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  • 1.
    Bergqvist, Kersti
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Åberg Yngwe, Monica
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Lundberg, Olle
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Mid Sweden University, Sweden.
    Understanding the role of welfare state characteristics for health and inequalities - an analytical review2013In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 13, p. 1234-Article, review/survey (Refereed)
    Abstract [en]

    Background: The past decade has witnessed a growing body of research on welfare state characteristics and health inequalities but the picture is, despite this, inconsistent. We aim to review this research by focusing on theoretical and methodological differences between studies that at least in part may lead to these mixed findings. Methods: Three reviews and relevant bibliographies were manually explored in order to find studies for the review. Related articles were searched for in PubMed, Web of Science and Google Scholar. Database searches were done in PubMed and Web of Science. The search period was restricted to 2005-01-01 to 2013-02-28. Fifty-four studies met the inclusion criteria. Results: Three main approaches to comparative welfare state research are identified; the Regime approach, the Institutional approach, and the Expenditure approach. The Regime approach is the most common and regardless of the empirical regime theory employed and the amendments made to these, results are diverse and contradictory. When stratifying studies according to other features, not much added clarity is achieved. The Institutional approach shows more consistent results; generous policies and benefits seem to be associated with health in a positive way for all people in a population, not only those who are directly affected or targeted. The Expenditure approach finds that social and health spending is associated with increased levels of health and smaller health inequalities in one way or another but the studies are few in numbers making it somewhat difficult to get coherent results. Conclusions: Based on earlier reviews and our results we suggest that future research should focus less on welfare regimes and health inequalities and more on a multitude of different types of studies, including larger analyses of social spending and social rights in various policy areas and how these are linked to health in different social strata. But, we also need more detailed evaluation of specific programmes or interventions, as well as more qualitative analyses of the experiences of different types of policies among the people and families that need to draw on the collective resources.

  • 2. Kondo, N.
    et al.
    Rostila, Mikael
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Åberg Yngwe, Monica
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Rising inequality in mortality among working-age men and women in Sweden: a national registry-based repeated cohort study, 1990-20072014In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 68, no 12, p. 1145-1150Article in journal (Refereed)
  • 3. Kruize, Hanneke
    et al.
    van der Vliet, Nina
    Staatsen, Brigit
    Bell, Ruth
    Chiabai, Aline
    Muiños, Gabriel
    Higgins, Sahran
    Quiroga, Sonia
    Martinez-Juarez, Pablo
    Åberg Yngwe, Monica
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Tsichlas, Fotis
    Karnaki, Pania
    Lima, Maria Luísa
    García de Jalón, Silvestre
    Khan, Matluba
    Morris, George
    Stegeman, Ingrid
    Urban Green Space: Creating a Triple Win for Environmental Sustainability, Health, and Health Equity through Behavior Change2019In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 16, no 22, article id 4403Article, review/survey (Refereed)
    Abstract [en]

    Urbanization, costs of green space maintenance, and diminishing connection between people and nature all exert pressures on urban green space. This is regrettable as green space has the potential to create wins for environmental sustainability, health, and health equity. This paper explores this potential triple win and investigates how to increase the use of urban green space through behavior change. A narrative literature review was conducted and was supplemented with literature suggested by experts. Results show that creating well-designed green spaces and stimulating people to use them can indeed deliver this triple win. Providing accessible, attractive, well-maintained green space with room for socialization, and where people feel safe, may increase the opportunity and motivation of people to use it more often. Informing and educating people and organizing activities may increase capability (and motivation) to use green space. Since the use of green space depends on life stage, lifestyle factors and individual values, it is important to involve potential users in its design. We recommend a specific focus on those groups who may benefit most from the use of green space. More evaluation is needed to inform effective green space interventions and to assess related economic, social, and environmental benefits.

  • 4.
    Lundberg, Olle
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Fritzell, Johan
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Åberg Yngwe, Monica
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Kölegård, Maria L.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    The potential power of social policy programmes: income redistribution, economic resources and health2010In: International Journal of Social Welfare, ISSN 1369-6866, E-ISSN 1468-2397, Vol. 19, no s1, p. s2-s13Article in journal (Refereed)
    Abstract [en]

    This Supplement includes a number of articles dealing with the role of social policy schemes for public health across the life course. As a key social determinant of health, poverty and its consequences have historically been at the forefront of the public health discussion. But also in rich countries today, economic resources are likely to be important for health and survival, both on an individual and an aggregate level. This introductory article serves as a background for the more specific analyses that follow. The focus is on why income and income inequality could have an effect on individual and population health. We discuss relationships between the individual and population levels and between income and health, and some of the possible mechanisms involved. We also present arguments for why welfare state institutions may matter.

