Social health inequalities among older Europeans: the contribution of social and family background

Abstract

This analysis aims to get a step further in the understanding of the determining factors of social health inequalities, and to explore particularly the role played by parents' social status and their vital status or age at death on the social health inequalities in adulthood among European older adults. The wealth-related health inequalities are measured using the popular concentration index. We then implement the decomposition method of the indices and evaluate the contribution of the various determinants of health introduced in interval regression models. Health is measured using self-assessed health and country-specific cut-points that correct observed differences in self-report due to cross-cultural differences in reporting styles. This paper uses data for ten European countries from the first wave of the 2004 SHARE. The study highlights significantly higher wealth-related health inequalities in the Netherlands, Denmark and Germany. These social inequalities of health in Europe are explained largely by individuals' current social conditions, particularly wealth. Nevertheless, our analysis attests the existence of a long-term influence of initial conditions in childhood on health in middle-aged and beyond, independently of current social characteristics, which contribute to differences in health status across social groups. This article contributes to the identification of social determinants, which are important determinants of health and follows recommendations suggested to help 'close the gap' in various health inequities.

Estimating direct effects of parental occupation on Spaniards’ health by birth cohort

“…These results are consistent with previous studies which focused on elder Spaniards [11, 18, 21]. Once we control for the indirect effects of social circumstances (pathway hypothesis), we prove that there has been a direct impact of early-life conditions on individuals’ health.…”

“…The same result was found by Tubeuf and Jusot [11]. The higher the socioeconomic level associated with the father’s occupation, the more likely the individual will be more educated, healthier and occupy a top job, and these effects persist over time.…”

“…Tubeuf and Jusot [11] and Bricard et al [18] show how parents’ social status and initial conditions in childhood influence adults’ health in Spain and some other European countries, although they do not distinguish between direct and indirect effects. They also find that the contribution of family background to social health inequality in Spain is more important than the contribution of individual status.…”

Structural equation modeling for decomposing rank-dependent indicators of socioeconomic inequality of health: an empirical study

“…Even though empirical work suggests that the socioeconomic variable is an important predictor for health (see, e.g., [2, 11, 13, 17, 18, 25]), the OLS regression-based methodology of decomposition (I) does not provide the right framework to use this result for the explanation of socioeconomic inequality of health . To bridge the gap between the empirical result and the regression-based decomposition methodology, we propose using a SEM approach (see below) that unifies these contrasting themes.…”

“…The existence of a reciprocal relationship should be examined since health is potentially both a cause and a consequence of socioeconomic status [7, 16]. In the literature on the decomposition of socioeconomic inequality of health, several empirical studies (see, e.g., [2, 11, 13, 17, 18, 25]) have investigated the impact of socioeconomic status on health, reporting evidence that socioeconomic status is an important determinant of health. Gerdtham et al [7] argue, however, that an overall consensus about the causal impact of socioeconomic status on health has not yet been reached.…”