Abstract
BackgroundThe majority of empirical studies focus on a single Social Determinant of Health (SDH) when analysing health inequalities. We go beyond this by exploring how the combination of education (micro level) and household arrangements (mezzo level) is associated with self-perceived health.MethodsOur data source is the 2014 cross-sectional data from the European Survey of Living Conditions (EU-SILC). We calculate the predicted probabilities of poor self-perceived health for the middle-aged European population (30–59 years) as a function of the combination of the two SDHs. This is done separately for five European country groups (dual-earner; liberal; general family support; familistic; and post-socialist transition) and gender.ResultsWe observe a double health gradient in all the country groups: first, there is a common health gradient by education (the higher the education, the lower the probability of poor health); second, household arrangements define a health gradient within each educational level according to whether or not the individual lives with a partner (living with a partner is associated with a lower probability of poor health). We observe some specificity in this general pattern. Familistic and post-socialist transition countries display large differences in the predicted probabilities according to education and household arrangements when compared with the other three country groups. Familistic and post-socialist transition countries also show the largest gender differences.ConclusionsHealth differences in European populations seem to be defined, first, by education and, second, by living or not living with a partner. Additionally, different social contexts (gender inequalities, educational profile, etc.) in European countries change the influences on health of both the SDHs for both women and men.
Highlights
The majority of empirical studies focus on a single Social Determinant of Health (SDH) when analysing health inequalities
For this purpose we examine the combination between educational level and household arrangements, two outstanding SDHs from the micro and mezzo levels, among the middle-aged European population (30–59 years)
There is a health gradient within each educational level according to household arrangements, mainly defined by whether or not an individual lives with a partner, whereas having children only shows a small effect when education is taken into account
Summary
The majority of empirical studies focus on a single Social Determinant of Health (SDH) when analysing health inequalities. We go beyond this by exploring how the combination of education (micro level) and household arrangements (mezzo level) is associated with self-perceived health. SDH, which has contributed to having a detailed knowledge about how each single factor individually influences health inequalities. Among these SDHs, most attention has been given to socioeconomic characteristics of individuals (education, activity status, salary, etc.) [1]. The only exception to this is a recent case study for the Spanish adult population by Gumà et al [18] where the authors stated that combining information from education and household arrangements permits the definition of more precise health profiles
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