prof. dr. klaus hurrelmann: “reducing health inequalities – what do we really know about...

Prof. Dr. Klaus Hurrelmann: “Reducing Health Inequalities – What Do We Really Know About Successful Strategies?”, Conference 8 - 9 May 2009, Berlin

Health Inequalities in Welfare States The Need for a More

Health Sensitive Public Policy

Klaus Hurrelmann, Sebastian Duwe, David Gleicher, Katharina Rathmann, Naomi Woods, Matthias

Richter Hertie School of Governance, Berlin, and University of Bielefeld


In almost all countries, the health of rich people with good education and active participation in the labour forceis improving much more quickly than that of the poor withlow educational level and weak participation in the labour force. Increasing economic inequalities with growing income gaps between the rich and the poorrun parallel to this trend.

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Health problems are closely related to income and wealth linequalites in all highly developed countries.This is true for infant mortality and life expectancyand many other health indicators.

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Interdependence of income inequality and infant mortality in welfare states.

(Wilkinson and Pickett 2009, 82)

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Interdependence of income inequality and life expectancy in welfare states.

(Wilkinson and Pickett 2009, 82)

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It is not only income inequality which leads to healthinequality, but also the inequality of resources held bydifferent parts of the population due to systematic over- and under-investments across a wide range of community infrastructure.

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The quality of life and the economic productivity of the whole country is reduced if significant parts of the population are excluded from welfare resources that are available for the majority. Inequalities are condidered to be unfair. Therefore, effectivepolicy strategies fo reduce health inequalities should be part of comprehensive welfare policy approaches.

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Different states have different levels of health of their population and they also have different levels of healthinequality. The analysis of divergent structuresof policy strategies is an important tool to learnabout the possibility to influence the determinantsof health inequalities.

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Welfare state regime types are highly significant predictors of health indicators. They are influenced bythe traditional path to organize the societal Infrastructure and they influence the quality of the welfareof the whole population. Obviously, shared policy characteristics of a given welfare regime type do exist.

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Typologies are able to explain the relatively high degreeof social and economic inequalities in most of the SocialDemocratic regimes. Contrary to expectation, however,they are not able to explain why this regime does not always turn out to have the healthiest population, at least not with reference to all health indicators applied. We haveto search for more refined explanatory models.

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Explanatory Model 1

Politics

Time in government by different political traditions

Electoral support for different political traditions, measured by

Power resources suppor-ting each political tradition

Labour Market

Active population

Participation of women in the labour force

Rate of men’s unemployment

Rate of women’s unemployment

Welfare State

Public health expenditure

Public health care coverage

Economic inequality

Health outcomes

Navarro et al.2006, 1036

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Explanatory Model 2

Organisationof theSocietal Infrastructure

Quality of PopulationWelfare

Health Status of the Population

Health Sensitive Public Policy

Including intersectoral coordination,high political power for public healthand health care policy

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The welfare state regime type sets the stage for the architecture of public policy. The degree of „health sensitivity“ of this public policy influences the health outcome via two paths: First, indirectly, by determining the overall welfare of thepopulation and, second, directly, by shaping the institutionsand organizations which are responsible for health care.

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In using the term „Health Sensitive Public Policy“ weinvoke the wider European notion of social policy whichincludes not only health care but labour policy, socialsecurity, social housing, criminal justice, education policy,unemployment insurance, etc. as constitutional elementsof welfare policy.

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Health Sensitive Public Policy recognizes that welfareand health policy follow strong path dependencies. Therefore, states with different welfare traditions need specific strategies to reduce health inequalities.This is only possible if they implement pragmatic policy mixes.

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prof. dr. klaus hurrelmann: “reducing health inequalities – what do we really know about...

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