Explaining happiness trends in Europe.

In Europe, differences among countries in the overall change in happiness since the early 1980s have been due chiefly to the generosity of welfare state programs-increasing happiness going with increasing generosity and declining happiness with declining generosity. This is the principal conclusion from a time-series study of 10 Northern, Western, and Southern European countries with the requisite data. In the present study, cross-section analysis of recent data gives a misleading impression that economic growth, social capital, and/or quality of the environment are driving happiness trends, but in the long-term, time-series data, these variables have no relation to happiness.

Retirement Trajectories in Countries with Flexible Retirement Policies but Different Welfare Regimes.

We examine how both the welfare regime and health affect retirement trajectories in countries with flexible retirement policies using longitudinal methods and harmonized panel data from two social-democratic (Sweden and Denmark) and two liberal welfare regimes (Chile and the United States). An early retirement trajectory, which represents retirement in the early 60s, is the most frequent in all countries, although it is less prevalent in liberal than in social-democratic regimes. Adverse health conditions are more frequent among early retirees in liberal but not in social-democratic regimes. Overall, we do not find evidence for an inciting effect of flexible retirement policies on working life extension. However, welfare regimes substantially affect late-life labor force participation.

The future incidence, prevalence and costs of stroke in the UK.

BACKGROUND: we project incidence and prevalence of stroke in the UK and associated costs to society to 2035. We include future costs of health care, social care, unpaid care and lost productivity, drawing on recent estimates that there are almost 1 million people living with stroke and the current cost of their care is £26 billion. METHODS: we developed a model to produce projections, building on earlier work to estimate the costs of stroke care by age, gender and other characteristics. Our cell-based simulation model uses the 2014-based Office for National Statistics population projections; future trends in incidence and prevalence rates of stroke derived from an expert consultation exercise; and data from the Office for Budget Responsibility on expected future changes in productivity and average earnings. RESULTS: between 2015 and 2035, the number of strokes in the UK per year is projected to increase by 60% and the number of stroke survivors is projected to more than double. Under current patterns of care, the societal cost is projected to almost treble in constant prices over the period. The greatest increase is projected to be in social care costs-both public and private-which we anticipate will rise by as much as 250% between 2015 and 2035. CONCLUSION: the costs of stroke care in the UK are expected to rise rapidly over the next two decades unless measures to prevent strokes and to reduce the disabling effects of strokes can be successfully developed and implemented.

Building Community Partnership to Sustain the Minnesota Student Parent Support Initiative.

PURPOSE: Considerable attention has been given to the sustainability of adolescent health programs as federal funds have become limited. This article describes important steps and lessons learned in seeking buy-in from stakeholders to promote sustainability and secure non-federal funds to maintain the Minnesota Student Parent Support Initiative (MSPSI) after federal funding ended. DESCRIPTION: MSPSI was established in 2010 to address the academic and health needs of expectant and parenting postsecondary students. MSPSI provided coordinated case management and referrals to health, education, and social services for expectant and parenting adolescents, as well as for their children, through Student Parent Centers (SPCs). Six important actions sustained the SPCs after the Office of Population Affairs (OPA) grant funds ended in November 2017: (1) preparing and planning for sustainability, (2) creating and engaging a sustainability committee, (3) assessing sustainability needs and creating a sustainability plan, (4) creating a data system to collect relevant data, (5) building capacity to support communication with decision makers, and (6) sharing data and success stories. ASSESSMENT: The implementation of the sustainability plan resulted in ongoing communications and data sharing with key partners that helped secure additional funds for continuing the program after OPA funding ended. CONCLUSION: Implementing the MSPSI sustainability plan developed from OPA's sustainability framework was effective in sustaining the SPCs after federal funding ended. The sustainability planning, the ability to secure funds, the attempt at passing legislation, and the lessons shared in this article provide valuable guidance to organizations seeking strategies to sustain adolescent health programs.

Welfare consequences for people diagnosed with nonepileptic seizures: A matched nationwide study in Denmark.

