Abstract
In this article, we examine the extent and pattern of country level differences in later life health in Europe and compare five competing explanations for this variation. We used data from 14 European countries, drawn from Northern (Denmark and Sweden), Western (Austria, France, Ireland, Germany Belgium, the Netherlands and Switzerland), Mediterranean (Spain, Italy and Greece) and Eastern (Poland and Czechia) regions of Europe, N = 33,528. Our results suggest that about a quarter (24%) of the overall variation in later life health in Europe appears to be due to country level differences. The Scandinavian countries along with Germany, the Netherlands and Switzerland appear to have the best health, whereas Spain, Italy and Poland had the lowest health score. Country level influences on health were largely associated with differences in the level of egalitarianism of each country as measured by the Gini coefficient, with more inequality being associated with poorer health. Differences in health-related lifestyle, as approximated by the prevalence of obesity in each country, also had a substantial macrolevel influence on later life health, with a lower national prevalence of obesity being associated with better health. Our results indicate the presence of systematic macrolevel health variation in Europe and suggest that policies to reduce income inequality as well as population interventions to promote healthier lifestyles and decrease the prevalence of obesity have the potential to improve population health and potentially offset some of the challenges posed by population ageing in Europe.
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Avendano M, Glymour MM, Banks J, Mackenbach JP (2009) Health disadvantage in US adults aged 50 to 74 years: a comparison of the health of rich and poor Americans with that of Europeans. Am J Public Health 99(3):540–548. doi:10.2105/ajph.2008.139469
Beckfield J (2004) Does income inequality harm health? New cross-national evidence. J Health Soc Behav 45(3):231–248. doi:10.1177/002214650404500301
Beckfield J, Krieger N (2009) Epi + demos + cracy: linking political systems and priorities to the magnitude of health inequities—evidence, gaps, and a research agenda. Epidemiol Rev 31(1):152–177. doi:10.1093/epirev/mxp002
Beugelsdijk S, Van Schaik T (2005) Differences in social capital between 54 Western European regions. Reg Stud 39(8):1053–1064. doi:10.1080/00343400500328040
Bloom DE, Canning D (2007) Commentary: the Preston curve 30 years on: still sparking fires. Int J Epidemiol 36(3):498–499. doi:10.1093/ije/dym079
Börsch-Supan A, Jürges H (eds) (2005) The survey of health, aging and retirement in Europe: methodology. Research Institute for the Economics of Ageing, Manheim
Carlson P (1998) Self-perceived health in East and West Europe: another European health divide. Soc Sci Med 46(10):1355–1366
Cavelaars A, Kunst AE, Geurts JJM, Crialesi R, Grotvedt L, Helmert U, Lahelma E, Lundberg O, Matheson J, Mielck A, Mizrahi A, Rasmussen NK, Regidor E, Spuhler T, Mackenbach JP (1998) Differences in self reported morbidity by educational level: a comparison of 11 Western European countries. J Epidemiol Community Health 52(4):219–227
Chung H, Muntaner C (2007) Welfare state matters: a typological multilevel analysis of wealthy countries. Health Pol 80(2):328–339
Coburn D (2004) Beyond the income inequality hypothesis: class, neo-liberalism, and health inequalities. Soc Sci Med 58(1):41–56
Cockerham WC (1997) The social determinants of the decline of life expectancy in Russia and Eastern Europe: a lifestyle explanation. J Health Soc Behav 38(2):117–130
de Groot L, Verheijden MW, de Henauw S, Schroll M, van Staveren WA, Investigators S (2004) Lifestyle, Nutritional status, health, and mortality in Elderly people across Europe: a review of the longitudinal results of the SENECA study. J Gerontol Ser A-Biol Sci Med Sci 59(12):1277–1284
Desesquelles AF, Egidi V, Salvatore MA (2009) Why do Italian people rate their health worse than French people do? An exploration of cross-country differentials of self-rated health. Soc Sci Med 68(6):1124–1128
