One generation apart: Individual income and life expectancy in two Swedish cohorts born before and after the expansion of the welfare state.

AIMS: Social inequalities in mortality persist or even increase in high-income countries. Most evidence is based on a period approach to measuring mortality - that is, data from individuals born decades apart. A cohort approach, however, provides complementary insights using data from individuals who grow up and age under similar social and institutional arrangements. This study compares income inequalities in cohort life expectancy in two Swedish cohorts, one born before and one born after the expansion of the welfare state. METHODS: Data on individuals born in Sweden in 1922-1926 and 1951-1955 were obtained from total population registries. These data were linked to individual disposable income from 1970 and 1999 and mortality between 50 and 61 years of age in 1972-1987 and 2001-2016, respectively. We calculated cohort temporary life expectancies in the two cohorts by income and gender. RESULTS: Life expectancy, income, and income inequalities in life expectancy increased between the two cohorts, for both men and women. Women born in 1922-1926 had modest income differences in life expectancy, but pronounced differences emerged in the cohort born in 1951-1955. Men with low incomes born in 1951-1955 had roughly similar life expectancy as those with low incomes born in 1922-1926. CONCLUSIONS: Compared with a period approach to life expectancy trends, the cohort approach highlights the stagnation of mortality at the lowest income groups for men and the rapid emergence of a mortality gradient for women. Future research on health inequalities in welfare states should consider underlying factors both from a cohort and period perspective.

Is Redistribution Good for Our Health? Examining the Macro-Correlation between Welfare Generosity and Health across EU Nations over the Last 40 Years.

CONTEXT: Social determinants of health are finally getting much needed policy attention. Yet, their political origins remain underexplored. In this paper, we advance a theory of political determinants as accruing along three pathways of welfare state effects (redistribution, poverty reduction and status preservation) and test these assumptions by examining impacts of policy generosity on life expectancy (LE) over the last 40 years. METHODS: We merge new and existing welfare policy generosity data from the Comparative Welfare Entitlement Project (CWEP) with data on LE spanning 1980-2018 across 21 OECD countries. We then examine relationships between five welfare policy generosity measures and LE using cross-sectional differencing and auto-regressive lag models. FINDINGS: We find consistent and positive effects for total generosity (an existing measure of social insurance generosity) on LE at birth across different model specifications in the magnitude of a 0.10-0.15-year increase in LE at birth (p < 0.05) and a measure of status preservation (0.11, p < 0.05). We find less consistent support for our redistribution and poverty reduction measures. CONCLUSIONS: We conclude that in addition to generalized effects of policy generosity on health, status-preserving social insurance may be an important, and relatively overlooked, mechanism in increasing life expectancies over time in advanced democracies.

Bread or roses? Trade unions, female employment and the expansion of work-family policies.

In the Fordist era, trade unions promoted welfare state expansion and coverage against risks for the broader workforce. With the shift to the post-industrial economy, however, new economic groups have been left without representation. This is particularly evident for women: despite a rapid increase in female employment since the 1980s, unions' membership base remains anchored in the male, old and industrial working class. Without the crucial pressure of labour, welfare systems have failed to enhance the reconciliation of work and family life. Under which conditions do unions support the expansion of work-family policies? Marshalling evidence from 20 OECD countries in the 1980-2010 period, this paper investigates the role of political actors in family policy reform. Findings suggest that unions promote the expansion of work-family packages when they are gender-inclusive and have institutional access to policy-making.

Health-related exit from employment before and during the COVID-19 pandemic in Norway: Analysis of population-wide register data 2013-2021.

