Age Differences of SES Inequalities in Health: The Role of Social State

Abstract

This article is devoted to such an issue as the changing socio-economic inequalities in health that come with age. According to one theoretical explanation, these inequalities increase when people get older: in the lower strata, the negative effects of life’s hardships on health accumulate, and in the well-off ones, conversely, an accumulated positive effect occurs. This explanation is opposed by theories that predict a reduction in inequality. In older cohorts, as one of them notes, inequalities decrease as the physiological mechanisms of aging begin to play an increasingly important role, reducing the importance of social factors. Selective mortality can also help equalize structural distinction — reducing the number of low-status individuals with poor health leads to social differences smoothening out. Proponents of another theory emphasize the importance of social policy — state support and protection, including special social security programs for the elderly, in helping to maintain the health of vulnerable groups. The empirical results contradict the hypotheses and do not provide convincing evidence for any of the assumptions. Two-level modeling with survey data from the European Social Survey (ESS 2012) for 27 countries and statistical data on these countries, as well as regression analysis carried out on arrays of two groups of countries — with low and high government expenditure on health – showed that, as the transition to older age cohorts occurs, there is a gradual expansion of status inequalities, especially noticeable in countries with low budget spending on health. In the most developed social democracies, this trend did not persist — a slight increase in inequality continues until pre-retirement age, and then — in the category of older people — they smoothen out. The findings support arguments about the positive role of the social state in improving national health and reducing health inequalities after retirement.