Gender, health inequalities and welfare state regimes: a cross-national study of 13 European countries

Abstract

Background: This study is the first to examine the relationship between gender and self-assessed health (SAH), and the extent to which this varies by socioeconomic position in different European welfare state regimes (Liberal, Corporatist, Social Democratic, Southern). Methods: The EUROTHINE harmonised data set (based on representative cross-sectional national health surveys conducted between 1998 and 2004) was used to analyse SAH differences by gender and socioeconomic position (educational rank) in different welfare states. The sample sizes ranged from 7124 (Germany) to 118 245 (Italy) and concerned the adult population (aged >16 years). Results: Logistic regression analysis (adjusting for age) identified significant gender differences in SAH in nine European welfare states. In the UK (OR 0.88; 95% CI 0.78 to 0.99) and Finland (OR 0.85; 95% CI 0.77 to 0.95), men were significantly more likely to report ''bad'' or ''very bad'' health. In Denmark, Sweden, Norway, Holland, Italy, Spain and Portugal, a significantly higher proportion of women than men reported that their health was ''bad'' or ''very bad''. The increased risk of poor SAH experienced by women from these countries ranged from a 23% increase in Denmark (OR 1.23; 95% CI 1.08 to 1.39) to more than a twofold increase in Portugal (OR 2.01; 95% CI 1.87 to 2.15). For some countries (Italy, Portugal, Sweden), women's relatively worse SAH tended to be most prominent in the group with the highest level of education. Discussion: Women in the Social Democratic and Southern welfare states were more likely to report worse SAH than men. In the Corporatist countries, there were no gender differences in SAH. There was no consistent welfare state regime patterning for gender differences in SAH by socioeconomic position. These findings constitute a challenge to regime theory and comparative social epidemiology to engage more with issues of gender.Gender differences in health are well documented in terms of both mortality and morbidity. However, the extent to which gender differences in health vary by socioeconomic position is less well documented.2 Furthermore, although welfare state arrangements and social policies are increasingly being acknowledged as important determinants of health and of inequalities in health, [3][4][5][6][7][8] there is little research into how gender differences in health vary by welfare state; specifically, there has been little gendered analysis with a focus on the implications for women. [9][10][11] As part of the EUROTHINE project, this study focused on gender and health inequality in 13European welfare states, representing four welfare state regimes: Finland,

Gender gap in health expectancy

“…Previous research reports that women report worse selfrated health than men, although the magnitude of sex differences varies across EU countries (Bambra et al 2008). It has also been demonstrated that men have superior physical performance (Jeune et al 2006;Oksuzyan et al 2010) and fewer limitations in functional abilities compared with the same-aged women .…”

Welfare State Regime Life Courses: The Development of Western European Welfare State Regimes and Age-Related Patterns of Educational Inequalities in Self-Reported Health

“…It results in a fourfold typology of European welfare state regimes: Scandinavian (social democratic), Anglo-Saxon (liberal), Bismarckian (conservative), and Southern (see Box 1). In this article, as with our previous research on welfare state regimes and health outcomes (6,(12)(13)(14)27), we use the Ferrera typology.…”

Thirty years of gender differences in self-assessed health: the case of Slovenia / Trideset let razlik v samoocenah zdravja med spoloma: primer Slovenije

“…This is why the most important message concerning the issue of women's health in Slovenia and elsewhere in times of economic downturn is the vital role of welfare and health policies. Welfare states are important determinants of health and health inequalities as they mediate the extent and impact of socioeconomic position on health (16). As UK scholars point out, their country's case is particularly instructive because of the process of polarization that occurred during two decades when inequality was off the political agenda from 1979 to 1997.…”

“…The datasets we used in this case come from four time points: 1994 (N=1037), 2001 (N=1093), 2009 (N=1065) and 2012 (N=1034). For the purpose of our analysis, educational rank was used as a proxy for socioeconomic position, as is done frequently in similar surveys (16,18). Although people's socioeconomic position may be more accurately expressed by occupation or income, education lies at the heart of people's position in society because it is a fundamental determinant of both occupation and income.…”