People with health problems experience various labor market disadvantages, such as hiring discrimination and heightened risk of firing, but the impact of deteriorating economic conditions on health-related labor market mobility remains poorly understood. The strength of the downturn/crisis will most likely make a difference. During minor downturns, when few employees are made redundant, health-related exit may occur frequently since employers prefer to keep those with good health on the payroll. However, during major economic crises, when large-scale downsizing and firm closures abound, there will be less discretionary room for employers. Thus, some mechanisms that usually are damaging for people with health problems (e.g., seniority rules and negative connotations), can be neutralized, ultimately leading to smaller health differentials in labor market outcomes. The current study used population-wide administrative register data, covering the years 2013-2021, to examine health-related exit from employment (to unemployment/social assistance) before and during the COVID-19 pandemic in Norway. The pandemic spurred a major crisis on the Norwegian labor market and led to a record-high unemployment rate of 10.6 percent in March 2020. Restricting the analytical samples to labor market insiders, linear probability models showed that previous recipients of health-related benefits had a higher unemployment likelihood in the pre-crisis year 2019. The relative importance of poor health changed non-negligibly, however, during the COVID-19 pandemic. When identical statistical analyses were run on the crisis year 2020, health-related exit from employment was dampened. Yet, this labor market equalization was not followed by smaller health differentials in work income in 2021, mainly because people with good health retained or regained decent-paying jobs when the economic conditions improved again. In conclusion, major economic crises can lead to an equalization of labor market disadvantages for people with health problems, but health-related inequalities may reemerge when the economy recovers.

The policy and politics of healthcare corporatisation: The case of the English NHS.

RATIONALE: Few accounts of healthcare corporatisation examine the effects of the 2008 financial crisis. New Politics of the Welfare State (NPWS) theories recognise the relevance of crises but give more attention to programmatic than systemic (structural) retrenchment, and little to healthcare corporatisation. OBJECTIVE: To examine what changes the 2008 financial crisis produced in the pattern of healthcare corporatisation, and the implications for NPWS theories. METHODS: Using administrative data from the English NHS during 1995-2019 we formulated a multi-dimensional index of corporatisation, tested its validity, and used it to analyse longitudinally how the financial crisis affected the balance between the responsibilization of management and re-commodification (introduction of market-like practices) in provider corporatisation. RESULTS: The financial crisis influenced NHS corporatisation through the fiscal austerity with which governments responded. The re-commodification of NHS providers stalled but not the responsibilization of NHS managers. CONCLUSIONS: The corporatisation of NHS providers faltered after the financial crisis. These findings corroborate parts of NPWS theory but also reveal scope for further elaborating its accounts of systemic retrenchment in health systems.

Food Insecurity and Social Policy: A Comparative Analysis of Welfare State Regimes in 19 Countries.

We sought to determine whether a country's social policy configuration-its welfare state regime-is associated with food insecurity risk. We conducted a cross-sectional study of 2017 U.N. Food and Agriculture Organization individual-level food insecurity survey data from 19 countries (the most recent data available prior to COVID-19). Countries were categorized into three welfare state regimes: liberal (e.g., the United States), corporatist (e.g., Germany), or social democratic (e.g., Norway). Food insecurity probability, calibrated to an international reference standard, was calculated using a Rasch model. We used linear regression to compare food insecurity probability across regime types, adjusting for per-capita gross domestic product, age, gender, education, and household composition. There were 19,008 participants. The mean food insecurity probability was 0.067 (SD: 0.217). In adjusted analyses and compared with liberal regimes, food insecurity probability was lower in corporatist (risk difference: -0.039, 95% CI -0.066 to -0.011, p = .006) and social democratic regimes (risk difference: -0.037, 95% CI -0.062 to -0.012, p = .004). Social policy configuration is strongly associated with food insecurity risk. Social policy changes may help lower food insecurity risk in countries with high risk.

No evidence that social-democratic welfare states equalize valued outcomes for individuals with disabilities.

It is acknowledged that generous welfare states can provide better outcomes to their populations in terms of objective and subjective indicators of well-being, yet there is little comparative evidence of the role that the welfare state regime plays in lessening disability-based inequalities. Using a large comparative data set of most European societies, Tukey's honestly significant difference and generalized Hausman tests for six welfare state regimes, we examine the assumption that social-democratic countries perform better in mitigating disability-based inequalities than conservative, liberal, Southern, Eastern European, and the former Soviet Union welfare state regimes. We compare the valued outcomes for individuals with and without disabilities regarding their education, labour market participation, material well-being, and life satisfaction. The main finding of this study is that the most generous welfare states in Europe do not perform better, and in some cases, perform worse, than other less comprehensive welfare state regimes in closing the gap in valued outcomes between individuals with disabilities and the rest of the population. We discuss potential explanations of these inequalities such as the nature of expectations and changing characteristics of welfare state regimes, and difficulties related to measuring disabilities across European societies.

