European Health Inequality Through the 'Great Recession': Social Policy Matters

Sociol Health Illn. 2018 May;40(4):750-768. doi: 10.1111/1467-9566.12723. Epub 2018 Mar 2.


This paper investigates the association between the Great Recession and educational inequalities in self-rated general health in 25 European countries. We investigate four different indicators related to economic recession: GDP; unemployment; austerity and a 'crisis' indicator signifying severe simultaneous drops in GDP and welfare generosity. We also assess the extent to which health inequality changes can be attributed to changes in the economic conditions and social capital in the European populations. The paper uses data from the European Social Survey (2002-2014). The analyses include both cross-sectional and lagged associations using multilevel linear regression models with country fixed effects. This approach allows us to identify health inequality changes net of all time-invariant differences between countries. GDP drops and increasing unemployment were associated with decreasing health inequalities. Austerity, however, was related to increasing health inequalities, an association that grew stronger with time. The strongest increase in health inequality was found for the more robust 'crisis' indicator. Changes in trust, social relationships and in the experience of economic hardship of the populations accounted for much of the increase in health inequality. The paper concludes that social policy has an important role in the development of health inequalities, particularly during times of economic crisis.

Keywords: inequalities/social inequalities in health status; social capital; social change; social determinants of health; welfare state.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Cross-Sectional Studies
  • Diagnostic Self Evaluation
  • Economic Recession / statistics & numerical data*
  • Europe
  • Female
  • Health Status Disparities*
  • Humans
  • Male
  • Middle Aged
  • Public Policy*
  • Social Determinants of Health*
  • Social Welfare
  • Surveys and Questionnaires
  • Unemployment / statistics & numerical data