  • 5.
    Lundberg, Olle
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Yngwe Åberg, Monica
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Bergqvist, Kersti
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Sjöberg, Ola
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    The role of income and social protection for inequalities in health, evidence and policy implications.2014Report (Other academic)
  • 6.
    Lundberg, Olle
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). University of London, England.
    Åberg Yngwe, Monica
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Bergqvist, Kersti
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Sjöberg, Ola
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Stockholm University, Faculty of Social Sciences, The Swedish Institute for Social Research (SOFI).
    Welfare states and health inequalities2015In: Canadian public policy, ISSN 0317-0861, E-ISSN 1911-9917, Vol. 41, no Suppl. 2, p. S26-S33Article in journal (Refereed)
    Abstract [en]

    While much research points to the importance of a range of welfare state policies to reduce inequalities in health, the growing literature in this field is full of mixed and contradictory results. In this paper, we provide a brief discussion about the different conceptual and methodological approaches used in comparative research on the relationship between welfare policies and health. Against a theoretical discussion of possible linkages among one central welfare policy, unemployment benefit schemes, and health, we also provide examples of findings on how two central dimensions of such schemes—coverage and replacement rates—are linked to health and health inequalities across Europe. These examples indicate not only that welfare state programs can contribute to smaller health inequalities but also that their effectiveness in this respect depends on their institutional set-up.

  • 7.
    Lundberg, Olle
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Åberg Yngwe, Monica
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Fritzell, Johan
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Bacchus Hertzman, Jennie
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Bergqvist, Kersti
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Ferranini, Tommy
    Stockholm University, Faculty of Social Sciences, The Swedish Institute for Social Research (SOFI).
    Nelson, Kenneth
    Stockholm University, Faculty of Social Sciences, The Swedish Institute for Social Research (SOFI).
    Rehnberg, Johan
    Stockholm University, Faculty of Social Sciences, The Swedish Institute for Social Research (SOFI).
    Sjöberg, Ola
    Stockholm University, Faculty of Social Sciences, The Swedish Institute for Social Research (SOFI).
    The effect of social protection and income maintenance policies on health and health inequalities2013In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 23, no Suppl. 1Article in journal (Other academic)
    Abstract [en]

    Background

    As a starting point we review the existing evidence on welfare states, health and health inequalities, from 2005 onwards. Three different approaches emerge in these previous studies – the welfare regime approach, the welfare institutions approach and the social spending approach. While no clear picture emerges for the welfare regime approach, summarising findings regarding the institutional and expenditure approach suggest that a higher degree of generosity and social spending benefits public health. These are therefore approaches we follow to arrive at a better understanding of what type of policies are linked to smaller inequalities in health across the life-course.

    Methods

    A starting point in the analyses is the relation between income, poverty and mortality. The cross-national variation in poverty rates, both absolute (poverty threshold) and relative (60 per cent of median income) measure, and mortality rates in European 26 countries will be considered.

    The second step in the analysis focuses on the relationship between social rights and subjective health in Europe, with a focus on national variations and changes in social rights to levels and changes in subjective health outcomes across several countries. The data holds information regarding social rights and social expenditure, including individual data from EU-SILC.

    Results

    Preliminary results indicate that it is the totality of social protection that is important rather than individual policies. A sub-study regarding social rights and health among youth highlight also the importance of active and passive labour market policy in the 16 included countries.

    Conclusions

    In sum our diverse approach to analysing welfare state efforts and their links to health inequalities suggest that there is a clear relationship between more ambitious policies and smaller inequalities in health. These results are discussed in relation to previous findings.

  • 8.
    Lundberg, Olle
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Åberg Yngwe, Monica
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Kölegård Stjärne, Maria
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Björk, Lisa
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Fritzell, Johan
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    The Nordic Experience: Welfare States and Public Health (NEWS)2008Book (Other academic)
  • 9.
    Lundberg, Olle
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Åberg Yngwe, Monica
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Kölegård Stjärne, Maria
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Elstad, Jon Ivar
    Ferrarini, Tommy
    Stockholm University, Faculty of Social Sciences, The Swedish Institute for Social Research (SOFI).
    Kangas, Olli
    Norström, Thor
    Stockholm University, Faculty of Social Sciences, The Swedish Institute for Social Research (SOFI).
    Palme, Joakim
    Stockholm University, Faculty of Social Sciences, The Swedish Institute for Social Research (SOFI).
    Fritzell, Johan
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    The role of welfare state principles and generosity in social policy programmes for public health: an international comparative study2008In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 372, no 9650, p. 1633-1640Article in journal (Refereed)
    Abstract [en]

