Assessing where vulnerable groups fare worst: a global multilevel analysis on the impact of welfare regimes on disability across different socioeconomic groups

J Epidemiol Community Health. 2012 Sep;66(9):775-81. doi: 10.1136/jech-2011-200320. Epub 2011 Nov 1.

Abstract

Background: Investigations on health differences within welfare states between low- and high-socioeconomic groups are mainly conducted in Europe. With the aim of gaining global insight on the extent welfare regimes influence personal disability for the most vulnerable, we explore how these health differences vary between low- and high-socioeconomic groups.

Methods: The World Health Survey data were analysed on 199595 adults from 46 countries using the welfare regime classification developed by Wood and Gough. Multilevel logistic regression was used to estimate welfare regime differences in self-reported disability according to individual educational attainment and employment status.

Results: As compared with the low educated in the European-conservative regime, the odds of having a higher prevalence of disability was found among low-educated people residing in the informal-security regime of South Asia, with OR being 3.16 (95% CI 2.23 to 4.47). While state-organised regimes seemed to offer more protection against disability to the low educated, the productivist regime of East Asia trailed closely behind, with OR being 1.10 (95% CI 0.76 to 1.60) for the low educated. Similar findings were also observed in the unemployed.

Conclusions: State-organised regimes of Europe and the productivist regime of East Asia seem to contain protecting features against disability for all citizens and especially for the most vulnerable. Apart from the productivist regime of East Asia, the low educated and the unemployed seem to carry the greatest health burden within more insecure regimes, highlighting a deficiency in social provisions within these regimes aimed at protecting the most vulnerable.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Age Distribution
  • Aged
  • Aged, 80 and over
  • Cross-Sectional Studies
  • Disability Evaluation
  • Disabled Persons / psychology*
  • Disabled Persons / statistics & numerical data
  • Europe / epidemiology
  • Female
  • Health Status Disparities*
  • Humans
  • Logistic Models
  • Male
  • Middle Aged
  • Outcome Assessment, Health Care
  • Prevalence
  • Self Report
  • Social Class*
  • Social Welfare*
  • World Health Organization