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To what extent do financial strain and labour force status explain social class inequalities in self-rated health? Analysis of 20 countries in the European Social Survey.

Shaw RJ, Benzeval M, Popham F - PLoS ONE (2014)

Bottom Line: Nordic countries do not have the smallest health inequalities despite egalitarian social policies.The outcome was self-rated health in 5 categories.Adjusting for financial security and labour force status attenuates a high proportion of health inequalities in some counties, particularly Southern European countries, but attenuation in Nordic countries was modest and did not improve their relative position.

View Article: PubMed Central - PubMed

Affiliation: Medical Research Council/Chief Scientist Office Social and Public Health Sciences Unit, University of Glasgow, Glasgow, United Kingdom.

ABSTRACT

Introduction: Nordic countries do not have the smallest health inequalities despite egalitarian social policies. A possible explanation for this is that drivers of class differences in health such as financial strain and labour force status remain socially patterned in Nordic countries.

Methods: Our analyses used data for working age (25-59) men (n = 48,249) and women (n = 52,654) for 20 countries from five rounds (2002-2010) of the European Social Survey. The outcome was self-rated health in 5 categories. Stratified by gender we used fixed effects linear regression models and marginal standardisation to instigate how countries varied in the degree to which class inequalities were attenuated by financial strain and labour force status.

Results and discussion: Before adjustment, Nordic countries had large inequalities in self-rated health relative to other European countries. For example the regression coefficient for the difference in health between working class and professional men living in Norway was 0.34 (95% CI 0.26 to 0.42), while the comparable figure for Spain was 0.15 (95% CI 0.08 to 0.22). Adjusting for financial strain and labour force status led to attenuation of health inequalities in all countries. However, unlike some countries such as Spain, where after adjustment the regression coefficient for working class men was only 0.02 (95% CI -0.05 to 0.10), health inequalities persisted after adjustment for Nordic countries. For Norway the adjusted coefficient was 0.17 (95% CI 0.10 to 0.25). Results for women and men were similar. However, in comparison to men, class inequalities tended to be stronger for women and more persistent after adjustment.

Conclusions: Adjusting for financial security and labour force status attenuates a high proportion of health inequalities in some counties, particularly Southern European countries, but attenuation in Nordic countries was modest and did not improve their relative position.

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Labour force status by social class, country and welfare state for women.
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pone-0110362-g004: Labour force status by social class, country and welfare state for women.

Mentions: Economic activity by class, country and welfare state is shown in Figure 3 for men and Figure 4 for women. The percentage of intermediate and salariat men employed are very similar. In nearly all Southern, Nordic and Bismarkian countries more than 90% of the Salariat are employed. In contrast for Anglo-Saxon, Eastern European and Former-Soviet countries employment rates for the salariat are typically less than 90%. Across Europe employment rates for working class people were substantially lower than the more advantaged classes and, with the exception of Portugal and Switzerland, in all countries fewer than 80% of working class men were employed. For men unemployment is the largest non-employed category. Women's employment rates are substantially lower than for men. Only in Nordic countries do both salariat and intermediate class women have employment rates greater than 80%. In addition, there is a gradient of decreasing employment across the three classes. For women, the largest non-employed category in most countries was looking after home and providing care. The exceptions to this are the Nordic countries where a comparatively high proportion of women were in the “other” category. In some Anglo-Saxon, Nordic and Bismarkian countries a relatively high proportion of working class people are out of work due to incapacity, whilst in Eastern Europe and Former Soviet countries a relatively high proportion report being retired.


To what extent do financial strain and labour force status explain social class inequalities in self-rated health? Analysis of 20 countries in the European Social Survey.

Shaw RJ, Benzeval M, Popham F - PLoS ONE (2014)

Labour force status by social class, country and welfare state for women.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4196960&req=5

pone-0110362-g004: Labour force status by social class, country and welfare state for women.
Mentions: Economic activity by class, country and welfare state is shown in Figure 3 for men and Figure 4 for women. The percentage of intermediate and salariat men employed are very similar. In nearly all Southern, Nordic and Bismarkian countries more than 90% of the Salariat are employed. In contrast for Anglo-Saxon, Eastern European and Former-Soviet countries employment rates for the salariat are typically less than 90%. Across Europe employment rates for working class people were substantially lower than the more advantaged classes and, with the exception of Portugal and Switzerland, in all countries fewer than 80% of working class men were employed. For men unemployment is the largest non-employed category. Women's employment rates are substantially lower than for men. Only in Nordic countries do both salariat and intermediate class women have employment rates greater than 80%. In addition, there is a gradient of decreasing employment across the three classes. For women, the largest non-employed category in most countries was looking after home and providing care. The exceptions to this are the Nordic countries where a comparatively high proportion of women were in the “other” category. In some Anglo-Saxon, Nordic and Bismarkian countries a relatively high proportion of working class people are out of work due to incapacity, whilst in Eastern Europe and Former Soviet countries a relatively high proportion report being retired.

Bottom Line: Nordic countries do not have the smallest health inequalities despite egalitarian social policies.The outcome was self-rated health in 5 categories.Adjusting for financial security and labour force status attenuates a high proportion of health inequalities in some counties, particularly Southern European countries, but attenuation in Nordic countries was modest and did not improve their relative position.

View Article: PubMed Central - PubMed

Affiliation: Medical Research Council/Chief Scientist Office Social and Public Health Sciences Unit, University of Glasgow, Glasgow, United Kingdom.

ABSTRACT

Introduction: Nordic countries do not have the smallest health inequalities despite egalitarian social policies. A possible explanation for this is that drivers of class differences in health such as financial strain and labour force status remain socially patterned in Nordic countries.

Methods: Our analyses used data for working age (25-59) men (n = 48,249) and women (n = 52,654) for 20 countries from five rounds (2002-2010) of the European Social Survey. The outcome was self-rated health in 5 categories. Stratified by gender we used fixed effects linear regression models and marginal standardisation to instigate how countries varied in the degree to which class inequalities were attenuated by financial strain and labour force status.

Results and discussion: Before adjustment, Nordic countries had large inequalities in self-rated health relative to other European countries. For example the regression coefficient for the difference in health between working class and professional men living in Norway was 0.34 (95% CI 0.26 to 0.42), while the comparable figure for Spain was 0.15 (95% CI 0.08 to 0.22). Adjusting for financial strain and labour force status led to attenuation of health inequalities in all countries. However, unlike some countries such as Spain, where after adjustment the regression coefficient for working class men was only 0.02 (95% CI -0.05 to 0.10), health inequalities persisted after adjustment for Nordic countries. For Norway the adjusted coefficient was 0.17 (95% CI 0.10 to 0.25). Results for women and men were similar. However, in comparison to men, class inequalities tended to be stronger for women and more persistent after adjustment.

Conclusions: Adjusting for financial security and labour force status attenuates a high proportion of health inequalities in some counties, particularly Southern European countries, but attenuation in Nordic countries was modest and did not improve their relative position.

Show MeSH
Related in: MedlinePlus