Social transfers and the health status of mothers in Norway and Canada☆

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Abstract

The unconditional health status of lone mothers is worse than that of married mothers in Canada but not in Norway. Even controlling for demographic characteristics and health behaviours in Canada, the health status of lone mothers is worse. Only after we control for income does the differential in health status between married and lone mothers in Canada disappear. An important difference between the countries is that lone mothers are much less likely to be poor in Norway because they receive more generous social transfers. A simulation which involves ‘giving Canadian mothers Norwegian transfers,’ illustrates the possibility of significant gains in socioeconomic status and health of poor mothers in Canada.

Introduction

Whitehead, Burstrom and Diderichsen (2000) argue that policy can influence social position (e.g., lone mother status), exposure to health risks associated with different social positions (e.g., poverty) and the health consequences of exposures to health risks. We find that the unconditional health status of lone mothers in Canada is significantly lower than that of married mothers, while the same differential is not apparent in Norway. We also find that lone mothers are much more likely to be poorer than married mothers in Canada but not in Norway and that this is largely a result of the income transfers available to lone mothers in Norway. Thus, policy choices made in Norway significantly limit exposure to the health risk of poverty for lone mothers in Norway and in so doing, reduce health disparities. Variation in both policies and health outcomes across countries can help us better understand links between policy and health.

Norway and Canada are interesting countries to compare because, while similarly affluent, (e.g., gross domestic product (GDP) per capita, was just over $19,000 US in both countries in 1993), they have made some quite different policy choices. In this paper, we (1) provide an over-view of relevant policies in Canada and Norway, (2) assess implications of transfer programmes for the relative socioeconomic status of mothers in the two countries, (3) survey related literature, (4) conduct a multivariate analysis of links between socioeconomic status, family structure and the health status of mothers in Canada and Norway, (5) simulate potential consequences of ‘giving Canadian mothers the social transfers available in Norway’ and (6) conclude.

Section snippets

Health-care policy

Both Canada and Norway provide high-quality universal health-care coverage, spending close to the same percentage of GDP (van den Noord et al., 1998; World Health Organization Country Profiles, http://www.who.int/en/). Canada offers public health insurance with private provision of health care; most physicians are paid on a fee-for-service basis. Norway offers publicly provided health care.

In Canada, public health insurance is administered by the provinces. During our study period, the federal

Data

To study social transfers and incomes, we use the Luxembourg Income Study (LIS). LIS is a collection of microdata sets from different countries which have been re-coded to enhance comparability (e.g., of total transfers received). For Canada, the LIS data set is the 1995 Survey of Consumer Finance; for Norway, the LIS data file is the 1995 Statistics Norway Income Distribution Survey. For both the countries, we select a sample of mothers with children aged less than 18 years (13, 579

Literature review

Past research in many countries other than Canada or Norway has clearly indicated that lone mothers experience both a socioeconomic and a health disadvantage3

Social transfers and the relative socioeconomic status of mothers

In 1994/1995, before any state intervention, poverty rates for lone mothers were similar in Canada (56.7%) and Norway (50.1% in Norway).5 But, the Norwegian welfare state is more effective at alleviating poverty and reducing disparities between married and lone-mother families. After taxes and transfers, 9.2% of lone-mother families were poor in Norway compared to 33.0% in Canada. The

Multivariate analysis

Health status is measured as the respondent's self-reported general health. Since there are slight differences in wording across the countries (and we have a translation of the Norwegian question), we focus on a comparison of relative standings of married and lone mothers within countries. First, we find that the unconditional health status of lone mothers is worse than married mothers in Canada, but not in Norway (see Table 1). (A ‘lone mother’ dummy in an ordered probit model of health status

Potential health status consequences of ‘giving Canadian mothers Norwegian Transfers’

Finally, Fig. 2 presents the estimated marginal effects associated with moving individuals from the lowest income category into the second lowest category. The LIS data indicate that if the poorest Canadian mothers were to receive transfers according to the Norwegian system, their incomes would increase, on average, by $7019 (or 121%). This would move 97% of the mothers in the lowest-income category (household income of <$ 10,000) to the next higher income category (i.e., household income

Conclusions

This paper investigates the possible health consequences of social transfers for mothers, particularly lone mothers, living in Canada and Norway. Lone mothers have lower unconditional health status than married mothers in Canada but this is not true in Norway. Lone mothers are much less likely to be poor in Norway than in Canada, and social transfers are a major reason for this difference. Given the known importance of socioeconomic status as a determinant of health, differences in social

Acknowledgements

Authors have made equivalent contributions. We thank Lynn Lethbridge for superb research assistance, the NHRDP/CIHR for funding, members of the Canadian Institute for Advanced Research's Population Health Programme, and our colleagues at Dalhousie for comments.

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