Welfare regimes and health and gender inequalities in adolescence Alessio Zambon Università degli Studi di Torino, Dept. of Public Health

The original paper Alessio Zambon, Will Boyce, Ester Cois, Patrizia Lemma, Paola Dalmasso, Alberto Borraccino, Franco Cavallo, Candace Currie. Do welfare regimes mediate the effect of socio-economic position on health in adolescence? A cross-national comparison in Europe, North America, and Israel, in “The International Journal of Health Services”, 2006, vol. 36, Alessio Zambon, Will Boyce, Ester Cois, Patrizia Lemma, Paola Dalmasso, Alberto Borraccino, Franco Cavallo, Candace Currie. Do welfare regimes mediate the effect of socio-economic position on health in adolescence? A cross-national comparison in Europe, North America, and Israel, in “The International Journal of Health Services”, 2006, vol. 36,

Objective To check whether different types of welfare states mediate the effect of socio- economic position on adolescents’ health That is: can welfare policies reduce health inequalities in adolescence? New – many difference between welfare policies are based on the role of the family and therefor on gender roles: are gender differences also mediated by welfare policies, even in younger age?

Considered policy dimensions Welfare policies can be more or less strongly redistributive (Esping-Andersen Classification and following development) More redistributive groups: Socio-democratic systems (individual entitlement and universality) Continental systems (group-based entitlement) Less redistributive groups: Liberal systems (welfare as residual on market) Mediterranean systems (family based care) Countries in transition (unclear situation, growing inequalities)

Hypothesis 1.In more redistributive welfare systems the association between FAS and Health is weaker 2.The association between gender and health is weaker in welfare regimes which are individual based, rather than family based

Method: the HBSC survey Statistically representative sample of 11, 13 and 15 y.o. boys and girls within 35 countries, mostly European plus USA, Canada and Israel (since 1982 every 4th year) respondents overall. Statistically representative sample of 11, 13 and 15 y.o. boys and girls within 35 countries, mostly European plus USA, Canada and Israel (since 1982 every 4th year) respondents overall. Validated questionnaire (administered in schools) for cross-national comparisons Validated questionnaire (administered in schools) for cross-national comparisons Covered areas: perceived health, health behaviours, life contexts. Covered areas: perceived health, health behaviours, life contexts.

Method: SES measures and analysis FAS (Family Affluence Scale): scale based on the family consumes, cross-nationally validated, very low missing rate. Items: n. of cars, computers, holidays and own bedroom. Here used in 3 cat. version. FAS (Family Affluence Scale): scale based on the family consumes, cross-nationally validated, very low missing rate. Items: n. of cars, computers, holidays and own bedroom. Here used in 3 cat. version. Ordinal by ordinal association tested through Gamma index within countries. Ordinal by ordinal association tested through Gamma index within countries. Odds Ratio for the association between gender and perceived health Odds Ratio for the association between gender and perceived health Countries’ Gammas and OR compared through non parametric test (Mann-Whitney) Countries’ Gammas and OR compared through non parametric test (Mann-Whitney)

Results I

Results II: FAS and Health

Results III: Gender and Health All ORs are significant besides Ireland and Lithuania The ranking test is not significant, if welfare regimes are aggregate, there is a significant difference between Social-democratic, Conservative and Liberal on one side, and Mediterranean and transition countries on the other (p=0.035)

Conclusions Hypothesis 1 is confirmed: the association between FAS and health is weaker in more redistributive welfare systems Hypothesis 1 is confirmed: the association between FAS and health is weaker in more redistributive welfare systems Hypothesis 2 is partly confirmed, but more research is needed, especially in international comparisons of cultural patterns Hypothesis 2 is partly confirmed, but more research is needed, especially in international comparisons of cultural patterns HBSC data can be used in the evaluation of welfare policies in their impact on health inequalities. HBSC data can be used in the evaluation of welfare policies in their impact on health inequalities.

Are the differences small? An example for perceived health: Denmark: country with a social-democratic system and association index (gamma) = Portugal: country with a Mediterranean system and association index = 0.280

But… which consequences

Some subtractions In Denmark, low FAS adolescents: 17.74% (have a less than good health) – (all low FAS) = 4.32% In Portugal, low FAS adolescents: 44.07% (have a less than good health) – (all low FAS) = 15.11% =10.79% of low FAS Portuguese adolescents perceiving poorer health would not be in that situation if, keeping constant other dimensions, Portuguese welfare system would change into a Social-democratic one