Skip to main content

Advertisement

Log in

Objective and Subjective Health: An Analysis of Inequality for the European Union

  • Published:
Social Indicators Research Aims and scope Submit manuscript

Abstract

In advanced societies, the right to health has a leading position within the instruments enshrined in the human rights. All countries, including those at the top of economic prosperity and human development, record systematic, often substantial, inequalities in mortality and morbidity between people with higher socio-economic position and poorer citizens. This also applies to the welfare states of western Europe. This work proposes two indicators of “objective” and “subjective” health for EU countries and verifies their relationship with income distribution. In the emerging picture, the “objective” and “subjective” dimensions seem to have their own explanations, affected variously by income differences. The results provide useful hints for social and health policy in European countries.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2

Similar content being viewed by others

Notes

  1. Although the inclusion of Croatia would have been of great interest, we decided not to consider for two reasons: first, this research began immediately after its official entry, then many considerations and assessments were made without taking this into account; secondly, most of the databases used, due to the recent entry, did not include Croatia in numerous surveys.

  2. In this way, we obtained a complete and exhaustive dataset, with no missing data.

  3. They analysed 21 studies, 15 about the U.S.

  4. The same authors, reporting the conclusions of other studies, confirm however that there is a positive relation between universal welfare policy and overall level of health.

References

  • Abdi, H. (2003). Factor rotations in factor analyses. In M. Lewis-Beck, A. Bryman, & T. Futing (Eds.), Encyclopedia for research methods for the social sciences (pp. 792–795). Thousand Oaks, CA: Sage.

    Google Scholar 

  • Arber, S., Fenn, K., & Meadows, R. (2014). Subjective financial well-being, income and health inequalities in mid and later life in Britain. Social Science and Medicine, 100, 12–20.

    Article  Google Scholar 

  • Babones, S. J. (2008). Income inequality and population health: Correlation and causality. Social Science and Medicine, 66(7), 1614–1626.

    Article  Google Scholar 

  • Bailey, N., Spratt, J., Pickering, J., Goodlad, R., & Shucksmith, M. (2004). Deprivation and social exclusion in Argyll and Bute. Report to the Community Planning Partnership. Scottish Centre for Research on Social Justice. University of Glasgow e Aberdeen. Scotland.

  • Bartley, M. (2004). Health inequality: An introduction to theories, concepts and methods. Cambridge, MA: Polity Press.

    Google Scholar 

  • Beckett, M. (2000). Converging health inequalities in later life—An artifact of mortality selection. Journal of Health and Social Behavior, 41, 106–119.

    Article  Google Scholar 

  • Brook, R. H., Ware, J. E., Jr., Davies-Avery, A., Stewart, A. L., Donald, C. A., Rogers, W. H., et al. (1979). Overview of adult health status measures fielded in Rand’s Health Insurance Study. Medical Care, 17(Suppl), 1–131.

    Google Scholar 

  • Brook, R. H., Ware, J. E., Rogers, W. H., Keeler, E. B., Davies, A. R., Donald, C. A., et al. (1983). Does free care improve adults’ health? Results from a randomized controlled trial. New England Journal of Medicine, 309(23), 1426–1434.

    Article  Google Scholar 

  • Burns, J. K., Tomita, A., & Kapadia, A. S. (2014). Income inequality and schizophrenia: Increased schizophrenia incidence in countries with high levels of income inequality. International Journal of Social Psychiatry, 60(2), 185–196.

    Article  Google Scholar 

  • Carrieri, V., & Wübker, A. (2013). Assessing inequalities in preventive care use in Europe. Health Policy, 113(3), 247–257.

    Article  Google Scholar 

  • Carstairs, V. (2000). Socio-economic factors at area level and their relationship with health. In P. Elliott, J. Wakefield, N. Best, & D. Briggs (Eds.), Spatial epidemiology methods and applications (pp. 51–68). Oxford: Oxford University Press.

    Google Scholar 

  • Carstairs, V., & Morris, R. (1989). Deprivation, mortality and resource allocation. Community Medicine, 11, 210–219.

    Google Scholar 

  • Carstairs, V., & Morris, R. (1991). Which deprivation? A comparison of selected deprivation indexes. Journal of Public Health Medicine, 13(4), 318–326.