Dowd JB, Zajacova A (2007) Does the predictive power of self-rated health for subsequent mortality risk vary by socioeconomic status in the US? Int J Epidemiol 36:1214–1221. doi:10.1093/ije/dym214
Doyle Y, McKee M, Rechel B, Grundy E (2009) Meeting the challenge of population ageing. BMJ 339. doi:10.1136/bmj.b3926
Drasgow F (1984) Scrutinizing psychological tests: measurement equivalence and equivalent relations with external variables are the central issues. Psychol Bull 95(1):134–135
Eikemo TA, Bambra C, Judge K, Ringdal K (2008) Welfare state regimes and differences in self-perceived health in Europe: a multilevel analysis. Soc Sci Med 66(11):2281–2295
Espelt A, Borrell C, Rodriguez-Sanz M, Muntaner C, Pasarin MI, Benach J, Schaap M, Kunst AE, Navarro V (2008) Inequalities in health by social class dimensions in European countries of different political traditions. Int J Epidemiol 37(5):1095–1105. doi:10.1093/ije/dyn051
Grundy E (2006) Ageing and vulnerable elderly people: European perspectives. Ageing Soc 26:105–134
Hebert JR, Peterson KE, Hurley TG, Stoddard AM, Cohen N, Field AE, Sorensen G (2001) The effect of social desirability trait on self-reported dietary measures among multi-ethnic female health center employees. Ann Epidemiol 11(6):417–427
Jen MH, Jones K, Johnston R (2009a) Global variations in health: evaluating Wilkinson’s income inequality hypothesis using the world values survey. Soc Sci Med 68(4):643–653. doi:10.1016/j.socscimed.2008.11.026
Jen MH, Jones K, Johnston R (2009b) Compositional and contextual approaches to the study of health behaviour and outcomes: using multi-level modelling to evaluate Wilkinson’s income inequality hypothesis. Health Place 15(1):198–203. doi:10.1016/j.healthplace.2008.04.005
Joreskog KG (1971) Simultaneous factor analysis in several populations. Psychometrika 36(4):409–426
Joreskog KG, Moustaki I (2001) Factor analysis of ordinal variables: a comparison of three approaches. Multivar Behav Res 36(3):347–387
Kaariainen J, Lehtonen H (2006) The variety of social capital in welfare state regimes: a comparative study of 21 countries. Eur Soc 8(1):27–57. doi:10.1080/14616690500491399
Karlsson M, Nilsson T, Lyttkens CH, Leeson G (2010) Income inequality and health: Importance of a cross-country perspective. Soc Sci Med 70(6):875–885
Knesebeck OV, Verde PE, Dragano N (2006) Education and health in 22 European countries. Soc Sci Med 63(5):1344–1351. doi:10.1016/j.socscimed.2006.03.043
Little RJA, Rubin DB (2002) Statistical analysis with missing data, 2nd edn. Willey, Chichester
Lynch J, Smith GD, Hillemeier M, Shaw M, Raghunathan T, Kaplan G (2001) Income inequality, the psychosocial environment, and health: comparisons of wealthy nations. Lancet 358(9277):194–200
Lynch J, Smith GD, Harper S, Hillemeier M, Ross N, Kaplan GA, Wolfson M (2004) Is income inequality a determinant of population health? Part 1. A systematic review. Milbank Q 82(1):5–99
Mackenbach JP, Stirbu I, Roskam AJR, Schaap MM, Menvielle G, Leinsalu M, Kunst AE, European Union Working Group on Socioeconomic Inequalities in Health (2008) Socioeconomic inequalities in health in 22 European countries. N Engl J Med 358(23):2468–2481
McKee M (1998) An agenda for public health research in Europe. Eur J Public Health 8(1):3–7
Meredith W (1993) Measurement invariance, factor analysis and factorial invariance. Psychometrika 58(4):525–543
Minicuci N, Noale M, Bardage C, Blumstein T, Deeg DJH, Gindin J, Jylha M, Nikula S, Otero A, Pedersen NL, Pluijm SMF, Pluijm MF, Zunzunegui MV, Maggi S, Grp CW (2003) Cross-national determinants of quality of life from six longitudinal studies on aging: The CLESA Project. Aging Clin Exp Res 15(3):187–202
Minicuci N, Noale M, Pluijm SMF, Zunzunegui MV, Blumstein T, Deeg DJH, Bardage C, Jylhä M, The CLESA working group (2004) Disability-free life expectancy: a cross-national comparison of six longitudinal studies on aging. The CLESA project. Eur J Ageing 1(1):37–44. doi:10.1007/s10433-004-0002-5
