J Epidemiol Community Health 67:713-714 doi:10.1136/jech-2013-202937
  • Editorial

In defence of (social) democracy: on health inequalities and the welfare state

Editor's Choice
  1. Clare Bambra
  1. Correspondence to Professor Clare Bambra, Department of Geography, Wolfson Research Institute for Health and Wellbeing, Queen's Campus, Durham University, Stockton on Tees TS17 6BH, UK; clare.bambra{at}
  • Received 5 June 2013
  • Accepted 6 June 2013
  • Published Online First 27 June 2013

This issue features a comparative study by Guarnizo-Herreno et al1 on oral health inequalities in European welfare states. Looking at socioeconomic (occupational, educational and subjective social status) inequalities in functional dentition and edentulousness among adults aged 45 years and over, using data from the 2009 Eurobarometer, the authors conclude that relative and absolute health inequalities are present in all European welfare states (n=21) and that they are not smaller (and may actually be largest) in the social democratic welfare states of Denmark, Finland, Norway and Sweden.

This is consistent with the findings of a growing body of comparative research into the international patterning of inequalities in health by welfare state regime, whereby the social democratic welfare states fare best in terms of general population health outcomes (eg, life expectancy of all social groups tends to be higher) but less well in terms of socioeconomic inequalities in health.2 ,3 The findings of Guarnizo-Herreno and colleagues1 are similar to those for self-reported health,4 ,5 oral quality of life6 and obesity, smoking and mortality,7 for which ‘no evidence for systematically smaller inequalities in health in countries in northern Europe (Scandinavia)’ were found.7 Reviews of the political and welfare determinants of health have concluded similarly.3 ,8 ,9

This mismatch between doing well in overall health outcomes while doing less well in terms of reducing health inequalities …