ABSTRACT

This chapter discusses how health research has influenced the development of welfare state regime typologies, and how these typologies have themselves influenced health research. Three key developments are examined: firstly, the integration of healthcare services into the welfare state typologies literature; secondly, the importance of decommodification in regards to health and healthcare; and thirdly, how welfare state regimes have been used by comparative social epidemiologists to examine and explain international differences in population health and health inequalities. The chapter starts with a definition of key terms. It concludes by reflecting on the implications of health research for the further development of welfare state regime typologies and comparative social policy. Various key concepts are used within this chapter: decommodification, social epidemiology,

population health, health inequalities, and the social determinants of health. The key underlying concept in Esping-Andersen’s Three Worlds typology (1990) was decommodification. Decommodification is ‘the extent to which individuals and families can maintain a normal and socially acceptable standard of living regardless of their market performance’ (Esping-Andersen, 1987, p. 86). The welfare state decommodified labour because certain services and a certain standard of living became a right of citizenship and reliance on the market for survival decreased (Esping-Andersen, 1990, p. 22). Health can itself be regarded as something which is variously commodified and decommodified (Bambra et al., 2005). Social epidemiology is about the social causes of disease distribution within and between societies, it is ‘about why different societies – and within societies, why different societal groups – have better or worse health than others’ (Kriegar, 2011, p. vii). Population health refers to the health status of populations as opposed to individuals: the ‘extant and changing population distributions of health, disease, and death’ (ibid.). Health inequality is a term used to describe systematic differences in health status between different social or demographic groups (such as inequalities by gender or ethnicity). Most usually it is used to refer to socio-economic class inequalities in health (measured by education, income, or occupational class): inequalities in health are ‘systematic differences in health between different socio-economic groups within a society. As they are socially produced, they are potentially avoidable and widely considered unacceptable in a civilised society’ (Whitehead, 2007, p. 473).

Health inequality is measured in absolute or relative terms (for more detail see Bambra, 2011a). In developed countries, welfare states are important macro-level determinants of health as they mediate the health impact of socio-economic position and the exposure of different population groups to the social determinants of health: access to essential goods and services (specifically water and sanitation, and food); housing and the living environment; transport; unemployment and social security; working conditions; and access to healthcare (Bambra, 2011a).