Explaining health marginalisation of the lower educated: the role of cross-national variations in health expenditure and labour market conditions

Several studies have shown ample cross-national variation in the risk that lower educated people run to be in poor health. However, explanations for this cross-national variation are still scarce. In this article we aim at filling this lacuna by investigating to what extent cross-national variation in the health gap between the lower and higher educated in Europe is explained by governmental health expenditure, namely, how much governments contribute to a country's total healthcare costs, and labour market conditions, that is, unemployment rates and modernisation of the labour market. We used information from the European Social Survey (ESS) 2002-2008 on more than 90,000 individuals in 32 European nations, and estimated hierarchical models with cross-level interactions to test our expectations. Our results show that the relative risk of being in poor health of lower educated individuals is smaller in countries where the government spends much on healthcare and with a highly modernised labour market.