Between-country inequalities in health lifestyles

Abstract

How does engagement in multiple health behaviors consolidate into health promoting health lifestyles, and how does economic development provide a broadly shared living condition to enable participation in health promoting health lifestyles? To answer these questions, we harmonize information from the 2011 International Social Survey Programme and the 2014 European Social Survey to examine patterns of health lifestyles and subsequent associations with self-rated health in representative samples of 52 country-years nested in 35 countries, with repeated observations from 17 countries. We find individuals engage more frequently in health promoting behaviors in countries with higher levels of economic development. Moreover, we find a tighter connection between health lifestyles and health in countries with higher levels of economic development. Critically, we move health lifestyles research forward by testing the consequences of within country changes in economic development, finding that growth in economic development increases the engagement of health promoting health behaviors. Policy and theoretical implications are discussed.

Health Lifestyle Theory in a Changing Society: The Rise of Infectious Diseases and Digitalization

“…Health lifestyles are obviously most effective in producing health in positive living situations and least effective in disadvantaged neighborhoods where poor health behaviors and unhealthy settings are common (Fitzpatrick and LaGory 2011; Frohlich and Abel 2014; van den Broek 2021). An innovative extension of the living conditions variable in health lifestyle theory to the level of countries shows the importance of national contexts for acquiring a healthy lifestyle (VanHeuvelen and VanHeuvelen 2021).…”

“…As a result, health in today’s modernity is normatively viewed as an achievement (“a goal to work toward”) rather than a taken-for-granted physical condition passively accepted as is by the individual (Cockerham 2005, 2021). The pursuit of health by way of a healthy lifestyle has become not only a societal norm in economically advanced countries (VanHeuvelen and VanHeuvelen 2021) but also a duty (Lupton 2013).…”

“…Health lifestyle theory, as noted, was intended to advance understanding of how lifestyles impact the health of different social groups and serve as a theoretical framework for empirical research on the topic. It has become “a mature theory in medical sociology used to explain the combination of health behaviors and their associations with health outcomes” (VanHeuvelen and VanHeuvelen 2021: 205). However, the COVID-19 pandemic and the spread of digitalization in society provide a new social context for the theory to address.…”

Response scale overstretch: linear stretching of response scales does not ensure cross-project equivalence in harmonised data

“…Ex-post harmonisation (henceforth, harmonisation) aims to merge data from different survey projects into a unified analysis-ready dataset, even if the original data were not intended for recycling (Granda et al 2010). While complete cross-project data harmonisation is typically only possible for socio-demographic variables (Hoffmeyer-Zlotnik and Wolf 2003), it remains partially possible for narrow and specific issues, e.g., corruption (Wysmułek 2019), democratic values and protest behaviours (Słomczyński et al 2016), European integration (Jabkowski and Cichocki 2022), general social trust (Bekkers et al 2018), health lifestyles (VanHeuvelen and VanHeuvelen 2021) or national identities and religion (Bechert et al 2020). In contrast to socio-demographic characteristics, cross-project harmonisation of substantive survey questions faces acute measurement problems.…”