Health Inequalities and Welfare Resources: Continuity and Change in Sweden. Johan Fritzell and Olle Lundberg(eds).
Year: 2007
Type: article
Abstract: Reducing health inequalities is now a high priority for most developed nations but remains a public policy challenge in both theoretical and applied domains. Researchers interested in the social determinants of health come to different conclusions about the relative importance of material and psychosocial pathways; public health interventions, as often serve to widen health inequalities as they succeed in narrowing them; and policy makers and politicians alike seem unwilling to shift from a view that individual behaviour is the chief determinant of health to one that recognizes the fundamental importance of the social and economic structure of society for the perpetuation of inequalities in health. Despite these uncertainties, there is a feeling that the Nordic states are doing something right. In any cross-national study of health and well-being, they come out looking good. In Sweden, life expectancy is high, infant mortality is low; there are low levels of violence, people trust each other, and levels of social mobility are high. In a recent UNICEF report on child well-being, Sweden came top in three out of six domains. The editors of this book aim first to ‘analyse, describe and understand health inequalities’ in Sweden, and, second, to show how they are ‘shaped, recreated, changed and influenced by social stratification, societal changes and public policy’. The contributors to this edited collection are mostly sociologists from the Centre for Health Equity Studies, a research institute of Stockholm University and Karolinska Institute. They have access to a rich data set, the longitudinal Swedish Level-of-Living Surveys, covering three decades (1970–2000), with additional data for school children and older adults. Within these data sets, they examine the interrelationships between social class, economic resources, work, family structure and health—over time, over the life course and by gender. Their analyses are set against the background of the Swedish welfare system, with its commitments to poverty reduction, labour market inclusion and full employment, care provision for children and the elderly, and generous benefits. The findings show a complicated picture, some of it surprising. In the early 1990s Sweden experienced a severe economic recession and the impact of this on health is explored in several chapters. Whilst life expectancy has improved for Swedes, levels of psychological distress and musculoskeletal pain are increasing and levels of self-rated health have declined. Although Sweden ranks high on women's empowerment, the gender gap in musculoskeletal pain has grown over time—which the authors ascribe to deteriorating working conditions for women and the fact that women have a high burden of unpaid domestic work in addition to employment. A chapter taking a life-course approach shows that social class inequalities in health have widened, but at the same time class of origin has become less predictive of later health, reflecting more equality of opportunity. Another chapter, on social capital and health, demonstrates how informal social ties and levels of trust have increased, whilst membership of voluntary societies has decreased. In yet another, we learn that relative income measured in comparison to people of similar socioeconomic status is related to health for men, whilst relative income measured as the ability to buy necessary goods matters much more for women. Psychosocial conditions at work deteriorated and psychological distress increased. But we are also presented with evidence that a sense of coherence can buffer the effects of work strain, at least for women. School children, especially girls, also appear to be under increasing strain and to have increasing levels of psychosomatic complaints, but again we see that the effects of such strain can be buffered by a sense of control. These complex findings and issues are clearly presented and discussed, and we learn much about the social determinants of health and levels of health inequalities in Sweden. Yet the book raises as many questions as it answers and never quite manages to live up to its goal of showing us how the Swedish welfare state shapes the health of the nation. What is missing, I believe, are two complementary scales of analysis that would enrich the interpretation of these findings. Although the authors of some chapters refer to other countries when discussing their findings, I found myself always wanting to know more about how Sweden compares to other countries. For example, it is clear that Swedish school students report high levels of parental and teacher support—85% report having support from both sources—but is this higher than in less equal countries like the UK and the USA? Are levels of support similar or different in other egalitarian countries, like Japan, that have very different welfare systems? Despite the methodological challenge of finding comparable data, understanding the ways in which social policies and social structures affect health and other outcomes requires analysis and comparison at the level of whole societies. At the same time, I often wanted to focus the analytical lens more narrowly, to learn what it is actually like to live in the Swedish welfare state, for men and women, for people of different ages and social classes, for Swedish born and immigrants. The insights that can be gained from the Swedish perspective would have been enriched by simultaneously widening and narrowing the scale of analysis. But although it doesn't quite do what it says on the tin, there are rich pickings, plenty of food for thought and a lot to digest in this book; as a comprehensive and very capable investigation of the social determinants of health in Sweden it makes an important contribution to health inequalities research.
DOI: 10.1093/ije/dym072
Author: K. E Pickett
Language: English
Subfield: Health
Field: Social Sciences
Domain: Social Sciences
Open Access status: hybrid
Estimated APC paid: $4,514
OpenAlex ID: W2127559829