Ageing, health inequalities and welfare state regimes – a multilevel analysis

Abstract: The paper studies class inequalities in health over the ageing process in a comparative perspective. It investigates if health inequalities among the elderly vary between European welfare state regimes, and if this variation is age-dependent. Previous comparative research on health inequalities have largely failed to take age and ageing into account, and have not investigated whether cross-country variation in health inequalities might differ for different age categories. Since the elderly belong to the demographic category most dependent on welfare policies, an ageing perspective is warranted. The study combines fives data rounds (2002 to 2010) from the European Social Survey. Multilevel techniques are used, and the analysis is stratified by age, comparing the 50-64 year olds with those aged 65-80 years. Health is measured by self-assessed general health and disability status. Two results stand out. First, class differences in health are strongly reduced or vanish completely for the 65-80 year olds in the Social democratic welfare states, while they remain stable or are in some cases even intensified in almost all other welfare states. Second, the cross-country variation in health inequalities is much larger for the oldest (aged 65-80 years) than is the case for the 50-64 year olds. It is concluded that welfare policies seem to influence the magnitude of health inequalities, and that the importance of welfare state context is greater for the elderly, who are more fragile and more reliant on welfare policies such as public pensions and elderly care.