OBJECTIVE: We aimed to evaluate the excess direct and indirect costs associated with nonepileptic seizures. METHODS: From the Danish National Patient Registry (2011-2016), we identified 1057 people of any age with a diagnosis of psychogenic nonepileptic seizures (PNESs) and matched them with 2113 control individuals. Additionally, 239 partners of patients with PNES aged ≥18 years were identified and compared with 471 control partners. Direct costs included frequencies and costs of hospitalizations and outpatient use weighted by diagnosis-related group, and specific outpatient costs based on data from the Danish Ministry of Health. The use and costs of drugs were based on data from the Danish Medicines Agency. The frequencies of visits and hospitalizations and costs of general practice were derived from National Health Security data. Indirect costs included labor supply-based income data, and all social transfer payments were obtained from Coherent Social Statistics. RESULTS: A higher percentage of people with PNES and their partners compared with respective control subjects received welfare benefits (sick pay, disability pension, home care). Those with PNES had a lower employment rate than did controls for equivalent periods up to three years before the diagnosis was made. The additional direct and indirect annual costs for those aged ≥18 years, including transfers to patients with PNES, compared with controls, were €33,697 for people with PNES and €15,121 for their partners. SIGNIFICANCE: Psychogenic nonepileptic seizures have substantial socioeconomic consequences for individual patients, their partners, and society.

The influence of welfare state factors on nursing professionalization and nursing human resources: A time-series cross-sectional analysis, 2000-2015.

AIM: The aim of this study was to examine the relationship between welfare states and nursing professionalization indicators. DESIGN: We used a time-series, cross-sectional design. The analysis covered 16 years and 22 countries: Australia, Austria, Belgium, Canada, Denmark, Finland, France, Germany, Greece, Ireland, Italy, Japan, Netherlands, New Zealand, Norway, Portugal, South Korea, Spain, Sweden, Switzerland, United Kingdom, and the United States, allocated to five welfare state regimes: Social Democratic, Christian Democratic, Liberal, Authoritarian Conservative, and Confucian. METHODS: We used fixed-effects linear regression models and conducted Prais-Winsten regressions with panel-corrected standard errors, including a first-order autocorrelation correction. We applied the Amelia II multiple imputation strategy to replace missing observations. Data were collected from March-December 2017 and subsequently updated from August-September 2018. RESULTS: Our findings highlight positive connections between the regulated nurse and nurse graduate ratios and welfare state measures of education, health, and family policy. In addition, both outcome variables had averages that differed among welfare state regimes, the lowest being in Authoritarian Conservative regimes. CONCLUSION: Additional country-level and international comparative research is needed to further study the impact of a wide range of structural political and economic determinants of nursing professionalization. IMPACT: We examined the effects of welfare state characteristics on nursing professionalization indicators and found support for the claim that such features affect both the regulated nurse and nurse graduate ratios. These findings could be used to strengthen nursing and the nursing workforce through healthy public policies and increase the accuracy of health human resources forecasting tools.

Nursing professionalization and welfare state policies: A critical review of structural factors influencing the development of nursing and the nursing workforce.

Nursing professionalization is both ongoing and global, being significant not only for the nursing workforce but also for patients and healthcare systems. For this reason, it is important to have an in-depth understanding of this process and the factors that could affect it. This literature review utilizes a welfare state approach to examine macrolevel structural determinants of nursing professionalization, addressing a previously identified gap in this literature, and synthesizes research on the relevance of studying nursing professionalization. The use of a welfare state framework facilitates the understanding that the wider social, economic, and political system exercises significant power over the distribution of resources in a society, providing a glimpse into the complex politics of health and health care. The findings shed light on structural factors outside of nursing, such as country-level education, health, labor market, and gender policies that could impact the process of professionalization and thus could be utilized to strengthen nursing through facilitating increased professionalization levels. Addressing gender inequalities and other structural determinants of nursing professionalization could contribute to achieving health equity and could benefit health systems through enhanced availability, skill-level, and sustainability of nursing human resources, improved and efficient access to care, improved patient outcomes, and cost savings.

Home and Community-based Services and Life Satisfaction among Homebound and Poor Older Adults.

Little evidence exists regarding the role of Home and Community-Based Services (HCBS) utilization on life satisfaction among older people who are both homebound and low-income. Guided by the personal-environment (P-E) fit perspective, this study aims to: (1) describe characteristics of older people with homebound and low-income status; (2) investigate how the combination of homebound and low-income status is associated with life satisfaction; and (3) examine whether HCBS utilization moderates the association between homebound and low-income status and life satisfaction. Data were drawn from the 2012 Health and Retirement Study, and the sample included respondents who were 51+ years who completed a questionnaire for HCBS utilization (n= 1,662). Results describe sociodemographic, health-related, and environmental characteristics of older adults. Combined homebound and low-income status was a significant predictor of lower life satisfaction (ß = -0.15, p< .05), but better life satisfaction when they used HCBS (ß = 0.33, p <.10). These findings suggest that promoting HCBS utilization is a promising strategy to enhance well-being among those homebound and poor. Further studies are needed to test the effectiveness of HCBS with longitudinal data and to investigate the details of effective HCBS utilization such as frequency of use and types of services.

