Income, egalitarianism and attitudes towards healthcare policy: a study on public attitudes in 29 countries.

OBJECTIVES: To evaluate the relationship between income and egalitarian values and attitudes towards healthcare policy. STUDY DESIGN: Cross-sectional and cross-national study. METHODS: Data for 29 countries from the International Social Survey Programme (ISSP) 2011 were used. The dependent variables are a general attitude towards government involvement in healthcare provision and two attitudes regarding specific policies (taxes and public funding). Income and egalitarianism were also measured by using ISSP. Data were analysed using regression models that account for individual and country-level characteristics, and country-fixed effects. RESULTS: The effect of income is small and non-significant for attitudes towards government involvement and public funding. For willingness to pay (WTP) taxes to improve healthcare services, we find a positive association with income. Results for egalitarianism suggest a positive association with government involvement in healthcare provision and significant interactions with WTP taxes. CONCLUSIONS: The distinction of dimensions and mechanisms underlying policy attitudes appears as relevant. Citizens across socioeconomic groups are motivated to support state-funded healthcare, favouring the design of non-selfish policies. These findings suggest that there is space for policymakers who seek to increase healthcare spending encouraging either policies for specific groups or broader institutional changes.

Should non-citizens have access to publicly funded health care?: a study of public attitudes and their affecting factors.

OBJECTIVES: To analyse public attitudes towards access for non-citizens to publicly funded health care and to assess the factors that affect such attitudes. STUDY DESIGN: Cross-sectional study. METHODS: Data from 29 countries were used for a multilevel regression, and data from four countries (United States, Sweden, Philippines, and Korea) were used for a linear regression. The data were collected from the International Social Survey Program (ISSP), the World Bank, the Organization for Economic Cooperation and Development (OECD), and the United Nations. The dependent variable was considered to be agreement for non-citizen access to publicly funded health care. The independent variables included: the gross national income (GNI), the gross national income coefficient (GINI), sex, age, education, household income, employment, health insurance, self-related health status, chronic illness, percent having insurance, percent having public insurance, percent employed, percent migrants, percent of health expenditure of the total gross domestic product (GDP), and percent of social expenditure of the total GDP. Egalitarianism for education policy (EEP), egalitarianism for health policy (EHP), and willingness to contribute to an egalitarian health policy (WCHP) were also examined. RESULTS: In the countries surveyed, more than half of the citizens agreed that non-citizens should have access to publicly funded health care. Agreement with that statement had a negative trend with respect to the GNI. The percent having public insurance and WCHP had a significantly positive association with agreement while the percent of those with insurance had a negative relationship. In the USA, household income, EHP, and WCHP were positively associated with agreement, while females were inversely associated with agreement. In Sweden, having health insurance had an inverse association to agreement while females, postsecondary education, health insurance coverage, and WCHP were positively associated with agreement. In the Philippines, household income, EEP, and EHP had significant negative associations with agreement while WCHP had a positive relationship. In Korea, household income and self-rated health status were positively associated with agreement, while postsecondary education had a negative association. CONCLUSION: Public attitudes towards allowing non-citizens to have access to publicly funded health care present high levels of variation, even among developed countries or countries with similar GDPs. The specific socio-economic conditions within a country and an individual's own social, demographic, and economic background can have different effects on the individual's attitudes towards non-citizens. On a global level, coverage of public health insurance plays an important role for enhancing the public's positive attitudes towards non-citizens' access to publicly funded health care. On a national level, health care policies tailored toward non-citizens based on the specific situation of each country and region are necessary.

Cohort change and the diffusion of environmental concern: A cross-national analysis.

This study explores value change across cohorts for a multinational population sample. Employing a diffusion-of-innovations approach, we combine competing theories predicting the relationship between socio-economic status (SES) and environmentalism: post-materialism and affluence theories, and global environmentalism theory. The diffusion argument suggests that high-SES groups first adopt pro-environmental views, but as time passes by, environmentalism diffuses to lower-SES groups. We test the diffusion argument using a sample of 18 countries for two waves (years 1993 and 2000) from the International Social Survey Project (ISSP). Cross-classified multilevel modeling allows us to identify a non-linear interaction between cohort and education, our core measure of SES, in predicting environmental concern, while controlling for age and period. We find support for the diffusion argument and demonstrate that the positive effect of education on environmental concern first increases among older cohorts, then starts to level off until a bend-point is reached for individuals born around 1940 and becomes progressively weaker for younger cohorts.

A comparison of attitudes towards immigrants from the perspective of the political party vote.