COVID-19 Pandemic and Health and Social Inequalities Worldwide: Impact and Response Measures in Greece.

OBJECTIVES: The pandemic has exacerbated pre-existing health and socioeconomic inequalities around the globe. In order to mitigate the effects of extreme isolation and containment measures, governments have taken steps to protect the health, the economy, employment, and socially vulnerable groups. The health crisis should be treated as a pretext in order to ensure universal access to health and socioeconomics.The aim of this review was the presentation of the way the pandemic contributed to the worldwide deterioration of health inequities affecting in parallel the social protection in the health, economic and educational sector along with other factors, the effects and the measures taken, in order to face the consequences of a pandemic on the social protection in Greece in comparison with other countries of Europe. METHODS: A cross-sectional bibliographic study was undertaken using keywords and phrases such as "COVID-19," "Health inequities," "Social protection," and "Social identifiers." The search was done through the search engines google scholar, PubMed, Health link, and Elsevier using either the Greek or English language. The total number of evaluated read-used articles was 30. Inclusion criteria were free full-text meta-analyses, reviews, and systematic reviews. RESULTS: The socially disadvantaged groups in the United States were found to have a lower life expectancy and higher morbidity rates than privileged social groups, as economic, health, and sociocultural precariousness are major causes of death. Patients with underlying diseases are vulnerable groups and increase the risk of coronavirus infection and quite often lead to loss of life due to complications of the disease. Greece is ranked in the 4th worst position with 61.10% in employment in all European Union (EU) countries. There is a significant increase in deaths with a percentage change from 2018 to date of 17.50%. It also holds the 3rd worst position among EU countries in the field of unemployment, while women hold the 2nd worst with a rate of 13.50%. Overworked and overindebted households due to extreme measures due to the pandemic (reduction of working time, quarantine) led to unemployment, loss of income, poverty, widening social inequalities, and deteriorating care for people with disabilities. Children due to the closure of schools and the loss of school meals are led to food insecurity. The pandemic also left many children orphaned after the death of their parents by COVID-19, with psychosocial problems exacerbated by school closures. CONCLUSIONS: The pandemic has exacerbated long-standing health and socioeconomic inequalities, stressing to governments the need to adopt political strategies that will help address them. Measures have been taken in Greece for labor protection, and unemployment benefits, such as the two-month extension of the subsidy period for the unemployed and the long-term unemployed. Minimum insurance days have also been reduced so that citizens employed in tourism, catering, and other seasonal occupations can receive unemployment benefits.

Wealth inequalities in physical and cognitive impairments across Japan and Europe: the role of health expenditure and infrastructure.

Although prior research has provided insights into the association between country-level factors and health inequalities, key research gaps remain. First, most previous studies examine subjective rather than objective health measures. Second, the wealth dimension in health inequalities is understudied. Third, a handful of studies explicitly focus on older adults. To bridge these research gaps, this study measures wealth-related inequalities in physical and cognitive impairments and examines the extent to which welfare states moderate wealth inequalities in physical and cognitive impairments among older people across Japan and Europe. We utilized harmonized data on non-institutionalized individuals aged 50-75 from the Japanese Study of Aging and Retirement (JSTAR) and the Survey of Health, Ageing and Retirement in Europe (SHARE) (N = 31,969 for physical impairments and 31,348 for cognitive impairments). Our multilevel linear regression analyses examined whether national public health spending and healthcare access resources explained cross-country differences in wealth inequalities in physical and cognitive impairments. We applied a concentration index to quantify the degree of wealth inequalities in impairments. The findings indicate that inequalities in both impairment outcomes favored wealthier individuals in all countries, but the magnitude of inequality varied by country. Furthermore, a higher share of public health spending, lower out-of-pocket expenditure, and higher investment in healthcare resources were associated with lower wealth inequalities, especially for physical impairments. Our findings suggest that different health interventions and policies may be needed to mitigate specific impairment inequalities.

Institutionalizing Experimental Places for Inclusive Social Innovation: From Utopias to Heterotopias.

