a b s t r a c tThis study examines the welfare state arrangements and social policy, living conditions and health among lone and couple mothers in three contrasting policy environments: Italy, Sweden and Britain. These countries fall into distinctive family policy categories. Data were drawn from representative national household interview surveys. The findings highlight both similarities and differences. Lone mothers had significantly worse health than couple mothers in all three countries, were more likely to suffer material disadvantage and were much more likely to be smokers. They could be considered a disadvantaged group in particular need in all three countries, irrespective of the policy regime. It is the differences between countries, however, in the experiences of lone and couple mothers that indicate that the prevailing policy regime really does matter. There were telling differences in the prevalence of lone motherhood, their composition, rates of joblessness, poverty and health status of lone mothers in relation to couple mothers in each country. These may be traced back to the main policy regimes of each country, but also partly reflect culture and traditions. The study illustrates an emerging approach to investigating the health inequalities impact of complex social policy contexts. The experiences of lone mothers as a group may serve as a 'litmus' test of how each family policy system is operating and offer an early warning of adverse impacts when policies change.

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This study analyses self-rated health and non-employment and potential synergy effects among lone and couple mothers aged 25-59 in Britain, Sweden and Italy, representing different family policy categories using data from national surveys (2000)(2001)(2002)(2003)(2004)(2005). Synergy effects on health were calculated by synergy index. Non-employment only marginally contributed to the excess risk of poor health among lone mothers but there were synergy effects between lone motherhood and nonemployment in all three countries, producing a higher risk of poor health than would be expected from a simple addition of these exposures. Results are discussed in relation to the different family policy and living contexts. Responses to reviewer # 3's comments: The title would read better if "contribute to" is replaced by "associated with". Consider also omitting the subtitle. Response:We have changed the title accordingly, and altered the subtitle. The new title reads: "Is non-employment associated with the health disadvantage among lone mothers in Britain, Italy and Sweden? Family policy and synergy effects" Avoid causal arguments and terminology throughout the text ("causal", "impact", "effect" etc.). Response: We have searched the text for causal arguments and terminology, and changed the wording where we thought it appropriate, and kept the wording when referring to other studies where this terminology has been used. Use "employment" instead of "work" wherever appropriate. Response: We have gone through the article and change wherever appropriate. The country specific analyses have been separately conducted and therefore avoid direct comparisons of countries in terms of the levels of risk (OR). Interactions would be needed for direct country comparisons. Response: We agree and have made alterations in the text. The second para of Discussion says "Non-employment only partly explained.". In my mind the explanation was minimal. Response: We agree and have changed this to: "Non-employment only marginally contributed to the excess risk…." 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 Response to Reviewers AbstractThis study analyses self-rated health and non-employment and potential synergy effects among lone and couple mothers aged 25-59 in Britain, Sweden and Italy, representing different family policy categories using data from national surveys (2000)(2001)(2002)(2003)(2004)(2005). Synergy effects on health were calculated by synergy index. Non-employment only marginally contributed to the excess risk of poor health among lone mothers but there were synergy effects between lone motherhood and non-employment in all three countries, producing a higher risk of poor health than would be expected from a simple addition of these exposures.Results are discussed in relation to the different family policy and living co...

BackgroundIn Europe and elsewhere there is rising concern about inequality in health and increased prevalence of mental ill-health. Structural determinants such as welfare state arrangements may impact on levels of mental health and social inequalities. This systematic review aims to assess the current evidence on whether structural determinants are associated with inequalities in mental health outcomes.MethodsWe conducted a systematic review of quantitative studies published between 1996 and 2017 based on search results from the following databases Medline, Embase, PsychInfo, Web of Science, Sociological Abstracts and Eric. Studies were included if they focused on inequalities (measured by socio-economic position and gender), structural determinants (i.e. public policies affecting the whole population) and showed a change or comparison in mental health status in one (or more) of the Organisation for Economic Cooperation and Development (OECD) countries. All studies were assessed for inclusion and study quality by two independent reviewers. Data were extracted and synthesised using narrative analysis.ResultsTwenty-one articles (17 studies) met the inclusion criteria. Studies were heterogeneous with regards to methodology, mental health outcomes and policy settings. More comprehensive and gender inclusive welfare states (e.g. Nordic welfare states) had better mental health outcomes, especially for women, and less gender-related inequality. Nordic welfare regimes may also decrease inequalities between lone and couple mothers. A strong welfare state does not buffer against socio-economic inequalities in mental health outcomes. Austerity measures tended to worsen mental health and increase inequalities. Area-based initiatives and educational policy are understudied.ConclusionAlthough the literature on structural determinants and inequalities in mental health is limited, our review shows some evidence supporting the causal effects of structural determinants on mental health inequalities. The lack of evidence should not be interpreted as lack of effect. Future studies should apply innovative methods to overcome the inherent methodological challenges in this area, as structural determinants potentially affect both levels of mental health and social inequalities.Electronic supplementary materialThe online version of this article (10.1186/s12939-018-0879-9) contains supplementary material, which is available to authorized users.