    Google Scholar 

  • Cavelaars, A. (1998). Cross-national comparisons of socio-economic differences in health indicators. Thesis, Erasmus University, Rotterdam.

  • CNEL-ISTAT. (2016). Benessere Equo e Sostenibile. Roma, Italia.

  • Deaton, A., & Lubotsky, D. (2003). Mortality, inequality and race in American cities and states. Social Science and Medicine, 56(6), 1139–1153.

    Article  Google Scholar 

  • Deaton, A., & Paxson, C. (2001). Mortality, education, income and inequality among American cohorts. In D. Wise (Ed.), Themes in the economics of aging. Chicago, IL: University of Chicago Press.

    Google Scholar 

  • Devaux, M. (2015). Income-related inequalities and inequities in health care services utilisation in 18 selected OECD countries. The European Journal of Health Economics, 16(1), 21–33.

    Article  Google Scholar 

  • Drain, P. K., Smith, J. S., Hughes, J. P., Halperin, D. T., & Holmes, K. K. (2004). Correlates of national HIV seroprevalence: An ecologic analysis of 122 developing countries. JAIDS Journal of Acquired Immune Deficiency Syndromes, 35(4), 407–420.

    Article  Google Scholar 

  • Elo, I. T. (2009). Social class differentials in health and mortality: Patterns and explanations in comparative perspective. Annual Review of Sociology, 35, 553–572.

    Article  Google Scholar 

  • Esping-Andersen, G. (2013). The three worlds of welfare capitalism. London: Wiley.

    Google Scholar 

  • Esty, D. C., Levy, M., Srebotnjak, T., & De Sherbinin, A. (2005). 2005 Environmental sustainability index: Benchmarking national environment stewardship. Davos: Yale Center for Environmental Law and Policy and Center for International Earth Science Information Network.

    Google Scholar 

  • European Commission. (2013). Investing in Health. Commission staff working document, social investment package.

  • Fawcett, J., Blakely, T., & Kunst, A. (2005). Are mortality differences and trends by education any better or worse in New Zealand? A comparison study with Norway, Denmark and Finland, 1980–1990s. European Journal of Epidemiology, 20(8), 683–691.

    Article  Google Scholar 

  • Frank, R. H. (2004). Positional externalities cause large and preventable welfare losses. American Economic Review, 95(2), 137–141.

    Article  Google Scholar 

  • Frijters, P., Haisken-DeNew, J. P., & Shields, M. A. (2005). The causal effect of income on health: Evidence from German reunification. Journal of Health Economics, 24(5), 997–1017.

    Article  Google Scholar 

  • Fuchs, V. (2004). Reflections on the socio-economic correlates of health. Journal of Health Economics, 23, 653–661.

    Article  Google Scholar 

  • Grossman, G. M., & Helpman, E. (1991). Innovation and growth in the global economy. Cambridge, MA: MIT Press.

    Google Scholar 

  • Hales, S., Howden-Chapman, P., Salmond, C., Woodward, A., & Mackenbach, J. (1999). National infant mortality rates in relation to gross national product and distribution of income. The Lancet, 354(9195), 2047.

    Article  Google Scholar 

  • Härdle, W., & Simar, L. (2007). Applied multivariate statistical analysis. Berlin: Springer.

    Google Scholar 

  • Hart, C. L., Smith, G. D., & Blane, D. (1998). Inequalities in mortality by social class measured at 3 stages of the lifecourse. American Journal of Public Health, 88(3), 471–474.

    Article  Google Scholar 

  • Hogan, J., & Tchernis, R. (2004). Bayesian factor analysis for spatially correlated data with application to summarizing area-level material deprivation from census data. Journal of the American Statistical Association, 99, 314–324.

    Article  Google Scholar 

  • Holt-Lunstad, J., Smith, T. B., & Layton, J. B. (2010). Social relationships and mortality risk: A meta-analytic review. PLoS Med, 7(7), e1000316.

    Article  Google Scholar 

  • Ivaldi, E., Bonatti, G., & Soliani, R. (2016a). The construction of a synthetic index comparing multidimensional well-being in the European Union. Social Indicators Research, 125(2), 397–430. doi:10.1007/s11205-014-0855-8.