     Background Many important social determinants of health are also the focus for social policies. Welfare states contribute to the resources available for their citizens through cash transfer programmes and subsidised services. Although all rich nations have welfare programmes, there are clear cross-national differences with respect to their design and generosity These differences are evident in national variations in poverty rates, especially among children and elderly people. We investigated to what extent variations in family and pension policies are linked to infant mortality and old-age excess mortality. Methods Infant mortality rates and old-age excess mortality rates were analysed in relation to social policy characteristics and generosity. We did pooled cross-sectional time-series analyses of 18 OECD (Organisation for Economic Co-operation and Development) countries during the period 1970-2000 for family policies and 1950-2000 for pension policies. Findings Increased generosity in family policies that support dual-earner families is linked with lower infant mortality rates, whereas the generosity in family policies that support more traditional families with gainfully employed men and homemaking women is not. An increase by one percentage point in dual-earner support lowers infant mortality by 0.04 deaths per 1000 births. Generosity in basic security type of pensions is linked to lower old-age excess mortality, whereas the generosity of earnings-related income security pensions is not. An increase by one percentage point in basic security pensions is associated with a decrease in the old age excess mortality by 0.02 for men as well as for women. Interpretation The ways in which social policies are designed, as well as their generosity, are important for health because of the increase in resources that social policies entail. Hence, social policies are of major importance for how we can tackle the social determinants of health.

  • 10.
    Miething, Alexander
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Yngwe Åberg, Monica
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Stability and variability in income position over time: exploring their role inself-rated health in Swedish survey data2014In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 14, p. 1300-Article in journal (Refereed)
    Abstract [en]

    Background: The adverse relationship between income and health is well documented, but less is known of how income trajectories, i.e. downward or upward trends in income, determine health. We therefore link longitudinal income information to cross-sectional data on self-rated health and conduct logistic regression models in order to investigate income trends over time and their relationship with health. 

    Methods: The data, with the exception of income information, are derived from the Swedish Level-of-Living Survey 2000. The information on income was drawn from the income register covering the period 1995 to 2000. We used an age-restricted sample of those 30-64 years of age, and generated a series of models accounting for average income position, lagged income position, income decrease and increase, and annual periods in specific income positions. The analysis was conducted for men and women separately. 

    Results: Apart from the overall association between income and health, we found a similar pattern when including average and lagged income in the model. The analysis of length of time in a specific income position showed substantial sex differences in poor health. Income decrease was more strongly associated with men's poor health, whereas income increase revealed only weak associations with self-rated health. 

    Conclusions: It was shown that income changes and the time dimension of income are important for self-rated health. Self-rated health responds to decreases in absolute income and lowered rank position in the income distribution to a greater extent than to income gains over time. Lagged lower income position and its associations with health suggest that socio-economic disadvantages accumulate over time.

  • 11.
    Miething, Alexander
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Åberg Yngwe, Monica
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Persistence and variability in income: Exploring their role in self-rated health in Swedish survey dataManuscript (preprint) (Other academic)
    Abstract [en]

    The adverse relationship between income and health is well documented, but less is known of how income trajectories, i.e. downward or upward trends in income, determine health. We therefore link longitudinal income information to cross-sectional data on self-rated health and conduct logistic regression models in order to investigate income trends over time and their relationship with health.

    The data, with the exception of income information, are derived from the Swedish Level-of-Living Survey 2000. The information on income was drawn from the income register covering the period 1995 to 2000. We used an age-restricted sample of those 30-64 years of age, and generated a series of models accounting for average income position, lagged income position, income decrease and increase, and annual periods in specific income positions. The analysis was conducted for men and women separately.

    Apart from the overall association between income and health, we found a similar pattern when including average and lagged income in the model. The analysis of length of time in a specific income position showed substantial sex differences in poor health. Income decrease was more strongly associated with men’s poor health, whereas income increase revealed only weak associations with self-rated health.

    It was shown that income changes and the time dimension of income are important for self-rated health. Self-rated health responds to decreases in absolute and relative income to a greater extent than to income gains over time. Lagged lower income position and its associations with health suggest that socio-economic disadvantages accumulate over time.

  • 12. Möller, Jette
    et al.
    Björkenstam, Emma
    Ljung, Rickard
    Åberg Yngwe, Monica
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Widowhood and the risk of psychiatric care, psychotropic medication and all-cause mortality: a cohort study of 658 022 elderly people in Sweden2011In: Aging & Mental Health, ISSN 1360-7863, E-ISSN 1364-6915, Vol. 15, no 2, p. 259-266Article in journal (Refereed)
    Abstract [en]

