological problems involved when one attempts to relate international variations in complex welfare state structures on the one hand with mortality, ill health or health inequalities on the other. And because of the complexity of the task, the analytical choices made when designing a study become even more crucial than in regular individual-level epidemiological studies.
Examples of such choices include what kind of welfare state characteristics we believe to be of importance for public health outcomes; how data on these characteristics are handled and what kinds of public health outcomes are likely to be affected. I believe that the choices made by Espelt et al. need to be examined, since they have important consequences for our understanding of the links between welfare state characteristics and public health outcomes.
A fundamental question is of course what it is about welfare states that affect the health and longevity among their populations and that also vary systematically across different types of welfare state. Ultimately, I would argue, it is the resources available to people that will be of importance for the levels of and inequalities in health in a country.2 …….”
Inequalities in health by social class dimensions in European countries of different political traditions
Albert Espelt1,2, Carme Borrell 1,3,4,*, Maica Rodríguez-Sanz 1,3, Carles Muntaner 5, M Isabel Pasarín 1,3,4, Joan Benach 3,7,
Maartje Schaap 6, Anton E Kunst 6 and Vicente Navarro 4,8
1 Agència de Salut Pública de Barcelona, Barcelona, Spain.
2 Consorci de Serveis Socials de Barcelona, Barcelona, Spain.
3 CIBER de Epidemiología y Salud Pública (CIBERESP), Spain.
4 Universitat Pompeu Fabra,
5 Social Equity and Health Section, Center for Addictions and Mental Health and Faculty of Nursing,
6 Department of Public Health, University Medical Centre,
7 Health Inequalities Research Group, Occupational Health Research Unit, Universitat Pompeu Fabra,
8 Department of Health Policy and Management,
International Journal of Epidemiology - March 13, 2008
Website:
Objective To compare inequalities in self-perceived health in the population older than 50 years, in 2004, using Wright's social class dimensions, in nine European countries grouped in three political traditions (Social democracy, Christian democracy and Late democracies).
Methods Cross-sectional design, including data of the Survey of Health, Ageing and Retirement in Europe (
Results Absolute and relative health inequalities by social class dimensions are found in the three political traditions, but these differences are more marked in Late democracies and mainly among women. For example the prevalence ratio of poor self-perceived health comparing poorly educated women with highly educated women, was 1.75 (95% CI: 1.39–2.21) in Late democracies and 1.36 (95% CI: 1.21–1.52) in Social democracies. The prevalence differences were 24.2 and 13.7%, respectively.
Conclusion This study is one of the first to show the impact of different political traditions on social class inequalities in health. These results emphasize the need to evaluate the impact of the implementation of public policies.
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