    Article  Google Scholar 

  • Ivaldi, E., Bonatti, G., & Soliani, R. (2016b). An indicator for the measurement of political participation: The case of Italy. Social Indicators Research. doi:10.1007/s11205-016-1303-8.

    Google Scholar 

  • Ivaldi, E., & Testi, A. (2010). Genoa index of deprivation (GDI): An index of material deprivation for geographical areas. Social indicators: statistics, trends and policy development. Hauppauge, NY: Nova Science Publishers.

    Google Scholar 

  • Ivaldi, E., & Testi, A. (2011). Socio-economic conditions and health in Europe: A comparison among the 27 EU countries. In J. D. Rosen & A. P. Eliot (Eds.), Social inequalities (pp. 127–150). Hauppauge, NY: Nova Science Publishers.

    Google Scholar 

  • Jarman, B. (1984). Underprivileged areas: Validation and distribution of scores. British Medical Journal, 289, 1587–1592.

    Article  Google Scholar 

  • Johnston, D. W., Propper, C., & Shields, M. A. (2009). Comparing subjective and objective measures of health: Evidence from hypertension for the income/health gradient. Journal of Health Economics, 28(3), 540–552.

    Article  Google Scholar 

  • Kaiser, H. F. (1958). The varimax criterion for analytic rotation in factor analysis. Psychometrika, 23(3), 187–200.

    Article  Google Scholar 

  • Kalwij, A., & Vermeulen, F. (2008). Health and labour force participation of older people in Europe: What do objective health indicators add to the analysis? Health Economics, 17(5), 619–638.

    Article  Google Scholar 

  • Kaplan, G., & Baron-Epel, O. (2003). What lies behind the subjective evaluation of health status? Social Science and Medicine, 56(8), 1669–1676.

    Article  Google Scholar 

  • Kautto, M. (2001). Nordic welfare states in the European context. Hove: Psychology Press.

    Google Scholar 

  • Kennedy, B. P., Kawachi, I., & Prothrow-Stith, D. (1996). Income distribution and mortality: Cross-sectional ecological study of the Robin–Hood index in the United States. British Medical Journal, 312(7037), 1004–1007.

    Article  Google Scholar 

  • Link, B. G., & Phelan, J. C. (2005). Fundamental sources of health inequalities. In D. Mechanic et al. (Eds.), Policy challenges in modern health care (pp. 71–84). New Brunswick, NJ: Rutgers University Press.

    Google Scholar 

  • Lundberg, O. (2009). How do welfare policies contribute to the reduction of health inequalities? Eurohealth, 15(3), 24.

    Google Scholar 

  • Lynch, J. W., Kaplan, G. A., Pamuk, E. R., Cohen, R. D., Heck, K. E., Balfour, J. L., et al. (1998). Income inequality and mortality in metropolitan areas of the United States. Journal of Public Health, 88(7), 1074–1080.

    Google Scholar 

  • Macintyre, S., Ellaway, A., & Cummins, S. (2002). Place effects on health: How we can conceptualise, operationalise and measure them? Social Science and Medicine, 55, 125–139.

    Article  Google Scholar 

  • Mackenbach, J. P. (2012). The persistence of health inequalities in modern welfare states: The explanation of a paradox. Social Science and Medicine, 75(4), 761–769.

    Article  Google Scholar 

  • Mackenbach, J. P., Kulhánová, I., Menvielle, G., Bopp, M., Borrell, C., Costa, G., et al. (2015). Trends in inequalities in premature mortality: A study of 3.2 million deaths in 13 European countries. Journal of Epidemiology and Community Health, 69(3), 207–217.

    Article  Google Scholar 

  • Mackenbach, J. P., Stirbu, I., Roskam, A. J. R., Schaap, M. M., Menvielle, G., Leinsalu, M., et al. (2008). Socioeconomic inequalities in health in 22 European countries. New England Journal of Medicine, 358(23), 2468–2481.

    Article  Google Scholar 

  • Marmot, M. (2002). The influence of income on health: Views of an epidemiologist. Health Affairs, 21(2), 31–46.

    Article  Google Scholar 

  • Marmot, M. (2004). The status syndrome: How social standing affects our health and longevity. London: Bloomsbury.

    Google Scholar 

  • McKay, S., & Collard, S. (2003). Developing deprivation questions for the Family Resources Survey. United Kingdom Department for Work and Pensions. Working paper number 13.

