Introduction Previous studies have shown that macro-level factors, such as income inequality, wealth of countries or welfare state characteristics are crucial determinants of health and health inequalities among adults. So far, comparative research has rarely focused on children and adolescents. This study is among the first to examine whether different macro-level determinants are associated with differences in subjective health and socio-economic related health inequalities among adolescents in high-developed welfare states.
Methods Data were collected from the school based “Health Behaviour in School-aged Children”-study in 2005/2006, which includes 11- to 15-year old students from 27 European and North American countries (N=134.632), classified into five regimes (Scandinavian, Bismarckian, Liberal, Southern, Eastern). Hierarchical linear regression models were conducted for multiple complaints in health, including stepwise individual (family affluence) and extended by macro-level determinants (wealth of countries, income inequality, health expenditure, welfare state regime-dummies).
Results Boys and girls in the Southern, Eastern and Liberal regimes displayed the highest prevalence rates in multiple complaints in contrast to the social-democratic and conservative regimes. The liberal regime and, thus, countries with high income inequality showed significantly more complaints and a stronger impact of socio-economic determinants on complaints.
Conclusion Reducing health inequalities should continue to be an important public health strategy with emphasis on the young population in all welfare states regimes and particularly in the Liberal welfare states. Thus, welfare state characteristics and the extent of income inequality are considered as relevant factors in tackling socioeconomic inequalities in health of adolescents.
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