Income inequality and subjective well-being: a systematic review and meta-analysis.

BACKGROUND: Reducing income inequality is one possible approach to boost subjective well-being (SWB). Nevertheless, previous studies have reported positive, null and negative associations between income inequality and SWB. OBJECTIVES: This study reports the first systematic review and meta-analysis of the relationship between income inequality and SWB, and seeks to understand the heterogeneity in the literature. METHODS: This systematic review was conducted according to guidance (PRISMA and Cochrane Handbook) and searches (between January 1980 and October 2017) were carried out using Web of Science, Medline, Embase and PsycINFO databases. RESULTS: Thirty-nine studies were included in the review, but poor data reporting meant that only 24 studies were included in the meta-analysis. The narrative analysis of 39 studies found negative, positive and null associations between income inequality and SWB. The meta-analysis confirmed these findings. The overall association between income inequality and SWB was almost zero and not statistically significant (pooled r = - 0.01, 95% CI - 0.08 to 0.06; Q = 563.10, I 2 = 95.74%, p < 0.001), suggesting no association between income inequality and SWB. Subgroup analyses showed that the association between income inequality and SWB was moderated by the country economic development (i.e. developed countries: r = - 0.06, 95% CI -0.10 to -0.02 versus developing countries: r = 0.16, 95% CI 0.09-0.23). The association between income inequality and SWB was not influenced by: (a) the measure used to assess SWB, (b) geographic region, or (c) the way in which income inequality was operationalised. CONCLUSIONS: The association between income inequality and SWB is weak, complex and moderated by the country economic development.

Assessing reserve-building pursuits and person characteristics: psychometric validation of the Reserve-Building Measure.

AIMS: A growing body of research suggests that regularly engaging in stimulating activities across multiple domains-physical, cultural, intellectual, communal, and spiritual-builds resilience. This project investigated the psychometric characteristics of the DeltaQuest Reserve-Building Measure for use in prospective research. METHODS: The study included Rare Patient Voice panel participants. The web-based survey included the Reserve-Building Measure with one-week re-test, measures of quality of life (QOL) and well-being (PROMIS General Health; NeuroQOL Cognitive Function and Positive Affect & Well-Being short-forms; Ryff Environmental Mastery subscale); and the Big Five Inventory-10 personality measure. Classical test theory and item response theory (IRT) analyses investigated psychometric characteristics of the Reserve-Building Measure. RESULTS: This North American sample (n = 592) included both patients and caregivers [mean age = 44, SD 19)]. Psychometric analyses revealed distinct subscales measuring current reserve-building activities (Active in the World, Games, Outdoors, Creative, Religious/Spiritual, Exercise, Inner Life, Shopping/Cooking, Passive Media Consumption,), past reserve-building activities (Childhood Activities, Achievement), and reserve-related person-factors (Perseverance, Current and Past Social Support, and Work Value). Test-retest stability (n = 101) was moderately high for 11 of 15 subscales (ICC range 0.78-0.99); four were below 0.59 indicating a need for further refinement. IRT analyses supported the item functioning of all subscales. Correlational analyses suggest the measure's subscales tap distinct constructs (range r = 0.11-0.46) which are not redundant with QOL, well-being, or personality (range r = 0.11-0.48). CONCLUSIONS: The Reserve-Building Measure provides a measure of activities and person-factors related to reserve that may potentially be useful in prospective research.

The mediating role of relatedness need satisfaction in the relationship between charitable behavior and well-being: Empirical evidence from China.

