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Understanding the role of welfare state characteristics for health and inequalities - an analytical review
Centre for Health Equity Studies, Stockholm University, Karolinska Institutet, Stockholm, Sweden .
Centre for Health Equity Studies, Stockholm University, Karolinska Institutet, Stockholm, Sweden .
Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences. Centre for Health Equity Studies, Stockholm University, Karolinska Institutet, Stockholm, Sweden .
2013 (English)In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 13, Art. no. 1234- p.Article, review/survey (Refereed) Published
Abstract [en]

Background: The past decade has witnessed a growing body of research on welfare state characteristics and health inequalities but the picture is, despite this, inconsistent. We aim to review this research by focusing on theoretical and methodological differences between studies that at least in part may lead to these mixed findings. Methods: Three reviews and relevant bibliographies were manually explored in order to find studies for the review. Related articles were searched for in PubMed, Web of Science and Google Scholar. Database searches were done in PubMed and Web of Science. The search period was restricted to 2005-01-01 to 2013-02-28. Fifty-four studies met the inclusion criteria. Results: Three main approaches to comparative welfare state research are identified; the Regime approach, the Institutional approach, and the Expenditure approach. The Regime approach is the most common and regardless of the empirical regime theory employed and the amendments made to these, results are diverse and contradictory. When stratifying studies according to other features, not much added clarity is achieved. The Institutional approach shows more consistent results; generous policies and benefits seem to be associated with health in a positive way for all people in a population, not only those who are directly affected or targeted. The Expenditure approach finds that social and health spending is associated with increased levels of health and smaller health inequalities in one way or another but the studies are few in numbers making it somewhat difficult to get coherent results. Conclusions: Based on earlier reviews and our results we suggest that future research should focus less on welfare regimes and health inequalities and more on a multitude of different types of studies, including larger analyses of social spending and social rights in various policy areas and how these are linked to health in different social strata. But, we also need more detailed evaluation of specific programmes or interventions, as well as more qualitative analyses of the experiences of different types of policies among the people and families that need to draw on the collective resources.

Place, publisher, year, edition, pages
2013. Vol. 13, Art. no. 1234- p.
Keyword [en]
Health inequalities, Health, Welfare regime, Social expenditure, Welfare institutions
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
URN: urn:nbn:se:miun:diva-21989DOI: 10.1186/1471-2458-13-1234ISI: 000331284400001ScopusID: 2-s2.0-84890991197OAI: oai:DiVA.org:miun-21989DiVA: diva2:721642
Available from: 2014-06-04 Created: 2014-05-28 Last updated: 2016-10-20Bibliographically approved

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