Social inequalities in "sickness": does welfare state regime type make a difference? A multilevel analysis of men and women in 26 European countries

Int J Health Serv. 2012;42(2):235-55. doi: 10.2190/HS.42.2.f.


In comparative studies of health inequalities, public health researchers have usually studied only disease and illness. Recent studies have also examined the sickness dimension of health, that is, the extent to which ill health is accompanied by joblessness, and how this association varies by education within different welfare contexts. This research has used either a limited number of countries or quantitative welfare state measures in studies of many countries. In this study, the authors expand on this knowledge by investigating whether a regime approach to the welfare state produces consistent results. They analyze data from the European Union Statistics on Income and Living Conditions (EU-SILC); health was measured by limiting longstanding illness (LLSI). Results show that for both men and women reporting LLSI in combination with low educational level, the probabilities of non-employment were particularly high in the Anglo-Saxon and Eastern welfare regimes, and lowest in the Scandinavian regime. For men, absolute and relative social inequalities in sickness were lowest in the Southern regime; for women, inequalities were lowest in the Scandinavian regime. The authors conclude that the Scandinavian welfare regime is more able than other regimes to protect against non-employment in the face of illness, especially for individuals with low educational level.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Age Factors
  • Chronic Disease / economics*
  • Cost of Illness
  • Europe
  • Female
  • Health Care Costs
  • Health Status Disparities*
  • Humans
  • Male
  • Middle Aged
  • National Health Programs
  • Sex Factors
  • Social Welfare / economics*
  • Social Welfare / statistics & numerical data*
  • Socioeconomic Factors
  • Unemployment