Inequality of Opportunity in Health and the Principle of Natural Reward: evidence from European Countries (original) (raw)
Related papers
2017
This paper aims to quantify and compare inequalities of opportunity in health across European countries considering two alternative normative ways of treating the correlation between effort, as measured by lifestyles, and circumstances, as measured by parental and childhood characteristics, championed by Brian Barry and John Roemer. This study relies on regression analysis and proposed several measures of inequality of opportunities. Data from the Retrospective Survey of SHARELIFE, which focuses on life histories of European people aged 50 and over, are used. In Europe at the whole, inequalities in opportunities stand for almost 50% of the health inequality due to circumstances and efforts in Barry scenario and 57.5% in Roemer scenario. The comparison of the magnitude of inequalities of opportunity in health across European countries shows considerable inequalities in Austria, France, Spain, Germany, whereas Sweden, Poland, Belgium, the Netherlands and Switzerland present the lowest...
2013
This paper aims to quantify and compare inequalities of opportunity in health across European countries considering two alternative normative ways of treating the correlation between effort, as measured by lifestyles, and circumstances, as measured by parental and childhood characteristics, championed by Brian Barry and John Roemer. This study relies on regression analysis and proposed several measures of inequality of opportunities. Data from the Retrospective Survey of SHARELIFE, which focuses on life histories of European people aged 50 and over, are used. In Europe at the whole, inequalities in opportunities stand for almost 50% of the health inequality due to circumstances and efforts in Barry scenario and 57.5% in Roemer scenario. The comparison of the magnitude of inequalities of opportunity in health across European countries shows considerable inequalities in Austria,
Health and Income Inequalities in Europe: What Is the Role of Circumstances
Equality of opportunity theories distinguish between inequalities due to individual effort and those due to external circumstances. Recent research has shown that half of the variability in income of World population was determined by country of birth and income distribution. Since health and income are generally strictly related, the aim of this paper is to estimate how much variability in income and health is determined by external circumstances. We use data from the Survey of Health, Ageing and Retirement (SHARE) and the English Longitudinal Survey on Ageing (ELSA), two comparable multidisciplinary surveys that provide micro-level data on health and financial resources among the elderly for a large number of European countries. Our baseline estimation shows that about 20% of the variability in income is explained by current country-specific circumstances, while health outcomes range from 12% using BMI to 19% using self-rated health. By including early-life circumstances, the explained variability increases almost 20 percentage points for income and for self-rated health but less for other health outcomes. Finally, by controlling for endogeneity issues linked with effort, our estimates indicate that circumstances better explain variability in health outcomes. Results are robust to some tests, and the implications of these findings are discussed. © 2017 Elsevier B.V. All rights reserved.
Inequality of opportunity in health: evidence from a UK cohort study
Health Economics
This paper proposes an empirical implementation of the concept of inequality of opportunity in health and applies this to data from the UK National Child Development Study. Drawing on the distinction between circumstance and effort variables in John Roemer's work on equality of opportunity, circumstances are proxied by parental socio-economic status and childhood health; effort is proxied by health-related lifestyles and educational attainment. Stochastic dominance tests are used to detect inequality of opportunity in the conditional distributions of self-assessed health in adulthood. Two alternative approaches are used to measure inequality of opportunity. Econometric models are estimated to illuminate and quantify the triangular relationship between circumstances, effort and health. The results indicate the existence of a considerable and persistent inequality of opportunity in health. Circumstances affect health in adulthood both directly and through effort factors such as ed...
Effort or Circumstances: Which one matters in health inequality?
2010
This paper attempts to quantify the contribution of inequalities of opportunities and inequalities due to differences in effort to be in good health to overall health inequality in France. It examines three alternative specifications of legitimate and illegitimate inequalities drawing on ...
A comparative analysis of inequality in health across Europe
2010
The study of inequality in health concerns the relationship between socially structured characteristics and health outcomes. Howewer, health disparities are also linked to purely individual characteristics and contextual ones. In particular, the contextual effect at a national level may reflect differences in the functioning and performing of national health institutions, that may be conceived as further determinants of health inequalities. In this work we aim at estimating the effect of education on self-assessed health across European countries, taking into account potential confounders like age, gender and family social background. Using a multilevel model with individuals nested in countries, we can achieve two aims. First, we can see whether countries differ in their average self-assessed health score. Second, we can test our hypothesis about the existence of a European social gradient, that is that education exerts a relatively constant effect on self-assessed health. We develop our models using data from European Social Surveys (88,842 interviews).