Morris JN, Donkin AJM, Wonderling D, Wilkinson P, Dowler EA (2000) A minimum income for healthy living. J Epidemiol Community Health 54(12):885–889
Morris JN, Wilkinson P, Dangour AD, Deeming C, Fletcher A (2007) Defining a minimum income for healthy living (MIMHL): older age, England. Int J Epidemiol 36(6):1300–1307. doi:10.1093/ije/dym129
Muthen LK, Muthen BO (1998–2010) Mplus User’s Guide. 6th edn. Muthen & Muthen, Los Angeles
Navarro V, Shi L (2001) The political context of social inequalities and health. Soc Sci Med 52(3):481–491
Olsen KM, Dahl S-Å (2007) Health differences between European countries. Soc Sci Med 64(8):1665–1678
Omran AR (1971) Epidemiologic transition: theory of epidemiology of population change. Milbank Mem Fund Quart 49(4):509–538
Ploubidis GB, Grundy E (2009) Later-life mental health in Europe: a country-level comparison. J Gerontol Ser B-Psychol Sci Soc Sci 64(5):666–676. doi:10.1093/geronb/gbp026
Ploubidis G, Grundy E (2011) Health measurement in population surveys: combining information from self-reported and observer-measured health indicators. Demography 48(2):699–724. doi:10.1007/s13524-011-0028-1
Rabe-Hesketh S, Skrondal A (2008) Classical latent variable models for medical research. Stat Methods Med Res 17(1):5–32. doi:10.1177/0962280207081236
Rodgers GB (1979) Income and inequality as determinants of mortality: international cross-section analysis. Popul Stud-J Demogr 33(2):343–351
Schrijvers CTM, Stronks K, van de Mheen HD, Mackenbach JP (1999) Explaining educational differences in mortality: the role of behavioral and material factors. Am J Public Health 89(4):535–540
Schwartz S, Meyer IH (2010) Mental health disparities research: the impact of within and between group analyses on tests of social stress hypotheses. Soc Sci Med 70(8):1111–1118. doi:10.1016/j.socscimed.2009.11.032
Seeman TE, Singer BH, Rowe JW, Horwitz RI, McEwen BS (1997) Price of adaptation: allostatic load and its health consequences: MacArthur studies of successful aging. Arch Intern Med 157(19):2259–2268
Skrondal A, Rabe-Hesketh S (2008) Latent variable modelling. Stat Methods Med Res 17(1):3–4. doi:10.1177/0962280207081235
Stuckler D, Basu S, McKee M (2010) Budget crises, health, and social welfare programmes. BMJ 340:c3311. doi:10.1136/bmj.c3311
van den Brink CL, Tijhuis M, Kalmijn S, Klazinga NS, Nissinen A, Giampaoli S, Kivinen P, Kromhout D, van den Bos GAM (2003) Self-reported disability and its association with performance-based limitation in elderly men: a comparison of three European countries. J Am Geriatr Soc 51(6):782–788. doi:10.1046/j.1365-2389.2003.51258.x
Verropoulou G (2009) Key elements composing self-rated health in older adults: a comparative study of 11 European countries. Eur J Ageing 6(3):213–226. doi:10.1007/s10433-009-0125-9
Vogler GP, Sorensen TIA, Stunkard AJ, Srinivasan MR, Rao DC (1995) Influences of genes and shaved family environment on adult body mass index assessed in an adoption study by a comprehensive path model. Int J Obes 19(1):40–45
Wilkinson RG (1997) Socioeconomic determinants of health: health inequalities: relative or absolute material standards? BMJ 314(7080):591–595
Wilkinson RG, Pickett KE (2006) Income inequality and population health: a review and explanation of the evidence. Soc Sci Med 62(7):1768–1784. doi:10.1016/j.socscimed.2005.08-036
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George B. Ploubidis is supported by a Medical Research Council (MRC) Population Health Science fellowship, G0802442.
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Responsible Editor: H. Litwin (Guest Editor), D. J. H. Deeg.
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Ploubidis, G.B., Dale, C. & Grundy, E. Later life health in Europe: how important are country level influences?. Eur J Ageing 9, 5–13 (2012). https://doi.org/10.1007/s10433-011-0215-3
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DOI: https://doi.org/10.1007/s10433-011-0215-3