[What type of welfare policy promotes health?: the puzzling interrelation of economic and health inequality]

Abstract

In all highly developed countries, the overall health status of the population has significantly improved within the past 30 years. The most important reason for this is the increase in economic prosperity. Economic wealth, however, today is much more unequally distributed than it was 3 decades ago. Countries with relatively small disparities in the availability of material resources between socioeconomic groups, such as the Scandinavian countries, have better health outcomes on the population level. Health inequalities, however, have also reached a higher level than 30 years ago. As of today, we do not have convincing explanations for the interrelation of economic and health inequality. This paper gives an overview of existing research on a comparative basis. The research results are ambivalent. They show the puzzling result that the Scandinavian countries with their highly distributive welfare policy manage to achieve the comparatively highest level of economic, but not health, equity. Based on these results, we develop proposals for future research approaches. A central assumption is that in rich societies no longer only material, but more and more immaterial determinants are crucial for the formation of health inequality. The promotion of "salutogenic" self-management capabilities in socially disadvantaged groups is considered to be the central element in effective intervention strategies.