Inequalities in Self-assessed Health and Chronic Illnesses: A Study of Eleven European Nations
Sociology Graduate School of Economic and Social Sciences Mannheim, Germany
Sociology Boston University Boston, United States
Sociology Harvard University Cambridge, United States
While the role of social inequalities in health outcomes is well-established, fewer studies investigate cross-national variation in inequalities instead of in overall population health. The existing empirical work on health inequalities has largely focused on mortality and self-assessed health as the central outcome measures. While previous research established robust relationships between these measures and an individual?s social position, it stopped short of theorizing diverse causal pathways of how socioeconomic status translates into differences in physical health.
We argue that the debates about theoretical mechanisms can advance by shifting the focus from a general concept of health (as it is measured by self-assessed health) to the diversity of facets which constitute a person?s health. This analytical strategy yields the existence of many different pathways, demonstrating that not all illnesses are influenced by the same social conditions to the same extent.
We focus on person over 50 whose health status is very much determined by chronic illness. Using data from the Survey of Health, Ageing and Retirement, collected in 2004, we compare inequality levels for self-assessed health, different types of chronic illnesses as well as the number of chronic illnesses (as a measure for co- and multimorbidity). The results reveal substantial variation in health inequalities across different medical conditions. While a higher level of education or wealth buffers against certain conditions (e.g. diabetes, high blood pressure), we find almost no effect on others (e.g. cancer, asthma). Inequalities also vary dramatically across nations. We find that this variation in the socioeconomic gradient can be partially accounted for by cross-national differences in economic development and welfare state activity. Inequalities are highest for the existence of co- and multi-morbidity which indicates that health inequalities might not so much relate to the existence of certain conditions but to the severity of these illnesses. Consequently, the influence of social and societal effects on health inequalities in old age seems to rely not only on the prevention but also on the effective management of chronic illnesses.