European Journal of Public Health, 2017
Background: Health inequalities persist between and within European countries. Such inequalities are usually explained by health behaviours and according to the conditions in which people work and live. However, little is known about the relative contribution of these factors to health inequalities in European countries. This paper aims to investigate the independent and joint contribution of a comprehensive set of behavioural, occupational and living conditions factors in explaining social inequalities in self-rated health (SRH). Method: Data from 21 countries was obtained from the 2014 European Social Survey and examined for respondents aged 25-75. Adjusted rate differences (ARD) and adjusted rate risks (ARR), generated from binary logistic regression models, were used to measure health inequalities in SRH and the contribution of behavioural, occupational and living conditions factors. Result: Absolute and relative inequalities in SRH were found in all countries and the magnitude of socioeconomic inequalities varied considerably between countries. While factors were found to differentially contribute to the explanation of educational inequalities in different European countries, occupational and living conditions factors emerged as the leading causes of inequalities across most of the countries, contributing both independently and jointly with behavioural factors. Conclusion: The observed shared effects of different factors to health inequalities points to the interdependent nature of occupational, behavioural and living conditions factors. Tackling health inequalities should be a concentred effort that goes beyond interventions focused on single factors.
Inequality of opportunities in health in France: a first pass
Health Economics, 2009
This article analyses the role played by childhood circumstances, especially social and family background in explaining health status among older adults. We also explore the hypothesis of an intergenerational transmission of health inequalities using the French part of SHARE. As the impact of both social background and parents' health on health status in adulthood represent circumstances independent of individual responsibility, this study allows us to test for the existence in France of inequalities of opportunity in health related to family and social background. Empirically, our study relies both on tests of stochastic dominance at first order and multivariate regressions, supplemented by a counterfactual analysis to evaluate the longlasting impact of childhood conditions on inequality in health. Allocating the best circumstances in both parents' SES and parents' health reduces inequality in health by an impressive 57% using the Gini coefficient. The mother's social status has a direct effect on the health of her offspring. By contrast, the effect on the descendant's health from the father's social status is indirect only, going through the descendant's social status as an adult. There is also a direct effect of each parent's health on health in adulthood.
European Sociological Review, 2016
The European Social Survey (ESS) is a biennial, academically driven, cross-sectional, pan-European social survey that charts and explains the interactions between Europe's changing institutions and the attitudes, beliefs, and behaviour patterns of its diverse populations. As part of the seventh round of the ESS, we successfully developed a rotating module that provides a comprehensive and comparative pan-European data set on the social determinants of health and health inequalities. In this article, we present the rationale for the module, the health outcomes, and social determinants that were included, and some of the opportunities that the module provide for advancing research into explaining the distribution and aetiology of social inequalities in health in Europe. Thus far, no health survey has had sufficient data on the stratification system of societies, including rich data on living conditions, and there is no sociological survey with sufficient variety of lifestyle factors and health outcomes. By including unhealthy lifestyle behaviours, childhood conditions, housing conditions, working conditions, and variables describing access to healthcare, together with an extensive set of mental and physical health outcomes, the ESS has strengthened its position tremendously as a data source for sociologists wanting to perform European cross-national analyses of health inequalities. Background Health inequality usually refers to the systematic differences in health, which exist between social classes, areas, or groups (for example, by age, gender, race, or place). Health inequality can be defined in a purely descriptive way. For example, Kawachi and colleagues refer to health inequality as 'a term used to designate differences, variations, and disparities in the health achievements of individuals and groups' (Kawachi, Subramanian and Almeida-Filho, 2002). More commonly though, the moral and ethical dimensions of the term are emphasized: inequalities in health are thereby
Inequalities in health: the interaction of circumstances and health related behaviour
Sociology of Health and Illness, 1995
This paper derives its main hypothesis from results of the Health and Lifestyle Survey as reported in Blaxter's monograph Health and Lifestyles. In this book it is argued that in a favourable social environment a healthy lifestyle matters but in a unfavourable social environment a healthy lifestyle does not make much difference. This hypothesis is tested with data from health surveys from the Netherlands and Denmark. The Dutch data showed a highly significant relationship of unfavourable material and social circumstances with both poor health and an unhealthy lifestyle. In turn, an unhealthy lifestyle was also related to poor health. The Danish study showed similar, although generally weaker, associations. When the British findings would apply to Denmark and the Netherlands, we should find an interaction between material and social circumstances and health related behaviour in their association with health and illness. Neither the Dutch nor the Danish data showed an interaction of the type that the British study assumes. The paper concludes with a discussion of the reasons why the findings from the UK could not be replicated.