This essay embraces a notion of critical scholarship concerned with proposing normative and actionable alternatives that can create more inclusive societies and focuses on the role of institutionalizing experimental places for inclusive social innovation as a bottom-up strategic response to welfare state reforms. By mobilizing the notions of utopias and heterotopias in Foucault, the paper sheds light on the opportunity to move from policy utopias to democratic heterotopias, discussing the politics embedded in this cognitive shift and the democratic nature of social innovation changing social and governance relations by interacting with politico-administrative systems. Some obstacles to institutionalizing social innovation are highlighted, as well as some key governance mechanisms that can be activated either by public and/or social purpose organizations to try to overcome those obstacles. Finally, we discuss the importance of linking inclusive social innovation with democratic, rather than market logics.

Factores laborales, actitudes de género y bienestar asociados al conflicto trabajo y familia en Chile / Labor Factors, Gender Attitudes, and Welfare Associated With Work-Family Conflict in Chile / Conflict in Chile Fatores laborais, atitudes de gênero e bem-estar associados ao conflito laboral e familiar no Chile

La incidencia de factores sociales, culturales y normativos en el conflicto trabajo-familia ha sido abordada a nivel internacional, pero sin evidencia en Chile. En este estudio se analizó la incidencia de distintos factores sociolaborales, de género y las actitudes hacia el Esta- do de bienestar en el conflicto trabajo-familia, en una muestra de 550 trabajadores con hijos menores de 14 años, residentes de Santiago de Chile. Se aplicó un análisis de regresión logística para determinar las variables predictoras del conflicto trabajo-familia, y se profundizó en una de las direcciones, el conflicto de la familia a trabajo. Los resultados mostraron que las dificultades para conciliar en la empresa influyen positivamente en el conflicto trabajo-familia. Además, el ingreso mínimo influye en el conflicto trabajo-familia; mientras que el tiempo de cuidado incide en el conflicto familia a trabajo.

The incidence of social, cultural, and normative factors on work/family conflict has been addressed internationally. However, there is no evidence for the case of Chile. This study analyzed the effect of attitudes towards the welfare state and different socio-labor factors on this conflict in 550 working parents with children under 14 in Santiago, Chile. The logistic regression analysis showed that difficulties in reconciling work and family life in the company positively influence the conflict. In addition, earning the minimum wage generates greater conflict, while care time has an impact on family-to-work conflict.

A incidência de fatores sociais, culturais e normativos no conflito trabalho/família foi abordada internacionalmente, mas sem evidências no Chile. Neste estudo, analisou-se a incidência de diferentes fatores sociolaborais, gênero e atitudes perante o estado de bemestar no conflito trabalho/família em uma amostra de 550 trabalhadores com filhos menores de 14 anos residentes em Santiago, Chile. Aplicou-se uma análise de regressão logística para determinar as variáveis preditoras do conflito trabalho/ família, e aprofundou-se em uma das direções, o conflito da família em relação ao trabalho. Os resultados mos- traram que as dificuldades de conciliação na empresa influenciam positivamente no conflito trabalho/família. Além disso, a renda mínima influencia o conflito trabalho/ família; enquanto o tempo de cuidado afeta o conflito família em relação ao trabalho.

The Effect of Welfare State Policy Spending on the Equalization of Socioeconomic Status Disparities in Mental Health.

This article examines whether and how the relationship between socioeconomic status (SES) and depression is modified by welfare state spending using the 2006, 2012, and 2014 survey rounds of the European Social Survey (ESS) merged with macroeconomic data from the World Bank, Eurostat, and SOCX database (N = 87,466). Welfare state spending effort divided between social investment and social protection spending modifies the classic inverse relationship between SES and depression. Distinguishing policy areas in both social investment and social protection spending demonstrates that policy programs devoted to education, early childhood education and care, active labor market policies, old age care, and incapacity account for differences in the effect of SES across countries. Our analysis finds that social investment policies better explain cross-national differences in the effect of SES on depression, implying policies focused earlier in the life course matter more for understanding social disparities in the mental health of populations.

Caregiving and changes in health-related behaviour.

