The political context of social inequalities and health.
This analysis reflects on the importance of political parties, and the policies they implement when in government, in determining the level of equalities/inequalities in a society, the extent of the welfare state (including the level of health care coverage by the state), the employment/unemployment rate, and the level of population health. The study looks at the impact of the major political traditions in the advanced OECD countries during the golden years of capitalism (1945-1980) -- social democratic, Christian democratic, liberal, and ex-fascist -- in four areas: (1) the main determinants of income inequalities, such as the overall distribution of income derived from capital versus labor, wage dispersion in the labor force, the redistributive effect of the welfare state, and the levels and types of employment/ unemployment; (2) levels of public expenditures and health care benefits coverage; (3) public support of services to families, such as child care and domiciliary care; and (4) the level of population health as measured by infant mortality rates. The results indicate that political traditions more committed to redistributive policies (both economic and social) and full-employment policies, such as the social democratic parties, were generally more successful in improving the health of populations, such as reducing infant mortality. The erroneous assumption of a conflict between social equity and economic efficiency, as in the liberal tradition, is also discussed. The study aims at filling a void in the growing health and social inequalities literature, which rarely touches on the importance of political forces in influencing inequalities. The data used in the study are largely from OECD health data for 1997 and 1998; the OECD statistical services; the comparative welfare state data set assembled by Huber, Ragin and Stephens; and the US Bureau of Labor Statistics.
Navarro
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Department of Health Policy and Management, School of Hygiene & Public Health, Johns Hopkins University, Baltimore, MD 21205, USA. vnavarro@jhsph.edu
Shi
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D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002835:Christianity; D019049:Developed Countries / Q000706:statistics & numerical data; D003906:Developing Countries / Q000706:statistics & numerical data; D005191:Family Characteristics; D006297:Health Services Accessibility / Q000191:economics / Q000592:standards*; D006304:Health Status; D006801:Humans; D007182:Income; D007226:Infant Mortality; D007231:Infant, Newborn; D009313:National Health Programs; D011056:Political Systems; D011057:Politics; D011203:Poverty; D012923:Social Class; D012959:Socioeconomic Factors; D013222:State Medicine