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Welfare regimes, population health and health inequalities: a research synthesis
  1. Sarah Brennenstuhl1,
  2. Amélie Quesnel-Vallée2,3,
  3. Peggy McDonough1
  1. 1Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
  2. 2Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
  3. 3Department of Sociology, McGill University, Montreal, Quebec, Canada
  1. Correspondence to Dr Peggy McDonough, Dalla Lana School of Public Health, University of Toronto, 155 College Street 6th floor, Toronto M5T 3M7, Ontario, Canada; peggy.mcdonough{at}utoronto.ca

Abstract

Background Research on the social determinants of health is increasingly using welfare regime theory. Although a key argument is that population health will be better and health inequalities lower in social democratic regimes than in others, this research has not been subjected to a systematic review. This paper identifies and assesses empirical studies that explicitly use a welfare regime typology in comparative health research.

Methods 15 electronic databases and relevant bibliographies were searched to identify empirical studies published in English-language journals from January 1970 to February 2011. Thirty-three studies appearing in 14 peer-reviewed journals between 1994 and 2011 met the inclusion criteria.

Results Three welfare regime typologies and their variants dominated existing work, which consisted of two broad study types: One compared population health and health inequalities across welfare regimes; the other considered relationships between health and the political determinants and policies of welfare regimes. Studies were further distinguished by the presence or absence of statistical significance testing of relationships of interest. Just under one half of studies comparing outcomes by regime found at least some evidence that health inequalities were lowest or population health was the best in social democratic countries. Studies analysing the relationship between health (mortality) and the political determinants or policies of welfare states were more likely to report results consistent with welfare regime theory.

Conclusions Health differences by regime were not always consistent with welfare regime theory. Measurement of policy instruments or outcomes of welfare regimes may be more promising for public health research than the use of typologies alone.

  • Gender
  • inequalities
  • medical sociology FQ
  • poverty
  • public health
  • review
  • social epidemiology
  • social factors in
  • socioeconomic inequalities
  • welfare regimes

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Footnotes

  • Previous versions of this paper were presented at the Research Data Centres Conference on Health over the Life Course, University of Western Ontario, London, Ontario, 14–16 October 2009 and at the International Sociological Association (RC-15) Conference in Gothenberg, Sweden, July 2010.

  • Funding Funding for the project was provided by Population Change and Lifecourse Strategic Knowledge Cluster through the Social Sciences and Humanities Research Council of Canada. The funding source has no role in the study design; data collection or analysis, interpretation of data, writing of the report or decision to submit the paper for publication.

  • Competing interests None.

  • Provenance and peer review Not commissioned; internally peer reviewed.

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