This study uses data from the Organisation for Economic Co-operation and Development countries over the 2008–2010 period to construct indicators of “pro-primary” and “pro-secondary” distributions. The former is concerned with the original distribution of income through the market, whereas the latter is concerned with the redistribution efforts of the government. The study ranks these countries along these dimensions to create a distributional orientation map for such countries. It finds that the Scandinavian countries occupy the top rankings in terms of equity in pro-primary distribution, followed by countries with a Bismarckian welfare state regime. The Scandinavian countries also rank very high on equity in pro-secondary distribution, along with some of the top-ranking Bismarckian countries. More significantly, the study finds that the countries’ health outcomes are associated more strongly with the pro-primary distributional stance than with the pro-secondary distributional stance. A key policy implication is that to achieve better and more equitable health, it is more effective to design a level playing field for market participants in the first place, than to try to mend inequities after the fact through remedial social policy.
Marmot MG, Wilkinson RG, eds. Social Determinants of Health. Oxford: Oxford University Press; 1999.
2.
MarmotMGShipleyMJRoseG. Inequalities in death: specific explanations of a general pattern. Lancet1984; 323(8384): 1003–1006.
3.
MarmotMGStansfeldSPatelC. Health inequalities among British civil servants: the Whitehall II study. Lancet1991; 337(8754): 1387–1393.
4.
NavarroVShiL. The political context of social inequalities and health. Int. J Health Serv2001; 31(1): 1–21.
5.
ConleyDSpringerKW. Welfare state and infant mortality. Am J Sociol2001; 107(3): 768–807.
6.
NavarroVBorrellCBenachJ. The importance of the political and the social in explaining mortality differences among the countries of the OECD, 1950–1998. Int J Health Serv2003; 33(3): 419–494.
7.
BurströmBWhiteheadMLindholmCDiderichsenFInequality in the social consequences of illness: how well do people with long-term illness fare in the British and Swedish labor markets? In: NavarroVMuntanerC (eds). Political and Economic Determinants of Population Health and Well-Being – Controversies and Developments, New York, NY: Baywood Publishing Co, 2004, pp. 35–50.
8.
ChungHMuntanerC. Welfare state matters: a typological multilevel analysis of wealthy countries. Health Policy2007; 80(2): 328–339.
9.
LundbergOYngweMAStjärneMK. The role of welfare state principles and generosity in social policy programmes for public health: an international comparative study. Lancet2008; 732(9650): 1633–1640.
10.
BambraCEikemoTA. Welfare state regimes, unemployment and health: a comparative study of the relationship between unemployment and self-reported health in 23 European countries. J Epidemiol Commun Health2009; 63(2): 92–98.
11.
BambraC. Health inequalities and welfare state regimes: theoretical insights on a public health ‘puzzle’. J Epidemiol Commun Health2011; 65(9): 740–745.
12.
KimI-HMuntanerCVahid ShahidiFVivesAVanrolenCBenachJ. Welfare states, flexible employment, and health: a critical review. Health Policy2010; 104(2): 99–127.
13.
SafaeiJ. Social policy as social vaccine. Soc Med2014; 8(1): 11–22.
14.
WilkinsonRPickettK. The Spirit Level: Why More Equal Societies Almost Always Do Better, London: Penguin, 2009.
15.
SaltkjelTDahlEvan der WelKA. Health related social exclusion in Europe: a multilevel study of the role of welfare generosity. Int J Equity Health2013; 12: 81.
16.
HuberEStephensJ. Development and Crisis of the Welfare State: Parties and Policies in Global Markets, Chicago: University of Chicago Press, 2001. . doi:10.1017/S0047279402216931.
17.
SwankD. Globalization, domestic policies, and welfare retrenchment in capitalist democracies. Soc Policy Society2005; 4(2): 183–195.
Kvist J, Fritzel J, Hvinden B, Kangas O, eds. Changing Social Equality: The Nordic Welfare Model in the 21st Century. Bristol: Policy Press; 2011.
20.
BambraC. In defence of (social) democracy: on health inequalities and the welfare state. J Epidemiol Commun Health2013; 67(9): 713–714.
21.
RaphaelD. Challenges to promoting health in the modern welfare state: the case of the Nordic nations. Scand J Pub Health2013; 0: 1–11. http://www.equityhealth.com/content/12/1/81. Accessed February 15, 2014.
22.
LightmanE. Social Policy in Canada, Toronto: Oxford University Press Canada, 2003.
KitagawaEMHauserPM. Differential Mortality in the United States: A Study in Socio-economic Epidemiology, Cambridge, MA: Harvard University Press, 1973.
25.
TownsendPDavidsonN. Inequalities in Health: The Black Report, Harmondsworth, UK: Penguin Books, 1982.
26.
MarmotMKogevinasMElstomMA. Social/economic status and disease. Annu Rev Public Health1987; 8: 111–135.
27.
KunstAEMackenbachJP. The size of mortality differences associated with educational level in nine industrial countries. Am J Public Health1994; 84(6): 932–937.
28.
Navarro V, ed. Political and Economic Determinants of Population Health and Well-Being—Controversies and Developments. Amityville, NY: Baywood Publishing Co; 2004.
29.
Raphael D, ed. Social Determinants of Health - Canadian Perspectives. Toronto: Canadian Scholars’ Publishing; 2004.
30.
RoyJP. Socioeconomic status and health: a neurobiological perspective. Med Hypotheses2004; 62(2): 222–227.
31.
StrikePCSteptoeA. Psychosocial factors in the development of coronary artery disease. Prog Cardiovasc Dis2004; 46(4): 337–347.
32.
KristensonMEriksenHRSluiterJKStarkeDUrsinH. Psychobiological mechanisms of socioeconomic differences in health. Soc Sci Med2004; 58(8): 1511–1522.
LarsenCA. The Institutional Logic of Welfare Attitudes – How Welfare Regimes Influence Public Support, Hampshire, UK: Ashgate Publishing Limited, 2006.
40.
BambraC. Health status and worlds of welfare. Soc Policy Society2006; 5(1): 53–62.
41.
RaphaelD. Health equity in Canada. Soc Altern2010; 29(2): 41–49.
42.
PrestonSH. The changing relation between mortality and level of economic development. Popul Stud1975; 29(2): 231–248.
43.
Spence M, Lewis M, eds. Health and Growth. Washington DC: World Bank Publications; 2009.
44.
LynchJWKaplanGAPamukER. Income inequality and mortality in metropolitan areas of the United States. Am J Public Health1998; 88(7): 1074–1080.
45.
WilkinsonRG. Unfair Shares: The Effects of Widening Income Differences on the Welfare of the Young, Ilford, UK: Bernardo’s, 1994.
46.
SubramanianSVKawachiI. Income inequality and health: what have we learned so far? Epidemiol. Rev2004; 26(1): 78–91.
