Analysing changes of health inequalities in the Nordic welfare states

Abstract

This study examined changes over time in relative health inequalities among men and women in four Nordic countries, Denmark, Finland, Norway and Sweden. A serious economic recession burst out in the early 1990s particularly in Finland and Sweden. We ask whether this adverse social structural development influenced health inequalities by employment status and educational attainment, i.e. whether the trends in health inequalities were similar or dissimilar between the Nordic countries. The data derived from comparable interview surveys carried out in 1986/87 and 1994/95 in the four countries. Limiting long-standing illness and perceived health were analysed by age, gender, employment status and educational attainment. First, age-adjusted overall prevalence percentages were calculated. Second, changes in the magnitude of relative health inequalities were studied using logistic regression analysis. Within each country the prevalence of ill-health remained at a similar level, with Finns having the poorest health. Analysing all countries together health inequalities by employment status and education showed no major changes. There were slightly different tendencies among men and women in inequalities by both health indicators, although these did not reach statistical significance. Among men there was a suggestion of narrowing health inequalities, whereas among women such a suggestion could not be discerned. Looking at particular countries some small changes in men's as well as women's health inequalities could be found. Over a period of deep economic recession and a large increase in unemployment, particularly in Finland and Sweden, health inequalities by employment status and education remained broadly unchanged in all Nordic countries. Thus, during this fairly short period health inequalities in these countries were not strongly influenced by changes in other structural inequalities, in particular labour market inequalities. Institutional arrangements in the Nordic welfare states, including social benefits and services, were cut during the recession but nevertheless broadly remained, and are likely to have buffered against the structural pressures towards widening health inequalities.

Introduction

Socioeconomic inequalities in ill-health at one point of time have often been studied, but their changes over time have only seldom been under scrutiny (see e.g. Karisto, 1993; Elstad, 1996a; Lundberg, 1992). There are cross-sectional studies which have compared health inequalities in a number of countries (e.g. Mackenbach, Kunst, Cavelaars, Groenhof, Geurts, & the EU Working Group on Socioeconomic Inequalities in Health, 1997; Cavelaars et al., 1998; Lahelma, Manderbacka, Rahkonen, & Sihvonen, 1993; Lahelma & Arber, 1994), but we lack studies which have compared changes over time in two or more countries, i.e. looked whether health inequalities have changed in a similar or dissimilar way in different countries.

International comparisons are complicated for practical reasons, such as lack of comparable data, but also methodological reasons make such studies precarious. Countries which vary a lot with regard to social structure and culture do not easily allow focussed comparisons (Allardt, 1975). This study examines the Nordic countries, which share many similarities, and from which comparable data are available. Some previous cross-sectional Nordic comparisons have assessed socioeconomic inequalities in ill-health in the 1970s and 1980s (Karisto, Notkola, & Valkonen, 1978; Lahelma et al., 1993). However, no previous study has compared trends in health inequalities in the Nordic countries. Therefore, this study focussed on changes over time in inequalities in ill-health by employment status and educational attainment in four Nordic countries, that is Denmark, Finland, Norway and Sweden, from the mid-1980s to the mid-1990s.