Educational inequalities in health in European welfare states: A social expenditure approach

A puzzle in comparative health inequality research is the finding that egalitarian welfare states do not necessarily demonstrate narrow health inequalities. This paper interrogates into this puzzle by moving beyond welfare regimes to examine how welfare spending affect inequalities in self-rated across Europe. We operationalise welfare spending in four different ways and compare both absolute and relative health inequalities, as well as the level of poor self-rated health in the low education group across varying levels of social spending.The paper employs data from the EU Statistics of Income and Living Conditions (EU-SILC) and includes a sample of approximately 245,000 individuals aged 25–80+ years from 18 European countries. The data were examined by means of gender stratified multilevel logistic regression analyses. The results show that social expenditures are associated with lower health inequalities among women and, to a lesser degree, among men. Especially those with primary education benefit from high social transfers as compared with those who have tertiary education. This means that lower educational inequalities in health – in absolute and relative terms- are linked to higher social spending. The four different operationalisations of social spending produce similar patterns.

► Absolute and relative educational inequalities in poor health were smaller in European countries with high social spending.
► This was true whether we used net or total social spending or adjusted the measures for ‘need’.
► The association between social spending and health was more marked among women than among men.