Many reasons have shaped immigration into the EU over the past decade. Since then, attitudes towards immigration have not only gained public attention but have also shaped political debate and discourse in recent regional, national, and EU elections. The global financial crisis of 2008 increased the importance of migration in the social welfare upheaval in most Member States. Anti-immigrant sentiment and rhetoric became part of the narrative of some political parties during the campaign, and media coverage catalysed these social attitudes. The study used the 2013 International Social Survey Project (ISSP) dataset of six countries (namely Belgium, Germany, Spain, France, the UK, and Portugal) to see if the political party vote might have affected the attitude toward immigrants. The study extends other previous studies and presents new evidence on an under-researched topic. Results show that the left party voters are more open toward immigrants than the right party voters and that the green party voters show the most positive attitudes towards immigrants.

The politics of environmental concern: A cross-national analysis.

Prior research in the U.S. has found that liberals are generally more environmentally concerned than conservatives. The present study explores whether conservatives' opposition to environmental protection is solely a U.S. or a universal phenomenon and whether this association is contingent on country-level characteristics such as development, environmental conditions, and communist history. Employing data for 19 countries from the ISSP module "Environment II," this paper explores inter-country variations in the relationship between individual conservatism and environmental concern using multilevel modeling with cross-level interactions. The models reveal a number of intriguing associations. Most important, conservatives' support for environmental protection varies by country. This variation is a function of country-level characteristics. The strongest opposition of conservatives' toward environmental protection was observed in developed, capitalist nations, with superior environmental conditions. On the other hand, in less developed countries, and countries characterized by poor environmental quality, conservatives are more environmentally concerned than liberals.

Are Children a Joy or a Burden? Individual- and Macro-level Characteristics and the Perception of Children.

This study examines how individuals perceive children, focusing on two dimensions-the positive aspects of having children and the perception of children as a burden-and taking into account relations with both individual- and macro-level characteristics. Three dimensions are examined on the macro-level: policies that support families, the cultural environment, and economic conditions. The study is based on the 2012 ISSP module on "Family and Gender Roles" and covers 24 OECD countries. The findings show that countries vary widely in their negative perceptions of children, but evince relatively greater similarity in their positive perceptions. Institutional support for children and working parents and traditional family values as captured by religiosity are important factors in explaining cross-country variation in negative perceptions of children. Further, policies may help men and women adopt a more positive view of children and reduce differences among educational groups in relation to children.

Contextualizing geneticization and medical pluralism: How variable institutionalization of traditional, complementary, and alternative medicine (TCAM) conditions effects of genetic beliefs on utilization.

As genetic models are increasingly incorporated in medicine, health service users seem to accept these models to varying degrees. To appreciate these differences, this paper examines how health service users' genetic beliefs of health are associated with their use of traditional, complementary, and alternative medicine (TCAM) via responses from 31 countries in the 2011 ISSP survey. It finds an interesting contrast between East Asian countries and other countries in the world. The negative association between genetic beliefs and TCAM use is strong in the latter, whereas it is weak in the former. More intriguingly, the analysis demonstrates significant cross-national differences within East Asian countries. Chinese and Koreans reveal a negative relationship between genetic beliefs and TCAM use, while Japanese show a positive relationship. The paper provides an explanation to these cross-national differences by drawing on comparative studies of medical systems. When TCAM is institutionalized as valid and distinct medical resources, and when TCAM is practically available to everyday use, health service users who subscribe to genetic beliefs are likely to use TCAM as well. These findings contribute to revealing the pragmatic nature of health-seeking action and the institutional context in which geneticization and medical pluralism are conditioned to form.

Perception of Lay People Regarding Determinants of Health and Factors Affecting It: An Aggregated Analysis from 29 Countries.

BACKGROUND: This study aimed to evaluate the perception of lay people regarding determinants of health at global level and factors affecting it. METHODS: Data was collected from International Social Survey Program (ISSP) and World Bank website. Multilevel regression analysis was done and lay people's perception regarding health behavior, environment, poverty and genes as health determinants was assessed. Various socio demographic factors were used as independent variables. RESULTS: The highest percentage of people agreed environment as determinant of health. An inverse relationship was observed between GNI quartiles and an individual's agreement with poverty, health behavior, and environment as health determinant. There was a significant negative association of females with health damaging behavior (P<0.05) and positive association with environment and genes (P<0.05) as health determinants. Elderly people agreed with poverty as determinant of health (P<0.05). GNI was negatively related to environment (P<0.05) and poverty (P<0.05) as health determinant. CONCLUSION: The common public is now becoming aware of a broadened concept of health and people belonging to different backgrounds have different perceptions regarding determinants of health. Our results show that highest percentage of people agreed with environment as determinant of health, which is consistent with scientific view of increased burden of disease, caused by environmental factors. Thus, tailored health programs and policies that address an individual's specific problems are likely to induce a change in behavior and attitude, hence decreasing the disease burden.