Potential health risks for informal caregivers have been hypothesised to be partly related to adverse changes in health-related behaviour, but evidence is limited. We examined whether smoking, drinking, eating, physical activity or leisure pursuits change in relation to co-resident or out-of-home caregiving (for someone outside the household), and if associations differ by sex, educational attainment, and welfare state typology. We conducted a longitudinal study using six waves of the Survey of Health, Ageing and Retirement in Europe, collecting data repeatedly from 2004 to 2017 for adults aged 50 years and older living in 17 European countries (57,962 individuals). To control for measured and unmeasured within-individual time-invariant confounders, we used fixed effects logistic models to analyse the repeated measures of caregiving, behaviour and covariates and estimated odds ratios (OR) with 95% confidence intervals (95%CI). Among male participants, unhealthy eating increased while smoking decreased [ORs 1.26 (95%CI 1.01-1.58) and 0.53 (0.36-0.78), respectively] in survey waves in which they provided co-resident care, compared with the waves that they did not. Among female participants, there was little change in behaviour between waves with and without co-resident caregiving. When providing out-of-home care, lacks of physical activity and leisure pursuits declined. But in the same time, drinking increased both men and women, and especially among individuals with lower educational attainment and residing in non-Nordic countries. To conclude, overall, increased drinking when providing out-of-home care was most consistent, especially among individuals with lower educational attainment and residing in non-Nordic countries. Otherwise, the associations varied by the type of care, behaviour and population subgroups. These findings indicated that not all caregivers are susceptible to behavioural changes, and that not all behaviour may be involved similarly in linking caregiving to health risks. This opens possibilities to target specific behaviour and groups to prevent adverse changes in health behaviour in caregivers.

Sociosanitary Legal and Economic Aspects in Nursing Homes for the Elderly in Spain.

AIM: The study aimed to identify and compare aspects of the different Spanish regulations on the minimum conditions that nursing homes must meet and to compare whether these requirements significantly affect the price of a nursing home place in each region. METHODS: We analyzed and compared the 17 regional regulations that must be met by nursing homes in terms of equipment and social and healthcare staff and combined this information with regional information concerning the price and coverage of public and subsidized places in nursing homes. RESULTS: The study revealed significant regional inequality in physical facilities and human resources. However, the number of regulatory measures referring to the mandatory availability of physical space or specific material resources was not positively correlated with an increase in the price of a place in a public or subsidized nursing home. CONCLUSIONS: No unified regulations throughout Spain regulate the aspects that residential centers must comply with. There is a need to move towards a person-centered approach, providing an environment as close to home as possible. The regulation of minimum standards to be met by all nursing homes at the national level should not significantly impact prices.

Justice perceptions of sanctions for unemployed welfare recipients.

Institutions of the welfare state are supposed to function in accordance with normative principles of redistributive justice, which should guide not only the allocation but also the withdrawal of resources. Our study examines justice assessments of sanctions for unemployed individuals receiving welfare benefits, a much-discussed variant of benefit withdrawal. We present results from a factorial survey that asked German citizens to indicate which sanction they would perceive as just under different scenarios. In particular, we look at different kinds of deviant behavior on the part of the unemployed job seeker, which allows for a broad picture concerning potential sanction-triggering events. The findings show that the extent of sanctions perceived as just varies considerably across scenarios. Respondents would impose more sanctions on men, repeaters, and young people. Moreover, they have a clear picture of the severity of the deviant behavior.

Parental income gradients in child and adolescent mortality: Norwegian trends over half a century.

BACKGROUND: Child mortality has declined rapidly over the last century in many high-income countries. However, little is known about the socio-economic differences in this decline and whether these vary across causes of death. METHODS: We used register data that included all Norwegian births between 1968 and 2010 (2.1 million), and we analysed how all-cause and cause-specific child (0-4 years) and adolescent (5-20 years) mortality rates vary with relative parental income the year before the birth. RESULTS: Child and adolescent all-cause mortality decreased with increasing parental relative income within all birth cohorts. Among children aged 0-4 years, the socio-economic gradient in all-cause mortality and in mortality due to external causes, sudden infant deaths and perinatal factors declined over the period, while there was no systematic decline in mortality from congenital malformations. Among children aged 5-20 years, the gradient did not weaken similarly, although there were indications of declines in the socio-economic gradient related to all-cause deaths and deaths because of suicides and other external causes. While the absolute differences in mortality declined over time, the relative differences remained stable. CONCLUSIONS: Although children of low-income parents still have elevated mortality, there has been a large reduction in child mortality in all socio-economic groups across 50 years for all causes combined and most of the groups of specific causes of death.