Based on self-determination theory, the current research aimed to explore the potential mediating effect of relatedness need satisfaction on the relationship between charitable behavior and well-being in the Chinese context. Employing a cross-sectional design, participants reported data on the aforementioned variables in Study 1. The results indicated that relatedness need satisfaction mediated the positive relationship between charitable behavior and hedonic well-being and that between charitable behavior and eudaimonic well-being. Subsequently, a field experiment was conducted in Study 2. Participants rated their levels of relatedness need satisfaction and well-being after charitable donation behaviors were primed. We again observed consistent results. Specifically, charitable behavior was positively associated with both hedonic and eudaimonic well-being, and these relationships were mediated by relatedness need satisfaction. The above findings help to clarify the association between charitable behavior and people's subjective feelings (i.e., well-being), and they deepen our understanding of the underlying mechanism from the perspective of psychological needs satisfaction.

Getting Started: An Empirically Derived Logic Model for Age-Friendly Community Initiatives in the Early Planning Phase.

Age-friendly community initiatives (AFCIs) foster efforts across stakeholders to make localities more supportive and inclusive of older adults, and potentially better for residents of all ages. This study drew on in-depth interviews with leaders of nine newly forming AFCIs in northern New Jersey to develop an empirically based logic model for the initiatives in the early planning phase. The results obtained from a conventional content analysis indicated three main activities in the early planning phase: assessing the community; meeting; and communicating with stakeholders; and facilitating communitywide communications. These activities worked toward two outputs: increased understanding of aging in the community and more engaged stakeholders in aging. Participants described leveraging the contributions of lead staff, consultants, elected officials, organizational partners, volunteers, interns, funders, and other AFCIs to engage in their focal activities. Based on these findings, a logic model for AFCIs in the early planning phase is presented. AFCI leaders can draw on this model to evaluate AFCI processes and outcomes in their formative stages, as well as to strategically plan for the start of an AFCI within a given locality. Findings also suggest important directions for future research on the development of AFCIs and the community changes that they seek to influence.

Impact of extreme weather events and climate change for health and social care systems.

This review, commissioned by the Research Councils UK Living With Environmental Change (LWEC) programme, concerns research on the impacts on health and social care systems in the United Kingdom of extreme weather events, under conditions of climate change. Extreme weather events considered include heatwaves, coldwaves and flooding. Using a structured review method, we consider evidence regarding the currently observed and anticipated future impacts of extreme weather on health and social care systems and the potential of preparedness and adaptation measures that may enhance resilience. We highlight a number of general conclusions which are likely to be of international relevance, although the review focussed on the situation in the UK. Extreme weather events impact the operation of health services through the effects on built, social and institutional infrastructures which support health and health care, and also because of changes in service demand as extreme weather impacts on human health. Strategic planning for extreme weather and impacts on the care system should be sensitive to within country variations. Adaptation will require changes to built infrastructure systems (including transport and utilities as well as individual care facilities) and also to institutional and social infrastructure supporting the health care system. Care sector organisations, communities and individuals need to adapt their practices to improve resilience of health and health care to extreme weather. Preparedness and emergency response strategies call for action extending beyond the emergency response services, to include health and social care providers more generally.

Welfare Reform and Labor Force Exit by Young, Low-Skilled Single Males.

While the labor market woes of low-skilled male workers in the United States over the past several decades have been well documented, the academic literature identifying causal factors leading to declines in labor force participation (LFP) by young, low-skilled males remains scant. To address this gap, I use the timing and characteristics of welfare-reform policies implemented during the 1990s and fixed-effects, instrumental variable regression modeling to show that policies seeking to increase LFP rates for low-skilled single mothers inadvertently led to labor force exit by young, low-skilled single males. Using data from the Current Population Survey and a bundle of work inducements enacted by states throughout the 1990s as exogenous variation in a quasi-experimental design, I find that the roughly 10 percentage point increase in LFP for low-skilled single mothers facilitated by welfare reform resulted in a statistically significant 2.8 percentage point decline in LFP for young, low-skilled single males. After conducting a series of robustness checks, I conclude that this result is driven entirely by white males, who responded to welfare-reform policies with a 3.7 percentage point decline in labor supply. Young black males, as well as other groups of potentially affected workers, appear to be uninfluenced by the labor supply response of less-educated single mothers to welfare reform. Impacts on young, single white males are large and economically significant, suggesting that nearly 150,000 males departed the formal labor market in response to directed welfare-reform policies.

Integrated multidisciplinary community service for chronic obstructive pulmonary disease reduces hospitalisations.

