Understanding the role of welfare state characteristics for health and inequalities – an analytical review

Abstract

BackgroundThe past decade has witnessed a growing body of research on welfare state characteristics and health inequalities but the picture is, despite this, inconsistent. We aim to review this research by focusing on theoretical and methodological differences between studies that at least in part may lead to these mixed findings.MethodsThree reviews and relevant bibliographies were manually explored in order to find studies for the review. Related articles were searched for in PubMed, Web of Science and Google Scholar. Database searches were done in PubMed and Web of Science. The search period was restricted to 2005-01-01 to 2013-02-28. Fifty-four studies met the inclusion criteria.ResultsThree main approaches to comparative welfare state research are identified; the Regime approach, the Institutional approach, and the Expenditure approach. The Regime approach is the most common and regardless of the empirical regime theory employed and the amendments made to these, results are diverse and contradictory. When stratifying studies according to other features, not much added clarity is achieved. The Institutional approach shows more consistent results; generous policies and benefits seem to be associated with health in a positive way for all people in a population, not only those who are directly affected or targeted. The Expenditure approach finds that social and health spending is associated with increased levels of health and smaller health inequalities in one way or another but the studies are few in numbers making it somewhat difficult to get coherent results.ConclusionsBased on earlier reviews and our results we suggest that future research should focus less on welfare regimes and health inequalities and more on a multitude of different types of studies, including larger analyses of social spending and social rights in various policy areas and how these are linked to health in different social strata. But, we also need more detailed evaluation of specific programmes or interventions, as well as more qualitative analyses of the experiences of different types of policies among the people and families that need to draw on the collective resources.

Job Preferences in Comparative Perspective 1989–2015: A Multidimensional Evaluation of Individual and Contextual Influences

“…Studies with a specific focus on job security, as a particularly important job quality for most people, indicate that such values are quite widespread and relatively stable over time (Clark 2005b;Esser and Olsen 2018;Gallie 2007b;Kalleberg 2009). Related comparative research on employment commitment along an intrinsic-extrinsic continuum found substantial differences between countries (Berglund 2001;Esser 2005b;Hult and Svallfors 2002), also when unemployed people were compared across countries (Gallie and Alm 2000), generally lending evidence for the existence of stronger intrinsic values in more encompassing welfare states and more regulated labor markets (Esser 2005b). Yet, existing comparative research has been based on data for specific points in time or for a relatively short time-period.…”

An institutional theory of welfare state effects on the distribution of population health

“…However, the expectation that a high level of on-average population health (e.g., long life expectancy or low infant mortality) in encompassing welfare states should entail low levels of social inequality in health has not been borne out in a straightforward way (Mackenbach et al 2008), and has generated debate over relative vs. absolute measures of inequality (Brambra 2011a(Brambra , 2013, and the measurement of welfare states (Bergqvist et al 2013). This raises the intriguing possibility that the causes of on-average summary measures like infant mortality and life expectancy differ from the causes of social inequalities in health.…”

“…Even more recently, spurred in part by newly-available, cross-nationally comparable, individual-level data (Gornick and Jaentti 2013) and new techniques for the analysis of the multilevel data (Gelman and Hill 2007;Snijders and Bosker 2012), theories of inequality are turning toward macro-scale institutions to understand how "the rules of the game" (as a common English shorthand for "institution" puts it) create "winners" and "losers" in social life (Brady 2009;Fischer et al 1996;Kenworthy 2004;Western 2006;Pettit and Hook 2009;Pontusson 2005). Institutions, as we use the term, include welfare-state policies identified by Bergqvist et al (2013) in their review of three varieties of welfare-state and health research.…”

“…Although social inequalities in health exist in all societies worldwide (Beckfield et al 2013), the degree of these inequalities varies spatially, and notable differences exist within Europe (Bartley 2004;Beckfield and Olafsdottir 2009). There is a growing literature that examines how these between country differences in health inequalities are potentially related to variations in the provision of welfare across Europe (for overviews see Bambra, 2011a;Bambra and Beckfield, 2012;Bergqvist et al 2013). This literature highlights that the welfare state has an important role in mediating the effects of the social determinants of health and also of socio-economic class on health.…”

The triple bind of single-parent families

“…This strategy allows for examining determinants of single parents' health in a great level of detail, but typically reduces the variability in both single parents' health outcomes and social policies (as well as other contextual factors). Second, a number of studies have been based on welfare-state typologies, which makes it inherently difficult to analyse programme-specific effects of various policies related to health of single parents, as well as to analyse the impact of changes in policies over time (Bergqvist et al, 2013). Being able to do so, however, becomes increasingly important to assess the health impact of current reform developments in social policy.…”