  • Messias, E., Eaton, W. W., & Grooms, A. N. (2011). Economic grand rounds: Income inequality and depression prevalence across the United States: An ecological study. Psychiatric Services, 62(7), 710–712.

    Article  Google Scholar 

  • Mishra, S. K. (2012). A note on the indeterminacy and arbitrariness of Pena’s method of construction of synthetic indicator. SSRN: http://ssrn.com/abstract=2026293.

  • Montero, J. M., Chasco, C., & Larraz, B. (2010). Building an environmental quality index for a big city: A spatial interpolation approach combined with a distance indicator. Journal of Geographical Systems, 12(4), 435–459.

    Article  Google Scholar 

  • Muennig, P. (2008). The body politic: The relationship between stigma and obesity-associated disease. BMC Public Health, 8(1), 1.

    Article  Google Scholar 

  • Nardo, M., Saisana, M., Saltelli, A., Tarantola, S., Hoffman, A., & Giovannini, E. (2005). Handbook on constructing composite indicators: Methodology and user guide. No. 2005/3. OECD Publishing.

  • Nayak, P., Mishra, S. K. (2012). Efficiency of Pena’s P2 distance in construction of human development Indices. MPRA—Munich Personal RePEc Archive. Paper 39022.

  • Nayak, P., & Mishra, S. K. (2014). A state level analysis of the status of social sector in India (No. 58144). University Library of Munich, Germany.

  • Noble, M., Smith, G., Wright, G., Dibben, C., Loyd, M., Ratcliffe, A., et al. (2003). Scottish indices of deprivation 2003. Edinburgh: Scottish Executive.

    Google Scholar 

  • Nolan, A. (2014). Economic and social rights after the global financial crisis. Cambridge, UK: Cambridge University Press.

    Book  Google Scholar 

  • Peña, J. B. (1977). Problemas de la medición del bienestar y conceptos afines (Una aplicación al caso español). (Madrid: Instituto Nacional de Estadística (INE)).

  • Pickett, K. E., & Wilkinson, R. G. (2010). Inequality: An underacknowledged source of mental illness and distress. The British Journal of Psychiatry, 197(6), 426–428.

    Article  Google Scholar 

  • Pickett, K. E., & Wilkinson, R. G. (2015). Income inequality and health: A causal review. Social Science and Medicine, 128, 316–326.

    Article  Google Scholar 

  • Pituch, K. A., & Sevens, J. P. (2016). Applied multivariate statistics for the social sciences. New York, NY: Routledge.

    Google Scholar 

  • Porter, M., Stern, S., & Artavia Loria, R. (2013). Social Progress Index 2013. Social Progress Imperative Publication.

  • Präg, P., Mills, M., & Wittek, R. (2014). Income and income inequality as social determinants of health: Do social comparisons play a role? European Sociological Review, 30(2), 218–229.

    Article  Google Scholar 

  • Sanmartin, C., Ross, N. A., Tremblay, S., Wolfson, M., Dunn, J. R., & Lynch, J. (2003). Labour market income inequality and mortality in North American metropolitan areas. Journal of Epidemiology and Community Health, 57(10), 792–797.

    Article  Google Scholar 

  • Scambler, G. (2012). Health inequalities. Sociology of Health & Illness, 34(1), 130–146.

    Article  Google Scholar 

  • Soliani, R., Di Gennaro, A., & Ivaldi, E. (2012). An index of the quality of life for European Country: Evidence of deprivation from EU-Silc data. Review of Economics and Finance, 2(2), 1–14.

    Google Scholar 

  • Somarriba, N., & Peña, B. (2009). Synthetic indicators of quality of life in Europe. Social Indicators Research, 94(1), 115–133.

    Article  Google Scholar 

  • Starfield, B., & Birn, A. E. (2007). Income redistribution is not enough: Income inequality, social welfare programs, and achieving equity in health. Journal of Epidemiology and Community Health, 61(12), 1038–1041.

    Article  Google Scholar 

  • Strand, B. H., Steingrímsdóttir, Ó. A., Grøholt, E. K., Ariansen, I., Graff-Iversen, S., & Næss, Ø. (2014). Trends in educational inequalities in cause specific mortality in Norway from 1960 to 2010: A turning point for educational inequalities in cause specific mortality of Norwegian men after the millennium? BMC Public Health, 14(1), 1208.