BACKGROUND: Hospitalisations for chronic obstructive pulmonary disease (COPD) exacerbation affect patient outcomes and healthcare costs. The long-term impact of an integrated COPD disease-management approach on hospitalisation remains controversial. AIM: The aim of this study was to evaluate whether a multidisciplinary community service reduces respiratory hospitalisations for COPD patients. METHODS: A total of 346 patients was followed for a mean duration of 27.3 months. The number of admissions, total bed days for respiratory (COPD exacerbation or pneumonia) or general medical causes and length of stay (LOS) per respiratory admission was compared before and after referral with the service. A secondary multivariate analysis examined which clinical parameters best predict benefit from such service. RESULTS: The total respiratory admission and hospital bed days after referral were reduced by 31% (288 vs 417, P < 0.001) and 40.4% (1637 vs 2746, P < 0.0001) respectively, compared with the equivalent duration prior. The average LOS for each respiratory admission was also significantly reduced after referral (6.61 vs 5.70, P = 0.02). Overall, 55% patients experienced a reduction in admission frequency and hospital days. The impact on admission frequency and hospital days was the greatest in those with an at least moderate disease (GOLD ≥2, odds ratio (OR): 3.2, 95% confidence interval (CI): 1.2, 8.9; P = 0.019) and those who completed pulmonary rehabilitation (PR) (OR: 1.7, 95% CI: 1.1, 2.8; P = 0.04). In contrast, general medical admissions increased, one-third attributable to a cardiovascular cause both before and after referral. CONCLUSIONS: The implementation of COPD multidisciplinary community service was associated with reduced respiratory hospitalisations in the long term. Patients with moderate or severe disease and who are able to complete PR are much more likely to benefit.

Targeted social protection in a pastoralist economy: case study from Kenya.

Social protection programmes are designed to help vulnerable populations - including pastoralists - maintain a basic level of well-being, manage risk, and cope with negative shocks. Theory suggests that differential targeting according to poverty status can increase the reach and effectiveness of budgeted social protection programmes. Chronically poor households benefit most from social protection designed to help them meet their basic needs and make vital investments necessary to graduate from poverty. Vulnerable non-destitute households benefit from protection against costly temporary shocks, but do not necessarily need regular assistance. Welfare gains occur when a comprehensive social protection programme considers the needs of both types of households. The authors use evidence-based understanding of poverty dynamics in the pastoralist-based economy of northern Kenya's arid and semi-arid lands as a case study to discuss and compare the observed impacts of two different social protection schemes on heterogeneous pastoralist households: a targeted, unconditional, cash-transfer programme designed to support the poorest, and an index-based livestock insurance programme, which acts as a productive 'safety net' to help stem a descent into poverty and increase resilience. Both types of social protection scheme have been shown to decrease poverty, improve food security and protect child health. However, the behavioural response for asset accumulation varies with the type of protection and the household's unique situation. Poor households that receive cash transfers retain and accumulate assets quickly. Insured households, who are typically vulnerable yet not destitute, protect existing herds and invest more in the livestock they already own. The authors argue that differential targeting increases programme efficiency, and discuss Kenya's current approach to implementing differentially targeted social protection.

Les programmes de protection sociale ont pour but d'aider les populations vulnérables (y compris les pasteurs) à maintenir un niveau acceptable de bienêtre, à gérer le risque et à faire face aux situations de crise. Théoriquement, le traitement différencié en fonction du niveau de pauvreté permet d'accroître la couverture et l'efficacité des programmes de protection sociale budgétisés. Les ménages vivant dans une pauvreté chronique tirent un meilleur bénéfice d'une protection sociale leur permettant de couvrir leurs besoins de base et de réaliser les investissements indispensables pour sortir de la pauvreté. Les ménages vulnérables mais non entièrement démunis tirent un meilleur bénéfice d'une protection leur permettant de couvrir les dépenses liées à des crises ponctuelles, mais n'ont pas nécessairement besoin d'un dispositif d'aide permanent. Des gains de bien-être sont constatés lorsque des programmes de protection sociale complets prennent en compte les besoins de ces deux catégories de foyers. À partir d'éclairages factuels sur la dynamique de la pauvreté dans le système économique à dominante pastorale des régions arides et semi-arides du nord du Kenya, les auteurs réalisent une étude de cas qui leur permet d'examiner et de comparer les impacts avérés de deux dispositifs différents de protection sociale sur un ensemble hétérogène de ménages pastoraux : le premier est un programme ciblé de transfert de liquidités sans conditionnalités, destiné aux foyers les plus pauvres, le deuxième est un programme d'assurance du bétail doté d'une clause d'indexation et faisant office de « filet de sécurité ¼ productif pour aider les pasteurs à ne pas basculer dans la pauvreté en cas de coup dur et à améliorer leur capacité de résilience. Chacun des deux dispositifs de protection sociale permet de contenir la pauvreté, d'améliorer la sécurité alimentaire et de protéger la santé infantile. Néanmoins, les comportements qui en résultent en termes d'accumulation d'actifs varient suivant le type de protection et la situation particulière de chaque foyer. Les foyers les plus pauvres aidés par un apport de liquidités conservent et accumulent rapidement des actifs. Les foyers habituellement vulnérables mais pas entièrement démunis soutenus par un dispositif d'assurance protègent leurs troupeaux et investissent davantage pour le bétail qu'ils possèdent déjà. Après avoir plaidé en faveur du ciblage différencié, qui selon eux améliore l'efficacité des programmes, les auteurs font le point sur la manière dont le Kenya met actuellement en oeuvre une protection sociale ciblée et différentielle.

