ten - Health inequalities and welfare resources: findings and forecasts

Summary

Introduction

In this book we have analysed and discussed different forms of health inequalities, their size and shape, how they have changed over time, and how they are portrayed across various parts of the life course. We have also analysed a number of social determinants of health and how these may generate and sustain health inequalities. In doing this, we took Scandinavian welfare research as our point of departure in order to establish a conceptual framework of “command over resources … by means of which the individual can control and consciously direct her conditions of life” (Johansson, 1970, p 25). Resources central to health include work and working conditions, income and economic resources, family and social relations, all of which are brought into the analysis in several of the chapters.

The analyses in the book also rest on the welfare research tradition, in that we employ databases designed for the purpose of describing and analysing the distribution and development of welfare problems. Our main data source is the Swedish Level-of-Living Survey (LNU), but we also use Statistics Sweden's yearly Survey of Living Conditions (ULF) as well as amendments and extensions of these two databases that incorporate schoolchildren and the oldest old. Taken together, these data have enabled us to study social determinants of health over time, as well as to look across the life course from the age of nine to 99.

The general context for our analyses of health and inequalities is the Swedish welfare state. Changes in health and health inequalities are also discussed against the background of changes in welfare state institutions. Although the Swedish case may be seen as an ‘ideal type’ of what is known as the Scandinavian welfare state model, it is also likely that the crucial determinants of ill health, and how these are systematically related to social position in market societies, will share basic characteristics across countries. While different welfare state arrangements are likely to modify the processes linking social position with health outcomes (see below), these processes themselves will be similar in different types of welfare state. Although Sweden may stand out as an exception in terms of the ambitions of the welfare state and the strength of the economic and welfare state crisis experienced during the 1990s, our findings regarding mechanisms are therefore also applicable to other societies.