Johan Fritzell

The role of welfare state principles and generosity in social policy programmes for public health: an international comparative study

BACKGROUND Many important social determinants of health are also the focus for social policies. Welfare states contribute to the resources available for their citizens through cash transfer programmes and subsidised services. Although all rich nations have welfare programmes, there are clear cross-national differences with respect to their design and generosity. These differences are evident in national variations in poverty rates, especially among children and elderly people. We investigated to what extent variations in family and pension policies are linked to infant mortality and old-age excess mortality. METHODS Infant mortality rates and old-age excess mortality rates were analysed in relation to social policy characteristics and generosity. We did pooled cross-sectional time-series analyses of 18 OECD (Organisation for Economic Co-operation and Development) countries during the period 1970-2000 for family policies and 1950-2000 for pension policies. FINDINGS Increased generosity in family policies that support dual-earner families is linked with lower infant mortality rates, whereas the generosity in family policies that support more traditional families with gainfully employed men and homemaking women is not. An increase by one percentage point in dual-earner support lowers infant mortality by 0.04 deaths per 1000 births. Generosity in basic security type of pensions is linked to lower old-age excess mortality, whereas the generosity of earnings-related income security pensions is not. An increase by one percentage point in basic security pensions is associated with a decrease in the old age excess mortality by 0.02 for men as well as for women. INTERPRETATION The ways in which social policies are designed, as well as their generosity, are important for health because of the increase in resources that social policies entail. Hence, social policies are of major importance for how we can tackle the social determinants of health.

To what extent do fiscal regimes equalize opportunities for income acquisition among citizens

This project employs the theory of equality of opportunity, described in Roemers book (Equality of Opportunity, Harvard University Press, 1998), to compute the extent to which tax-and-transfer regimes in ten countries equalize opportunities among citizens for income acquisition. Roughly speaking, equality of opportunity for incomes has been achieved in a country when it is the case that the distributions of post-fisc income are the same for different types of citizen, where a citizens type is defined by the socioeconomic status of his parents. Intuitively, a country will have equalized opportunity if the chances of earning high (or low) income are equal for citizens from all family backgrounds. Of course, pre-fisc income distributions, by type, will not be identical, as long as the educational system does not entirely make up for the disadvantage that children, who come from poor families face, but the tax-and-transfer system can play a role in rectifying that inequality. We include, in our computation, two numbers that summarize the extent to which each countrys current fiscal regime achieves equalization of opportunities for income, and the deadweight loss that would be incurred by moving to the regime that does.

Exploring relative deprivation: is social comparison a mechanism in the relation between income and health?

During the last decade there has been a growing interest in the relation between income and health. The discussion has mostly focused on the individuals relative standing in the income distribution with the implicit understanding that the absolute level of income is not as relevant when the individuals basic needs are fulfilled. This study hypothesises relative deprivation to be a mechanism in the relation between income and health in Sweden: being relatively deprived in comparison to a reference group causes a stressful situation, which might affect self-rated health. Reference groups were formed by combining indicators of social class, age and living region, resulting in 40 reference groups. Within each of these groups a mean income level was calculated and individuals with an income below 70% of the mean income level in the reference group were considered as being relatively deprived. The results showed that more women than men were relatively deprived, but the effect of relative deprivation on self-rated health was more pronounced among men than among women. In order to estimate the importance of the effect of relative income versus the effect of absolute income, some analyses on the effect of relative deprivation on self-rated health were also carried out within different absolute income levels. When restricting the analysis to the lowest 40% of the income span the effect of relative deprivation almost disappeared. Relative deprivation may have a significant relation to health among men. However, for the 40% with the lowest income in the population the effect of relative deprivation on health is considerably reduced, possibly due to the more prominent relation between low absolute income and poor health.

The dynamics of income distribution: economic mobility in Sweden in comparison with the United States.

Abstract Cross-sectional income studies often tend to give the impression that peoples economic status is relatively stable and static. However, longitudinal data have shown that changes in economic well-being are surprisingly frequent over the life course. This paper examines economic mobility in Sweden in comparison with earlier American findings. A primary focus of attention is to explore whether the great impact of “family composition changes,” as a major cause of economic change in the United States, is also present in Sweden. The findings show the importance of changes in family composition in both countries, but this impact varies strongly both between different subgroups of each population and when comparing the subgroups cross-nationally. Whereas family composition changes are tied to changes in economic well-being for women in both countries, this connection does not hold for American men and Swedish children.

