Welfare states, the Great Recession and health: Trends in educational inequalities in self-reported health in 26 European countries.

Julian Perelman,Clare Bambra,Teresa Leão,Inês Campos-Matos,Giuliano Russo

doi:10.1371/journal.pone.0193165

Abstract

BackgroundAlthough socioeconomic inequalities in health have long been observed in Europe, few studies have analysed their recent patterning. In this paper, we examined how educational inequalities in self-reported health have evolved in different European countries and welfare state regimes over the last decade, which was troubled by the Great Recession.MethodsWe used cross-sectional data from the EU-SILC survey for adults from 26 European countries, from 2005 to 2014 (n = 3,030,595). We first calculated education-related absolute (SII) and relative (RII) inequalities in poor self-reported health by country-year, adjusting for age, sex, and EU-SILC survey weights. We then regressed the year- and country-specific RII and SII on a yearly time trend, globally and by welfare regime, adjusting for country fixed effects. We further adjusted the analysis for the economic cycle using GDP growth, unemployment, and income inequality.ResultsOverall, absolute inequalities persisted and relative inequalities slightly widened (betaRII = 0.0313, p<0.05). There were substantial differences by welfare regime: Anglo-Saxon countries experienced the largest increase in absolute inequalities (betaSII = 0.0032, p<0.05), followed by Bismarkian countries (betaSII = 0.0024, p<0.001), while they reduced in Post-Communist countries (betaSII = -0.0022, p<0.001). Post-Communist countries also experienced a widening in relative inequalities (betaRII = 0.1112, p<0.001), which were found to be stable elsewhere. Adjustment for income inequality only explained such trend in Anglo-Saxon countries.ConclusionsEducational inequalities in health have overall persisted across European countries over the last decade. However, there is considerable variation across welfare regimes, possibly related to underpinning social safety nets and to austerity measures implemented during this 10-year period.

Highlights

There were substantial differences by welfare regime: Anglo-Saxon countries experienced the largest increase in absolute inequalities, followed by Bismarkian countries, while they reduced in PostCommunist countries
There is considerable variation across welfare regimes, possibly related to underpinning social safety nets and to austerity measures implemented during this 10-year period
Lower educational status is usually associated with lower health literacy[5,6], worse working conditions, lower income and precarious living conditions[6] that affect physical and mental health.[6,7]. Though such health inequalities (HI) are observed across all European countries,[1,2,3,4] societies with strong social protection and high social cohesion are expected to mitigate the impact of unfavourable socioeconomic circumstances.[6,7,8,9]

Summary

Introduction

There is substantial evidence in Europe that individuals from lower educated groups experience a higher risk of mortality,[1] a higher prevalence of chronic diseases,[1,2] and poorer selfreported health (SHR).[1,3,4] Lower educational status is usually associated with lower health literacy[5,6], worse working conditions, lower income and precarious living conditions[6] that affect physical and mental health.[6,7]Though such health inequalities (HI) are observed across all European countries,[1,2,3,4] societies with strong social protection and high social cohesion are expected to mitigate the impact of unfavourable socioeconomic circumstances.[6,7,8,9] Countries with more redistributive social security systems, universal education and health coverage tend to experience better health amongst all socio-economic groups, there is less clear evidence about the magnitude of absolute and relative HI.[10]. Socioeconomic inequalities in health have long been observed in Europe, few studies have analysed their recent patterning. We examined how educational inequalities in self-reported health have evolved in different European countries and welfare state regimes over the last decade, which was troubled by the Great Recession

Methods

Results

Conclusion