Epi + demos + cracy: Linking Political Systems and Priorities to the Magnitude of Health Inequities--Evidence, Gaps, and a Research Agenda

Abstract

A new focus within both social epidemiology and political sociology investigates how political systems and priorities shape health inequities. To advance-and better integrate-research on political determinants of health inequities, the authors conducted a systematic search of the ISI Web of Knowledge and PubMed databases and identified 45 studies, commencing in 1992, that explicitly and empirically tested, in relation to an a priori political hypothesis, for either 1) changes in the magnitude of health inequities or 2) significant cross-national differences in the magnitude of health inequities. Overall, 84% of the studies focused on the global North, and all clustered around 4 political factors: 1) the transition to a capitalist economy; 2) neoliberal restructuring; 3) welfare states; and 4) political incorporation of subordinated racial/ethnic, indigenous, and gender groups. The evidence suggested that the first 2 factors probably increase health inequities, the third is inconsistently related, and the fourth helps reduce them. In this review, the authors critically summarize these studies' findings, consider methodological limitations, and propose a research agenda-with careful attention to spatiotemporal scale, level, time frame (e.g., life course, historical generation), choice of health outcomes, inclusion of polities, and specification of political mechanisms-to address the enormous gaps in knowledge that were identified.

Delayed and differential effects of the economic crisis in Sweden in the 1990s on health-related exclusion from the labour market: A health equity assessment

“…Empirical evidence on welfare states and public health outcomes indicates potentially important linkages (Navarro et al, 2006;Eikemo et al, 2008;Beckfield and Krieger 2009). A recent systematic review of ecological evidence found that social democratic regimes (including Sweden, Norway and Denmark) tended to fare best in terms of absolute health outcomes but the evidence was inconsistent in terms of relative health inequalities (Muntaner et al, 2011).…”

“…A recent systematic review of ecological evidence found that social democratic regimes (including Sweden, Norway and Denmark) tended to fare best in terms of absolute health outcomes but the evidence was inconsistent in terms of relative health inequalities (Muntaner et al, 2011). A second systematic review of the impact on health inequalities of politics and policies concluded that the transition to a capitalist economic and neoliberal restructuring probably increase health inequalities; the type of welfare state is inconsistently related to health inequalities; and political inclusion of subordinated racial/ethnic, indigenous and gender group helps to reduce health inequalities (Beckfield and Krieger, 2009). …”

Occupational inequalities in self-rated health and non-communicable diseases in different regions of Europe: findings from the European Social Survey (2014) special module on the social determinants of health

“…[6,7] Finally, previous work suggests that Anglo--Saxon countries in the North--West of Europe, specifically Ireland and the U.K., will have some of the highest levels of health inequality since policies in these countries have historically minimized the decommodification effects of the welfare--state. [13] Thus far, studies have not been able to comprehensively examine occupational inequalities in non--communicable diseases across European regions, due to a lack of comparable data. This paper is therefore the first to do so, using a newly available data set from the 2014 European Social Survey which had a special module on health inequalities.…”

Inequalities in health status depending on socio-economic situation in the European countries

“…However, the causal mechanisms underlying this relationship are complex and controversial (see for example Deaton, 2003;Beckfi eld & Krieger, 2009;Jayasinghe, 2015). However, the values of the Spearman correlation coeffi cients in Tab.…”