1. Welfare policies and
health inequalities:
Different approaches to measure
welfare state efforts
Olle Lundberg, Professor and Director CHESS
EPH Pre-conference on How to tackle health inequalities, Glasgow 141120
DRIVERS is co-ordinated by EuroHealthNet and has received funding from the European
Union’s Seventh Framework Programme (FP7/2007-2013) under grant agreement n°278350

2. How can we best capture Welfare
State efforts?
• Good reasons to assume smaller inequalities in more
ambitious WfS, but mixed findings in the literature
• An analytical review of 54 studies published Jan 2005-
Feb 2013
– Regime approach: 34
– Institutional approach: 14
– Expenditure approach: 8
• Can diverging results be understood as differences
between and within approaches?
2014-11-13/ Olle Lundberg

3. 2014-11-13/ Olle Lundberg
Source: Bergqvist, Åberg Yngwe, Lundberg BMC Public Health 2013; 13:1234

4. The analysis
• Most diverging results in the Regime type group,
therefore further elaborations were made
– By specific typology, by outcome (morbidity, mortality, best
health), by data source, by number of countries
• Still, little clarity was achieved – even within those sub-groups
there are large differences in number and choice
of countries, groupings, outcomes etc.
2014-11-13/ Olle Lundberg

5. General findings of the review
• The Regime approach generates mixed findings
– Nominal similarities obscure a multitude of differences
– Clustering of countries according to one dimension is
theoretically unlikely to be analytically useful
• The Institutional and Expenditure approaches are more
promising
– These approaches provide a possibility to use variables and
measure both qualitative and quantitative differences in welfare
policies
– Existing studies of these types give clear indication that the
welfare state context do matter for health inequalities
2014-11-13/ Olle Lundberg

6. Social spending is linked to better
health and smaller inequalities
2014-11-13/ Olle Lundberg Source: Dahl & van der Wel, Soc Sci Med 2013;81:60-69

7. Unemployment benefits and health
An interaction effect.
Much better health at
higher replacement
rates when coverage
is high.
This effect is stronger
for low educated,
contributing to
smaller inequalities.
Source: Sjöberg, Nelson, Ferrarini
(2014) Decomposing the effect of
social policies on population health
and inequalities. DRIVERS working
paper
2014-11-13/ Olle Lundberg

8. Some key messages
• A general effect of welfare regimes is difficult to
establish – a conceptual and measurement problem!
• However, there are clear relationships between social
protection in terms of social rights and social
expenditures, health and health inequalities
• New findings emerge when we disentangle different
aspects of policies. Coverage rates appear crucial.
• Further research should focus less on regime types and
more on spending and/or social rights
2014-11-13/ Olle Lundberg

9. Thank you!