Los programas de protección social están concebidos para ayudar a las poblaciones vulnerables (entre ellas, las pastorales) a mantener un nivel básico de bienestar, gestionar el riesgo y hacer frente a los acontecimientos negativos. Según la teoría, los programas de protección social presupuestados pueden revestir mayor alcance y eficacia cuando distinguen entre los beneficiarios y se adaptan a ellos en función de su nivel de pobreza. Las familias que sufren pobreza crónica son las que más se benefician de los dispositivos de protección social concebidos para ayudarles a cubrir sus necesidades básicas y hacer las inversiones vitales necesarias para salir de la pobreza. Las familias vulnerables, pero no desposeídas, se benefician de la protección contra malas rachas temporales que tienen un costo elevado, pero no necesitan forzosamente ayuda sistemática. Para que un programa integral de protección social depare mayores cotas de bienestar es preciso que en él se tengan en cuenta las necesidades de ambos tipos de familias. Los autores emplean una descripción científicamente contrastada de la dinámica de la pobreza en la economía basada en el pastoreo de las tierras áridas y semiáridas del norte de Kenia como estudio monográfico a partir del cual examinar y comparar los efectos observados de dos dispositivos diferentes de protección social en un conjunto heterogéneo de familias de pastores: un programa selectivo y no condicionado de transferencia de efectivo, destinado a respaldar a los más pobres; y un programa de seguro del ganado basado en un índice, que ofrece una «red de seguridad¼ productiva y ayuda a las familias en cuestión a protegerse de la pobreza y adquirir mayor resiliencia. Se ha demostrado que ambos tipos de programa de protección social reducen la pobreza, mejoran la seguridad alimentaria y protegen la salud infantil. Sin embargo, el comportamiento de respuesta en cuanto a la acumulación de activos difiere según el tipo de protección y la situación propia de cada familia. Los hogares pobres que reciben transferencias de efectivo retienen y acumulan activos rápidamente. Los hogares asegurados, que normalmente son vulnerables pero no están desposeídos, protegen los rebaños existentes e invierten más en el ganado que ya poseen. Los autores postulan que la diferenciación entre beneficiarios confiere mayor eficacia al programa, y examinan el planteamiento adoptado actualmente en Kenia, que consiste en aplicar dispositivos de protección social diferenciados en función del beneficiario.

Recommodification, Unemployment, and Health Inequalities: Trends in England and Sweden 1991-2011.

Recommodification, the withdrawal of social welfare, has been going on for some decades in both Sweden and England. Recommodification disproportionately affects the unemployed because of their weak market position. We investigated the impact recommodification has had on health inequalities between the employed and unemployed in Sweden and England. Using national surveys, odds ratios for the likelihood of reporting less than good health between the employed and unemployed were computed annually between 1991 and 2011. The correlation between these odds ratios and net replacement rates was then examined. Health inequalities between the employed and unemployed were greater in 2011 than in 1991 in both countries. Sweden began with smaller health inequalities, but by 2011, they were in line with those in England. Sweden experienced more recommodification than England during this period, although it started from a much less commodified position. Correspondingly, correlation between unemployment benefit generosity and health inequalities was stronger in Sweden than in England. Recommodification is linked to ill health among the unemployed and to the health gap between the employed and unemployed. We propose that further recommodification will be associated with increased health inequalities between the employed and unemployed.