Health for all? Pasts, presents and futures of aspirations for universal healthcare.

In this special issue, we bring together anthropological and historical work that considers successive aspirations towards 'health for all': their pasts, their futures, and their diverse meanings and iterations. Across the world, hopes for providing 'health for all' were central to nation building in the long 20th century, and for international relations, particularly after the second world war and the establishment of the WHO. Health became seen as a fundamental good by citizens of North and South and has remained a central force shaping global and national politics until today. But what does 'health for all' actually mean, and how did it come to matter? In this introduction we approach 'health for all as a situated, multi-faceted phenomenon, that - while having a shared aspiration towards universality of access and equality of care - comes into focus in partial, diverse and contentious policies, programmes, projects and practices. Beyond homogenising narratives that frame 'health for all' in terms of either success or failure, the special issue highlights the diverse iterations that 'health for all' has taken on the ground for different subjects and groups of people, exploring exclusions and limitations as well as dreams and aspirations.

A solidarity paradox - welfare state data in global health data economy.

Nordic welfare states have well institutionalised practises of gathering health and social wellbeing data from their citizens. The establishment of population registers coincided with the building of welfare state institutions and a social contract relying on solidarity. During the last decade, the significance of Nordic registers and health data has increased and they have become sources of economic value. Recent policies expect registers, health data and biobanks to attract international investments, making Nordic countries world-leaders in the global health data economy. In this article we question the conditions and boundaries of solidarity in the emerging data-driven health economy. We argue that the logics of welfare state and data-driven health economy create a paradox - the data economy is not possible without the welfare state data regime, but the logic of data-driven health economy contradicts the value bases of the welfare state data regime and therefore the justifications for data gathering and use become questionable. We develop the concept of solidarization to describe the process by which individuals are expected to behave in a solidaristic way to support data gathering and related policy processes. We demonstrate the solidarity paradox through a recent legislative and data infrastructure reform in Finland and discuss it in relation to academic literature on solidarity.

Developing a Framework for the Support of Informal Caregivers: Experiences from Sweden, Ireland, and the United States.

Policies and services to support informal caregivers vary considerably across countries. This paper examines the role of caregivers and how perspectives on that role may influence the availability of benefits and services in three countries that differ considerably in their care systems - Sweden, Ireland and the United States. We developed a nine-dimensional framework for examining differences, including policies and how the role of caregiver is conceptualized. We found differences in the three countries in how services are organized, which reflected assumptions about the caregiver role. There were also similarities in the three countries. Caregivers held an ambiguous position within each social system and there was little concern for equity in the delivery of support services. Increased clarity about the role of caregivers may facilitate development of policies that more effectively meet their varied needs.

From industrial to digital citizenship: rethinking social rights in cyberspace.

Growing social inequalities represent a major concern associated with the Digital Revolution. The article tackles this issue by exploring how welfare regulations and redistribution policies can be rethought in the age of digital capitalism. It focuses on the history and enduring crisis of social citizenship rights in their connection with technological changes, in order to draw a comparison between the industrial and the digital scenario. The first section addresses the link between the Industrial Revolution and the genesis of social rights. It describes the latter as a legal 'machine' designed to offset the imbalances produced by the technological movement of industrialization. The second and third sections introduce the notion of 'industrial citizenship' to describe the architecture of social rights in mature industrial societies and to contend that European systems of welfare are still largely modeled on an industrial standard. The fourth part investigates the impact of the Digital Revolution on this model of social citizenship. It identifies debates on basic income as a major trajectory for redesigning welfare regulations in a post-industrial era, and the digital user as a crucial emerging subject of rights. The final part explores how digital users could be entitled to social rights as data suppliers. To this end, it introduces the idea of 'digital-social rights' resulting from the incorporation of welfare and redistribution principles into emerging digital rights. Hence, it proposes a legal-political framework for the redistribution of the revenues generated by data in the form of a 'digital basic income' for citizens of cyberspace.