    Article  Google Scholar 

  • Subramanian, S. V., & Kawachi, I. (2004). Income inequality and health: What have we learned so far? Epidemiologic Reviews, 26(1), 78–91.

    Article  Google Scholar 

  • Tarkiainen, L., Martikainen, P., Laaksonen, M., & Valkonen, T. (2012). Trends in life expectancy by income from 1988 to 2007: Decomposition by age and cause of death. Journal of Epidemiology and Community Health, 66(7), 573–578.

    Article  Google Scholar 

  • Thoits, P. A. (2011). Mechanisms linking social ties and support to physical and mental health. Journal of Health and Social Behavior, 52(2), 145–161.

    Article  Google Scholar 

  • Van Doorslaer, E., & Gerdtham, U. G. (2003). Does inequality in self-assessed health predict inequality in survival by income? Evidence from Swedish data. Social Science and Medicine, 57(9), 1621–1629.

    Article  Google Scholar 

  • Van Doorslaer, E., Koolman, X., & Jones, A. M. (2004). Explaining income-related inequalities in doctor utilisation in Europe. Health Economics, 13(7), 629–647.

    Article  Google Scholar 

  • Ware, J. E., Jr., Davies-Avery, A., & Donald, C. A. (1978). Conceptualization and measurement of health for adults in the health insurance study (Vol. 5). Santa Monica, CA: General Health Perceptions, Rand.

    Google Scholar 

  • Whelan, C. T., Nolan, B., & Maître, B. (2008). Measuring material deprivation in the enlarged EU. Working paper, Dublin, Economic and Social Research Institute.

  • Wilkinson, R. G. (1989). Class mortality differentials, income distribution and trends in poverty 1921–1981. Journal of Social Policy, 18, 30–335.

    Article  Google Scholar 

  • Wilkinson, R. G., & Pickett, K. E. (2006). Income inequality and population health: A review and explanation of the evidence. Social Science and Medicine, 62(7), 1768–1784.

    Article  Google Scholar 

  • Wilkinson, R. G., & Pickett, K. E. (2008). Income inequality and socioeconomic gradients in mortality. American Journal of Public Health, 98(4), 699–704.

    Article  Google Scholar 

  • Wilkinson, R., & Pickett, K. (2010). The spirit level: Why equality is better for everyone. London: Penguin.

    Google Scholar 

  • Zullig, K. J., Ward, R. M., & Horn, T. (2006). The association between perceived spirituality, religiosity, and life satisfaction: The mediating role of self-rated health. Social Indicators Research, 79(2), 255.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Enrico Ivaldi.

Appendix: Descriptive Statistics of the Variables Selected

Appendix: Descriptive Statistics of the Variables Selected

 

Minimum

Maximum

Mean

SD

Asymmetry

Kurtosis

Descriptive statistics

Alcohol consumption

84.70

93.10

89.31

1.91

0.08

0.35

Tobacco consumption

60.00

87.00

71.70

5.18

0.38

2.30

Cancer deaths

0.42

0.85

0.60

0.09

0.59

1.30

Suicide deaths

0.03

0.34

0.11

0.07

2.12

5.14

Obesity rate

71.30

84.40

78.54

3.75

−0.02

−1.11

Infant mortality rate

90.60

97.90

95.89

1.75

−1.78

3.07

Individuals who experience anxiety

25.60

76.40

61.36

10.60

−1.41

3.85

Discouraged and or depressed individuals

43.90

90.70

77.88

9.74

−1.73

4.56

Practice of sport or exercise

3.90

44.10

16.47

9.19

1.17

1.88

Satisfaction with health

6.50

8.40

7.37

0.47

0.03

−0.45

Scale of psychological well-being

56.40

70.10

62.00

3.57

0.17

-0.84

  1. Sample size: 27 countries

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ivaldi, E., Bonatti, G. & Soliani, R. Objective and Subjective Health: An Analysis of Inequality for the European Union. Soc Indic Res 138, 1279–1295 (2018). https://doi.org/10.1007/s11205-017-1686-1

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11205-017-1686-1

Keywords

Navigation