    Objectives: To study the effect of widowhood on the risk of psychiatric care, psychotropic medication and mortality, and to study if the effect is modified by educational level. Method: A nationwide, register-based cohort study. All married or widowed individuals aged 75 and older who were alive and registered in Sweden on 31 December 2004 and still registered on 31 December 2005. A total of 658,022 individuals were included in the study and followed in 2006. Odds ratios (ORs) with corresponding 95% confidence intervals (CIs) were calculated. Results: Loss of spouse increased the risk of outpatient psychiatric visits, psychotropic medication and all-cause mortality. Prescribed psychotropic medication was more common among those newly bereaved, adjusted OR of 1.46 (95% CI 1.41-1.50), compared to those married. For those widowed for a longer period, the corresponding estimate was 1.12 (95% CI 1.11-1.14). The OR for all-cause mortality was 1.18 (95% CI 1.11-1.26). The analyses also indicated different effects on inpatient care depending on educational level. Conclusion: Loss of spouse increases the risk of people getting psychiatric care, both for severe and minor psychiatric conditions. The effect seems to differ depending on educational level. Further studies are needed to disentangle the mechanism behind the effects of each measurement of psychiatric conditions and how these are affected by educational level.

  • 13.
    Åberg Yngwe, Monica
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Fritzell, Johan
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Kölegård, Maria L.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Lundberg, Olle
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Social Policy and Public Health across the Life Course: Supplement to July Issue2010In: International Journal of Social Welfare, ISSN 1369-6866, E-ISSN 1468-2397, Vol. 19, no s1Article in journal (Refereed)
  • 14.
    Åberg Yngwe, Monica
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Kondo, Naoki
    Hägg, Sara
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Kawachi, Ichiro
    Relative deprivation and mortality - a longitudinal study in a Swedish population of 4,7 million, 1990-20062012In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 12, p. 664-Article in journal (Refereed)
    Abstract [en]

    Background: Relative deprivation has previously been discussed as a possible mechanism underlying the income-health relation. The idea is that income matters to the individual's health, over and above the increased command over resources, as the basis of social comparisons between a person and his or her reference group. The following study aimed to analyze the role of individual-level relative deprivation for all-cause mortality in the Swedish population. The Swedish context, characterized by relatively small income inequalities and promoting values as egalitarianism and equality, together with a large data material provide unique possibilities for analyzing the hypothesized mechanism. Methods: The data used are prospective longitudinal data from the Swedish population and based on a linkage of registers. Restricting selection to individuals 25-64 years, alive January 1st 1990, gave 4.7 million individuals, for whom a mortality follow-up was done over a 16-year period. The individual level relative deprivation was measured using the Yitzhaki index, calculating the accumulated shortfall between the individual's income and the income of all other's in the person's reference group. All-cause mortality was used as the outcome measure. Results: Relative deprivation, generated through social comparisons, is one possible mechanism within the income and health relation. The present study analyzed different types of objectively defined reference groups, all based on the idea that people compare themselves to similar others. Results show relative deprivation, when measured by the Yitzhaki index, to be significantly associated with mortality. Also, we found a stronger effect among men than among women. Analyzing the association within different income strata, the effect was shown to be weak among the poorest. Revealing the importance of relative deprivation for premature mortality, over and above the effect of absolute income, these results resemble previous findings. Conclusion: Relative deprivation, based on social comparisons of income, is significantly associated with premature mortality in Sweden, over and above the effect of absolute income. Also, it was found to be more important among men, but weak among the poorest.

  • 15.
    Åberg Yngwe, Monica
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Östberg, Viveca
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    The family's economic resources and adolescents' health complaints - do adolescents' own economic resources matter? 2013In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 23, no 1, p. 24-29Article in journal (Refereed)
    Abstract [en]

    Background: The present study focuses on the relevance of economic resources to psychological and psychosomatic health complaints during adolescence. It explores the link between the family's and the adolescent's economic resources and investigates whether or not differences in health complaints by the family's financial situation can be explained by adolescents' own economic resources. Methods: Drawing on data from two Swedish surveys on living conditions during adolescence (in the age group 10-18 years) conducted in 2002-03, logistic regressions were used to assess the associations between adolescents' own and household economic resources on two measures of health complaints. Results: The association between family economic hardship (i.e. lack of cash margin) and adolescents' health complaints largely disappeared when controlling for adolescents' own economic resources. Three measures of own absolute and relative economic resources were used. Out of these, the ability (or not) to buy things that others have was connected with both psychological [Odds ratio (OR) 2.16, 95% confidence interval (95% CI) 1.6-2.9] and psychosomatic complaints (OR 1.67, 95% CI 1.3-2.1), irrespective of age and gender. The importance of lacking a personal cash margin or not being able to join friends seemed to differ between age groups and genders. Conclusions: The importance of different aspects of economic resources seems to vary across age groups and gender. However, not being able to buy things that others have was clearly associated with health complaints irrespective of age and gender. Family economic hardship was associated with adolescents' health complaints, and this association was largely explained by adolescents' own economic resources.

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