The individual and contextual pathways between oral health and income inequality in Brazilian adolescents and adults

We evaluate the association between income inequality (Gini index) and oral health and in particular the role of alternative models in explaining this association. We also studied whether or not income at the individual level modifies the Gini effect. We used data from an oral health survey in Brazil in 2002-2003. Our analysis included 23,568 15-19 and 22,839 35-44 year-olds nested in 330 municipalities. Different models were fitted using multilevel analysis. The outcomes analysed were the number of untreated dental caries (count), having at least one missing tooth (dichotomous) and being edentulous (dichotomous). To assess interaction as a departure from additivity we used the Synergy Index. For this, we dichotomized the Gini coefficient (high vs low inequality) by the median value across municipalities and the individual income in the point beyond which it showed roughly no association with oral health. Adjusted rate ratio of mean untreated dental caries, respectively for the 15-19 and 35-44 age groups, was 1.12 and 1.16 for each 10 points increase in Gini scale. Adjusted odds ratio of a 15-19 year-old having at least one missing tooth or a 35-44 year-old being edentulous was, respectively, 1.19 and 1.01. High income inequality had no statistically significant synergistic effect with being poor or living in a poor municipality. Higher levels of income inequality at the municipal level were associated with worse oral health and there was an unexplained residual effect after controlling for potential confoundings and mediators. Municipal level income inequality had a similar, detrimental effect, among individuals with lower or higher income.

Welfare trends in Sweden: balancing the books for the 1990s

Welfare trends in Sweden: balancing the books for the 1990s : Journal of European Social Policy

Financial transfers between generations in Sweden

This study has examined the flow of financial transfers between generations in Sweden, measured as financial support in the form of relatively large money transactions or gifts over 12 months. Two questions are considered: is there a net downward flow in the Swedish welfare state and, if so, are there differences according to gender and social class? The questions were tested using data from two linked and nationally representative large-scale surveys. The results show that almost all inter-generational transfers are downward, from older to younger generations. Unlike earlier studies of inter-generational transfers, the analysis focuses on inequality, and the results reveal clear class and income gradients. Both giving and receiving were more common among people in the higher social strata. A gender gradient among unmarried (single) recipients was also found, whereby unmarried women more often received financial support than unmarried men. The paper concludes with a discussion of the implications of the results for social stratification and inequality. From a static or cross-sectional perspective, the results suggest that financial transfers are neutral or even equality promoting, but a dynamic or lifecourse interpretation suggests that financial transfers transmit or even reinforce class inequalities over generations.

Income Inequality Trends in the 1980s: A Five-Country Comparison

This paper compares recent developments in income inequality in Canada, Germany, Sweden, the United Kingdom, and the United States. In addition to descnbing cross- national variation in changes in income inequality, the paper examines different explana tory factors for these recent developments The findings reported indicate that there is substantial cross-national variation, not only with regard to the level of inequality, but furthermore with regard to changes in inequality. The results indicate that the equalizing effect of welfare state redistribution did not decrease in all countries By contrast, in all countries there was a universal tendency towards increased inequality in the pre-tax and transfer distribution, although the magnitude of the change differs from country to country. Even though a polarization of the earnings distribution is reported, the results still give no support to cross-national convergence with regard to income inequality during the 1980s.

The relationship between levels of income inequality and dental caries and periodontal diseases

The objective of this study was to evaluate the association between income inequality at a lagged time of 2 and 11 years with two short latency outcomes (untreated dental caries and gingivitis) and two long latency outcomes (edentulism and periodontal attachment loss > 8mm). We used data from the Brazilian oral health survey in 2002-2003. Our analysis included 13,405 subjects aged 35-44 years. Different lagged Gini at municipal level were fitted using logistic and negative binomial multilevel analyses. Covariates included municipal per capita income, equivalized income, age, sex, time since last dental visit and place of residence (rural versus urban). Crude estimates showed that only untreated dental caries was associated with current and lagged Gini, but in adjusted models only current Gini remained significant with a ratio of 1.19 (95%CI: 1.09-1.30) for every ten-point increase in the Gini coefficient. We conclude that lagged Gini showed no association with oral health; and current income Gini was associated with current dental caries but not with periodontal disease.

Time-for-Money Exchanges Between Older and Younger Generations in Swedish Families

Despite the maturation of welfare states, family solidarity continues to be strong and a growing body of research has shown that substantial financial transfers are passed from older to younger generations within the family. At the same time, family solidarity in terms of instrumental and social support is found to be mutual. This study examines eventual reciprocity in time-for-money exchanges, by combining two large-scale Swedish representative longitudinal studies. It analyzes how earlier social contacts (time) are related to financial transfers (money) and to what extent social class and gender differentials are visible. The findings indicate that parents provide economic transfers if they have more frequent social contact with any of their children, and that these time investments pay off for children who were of higher social class origins. In contrast, no support for gender-specific patterns is found. In conclusion, family solidarity seems to have different bases in different social strata.