Beckfield and Bambra

Introduction

  • The US shows a significant mortality disadvantage compared to other rich democracies (OECD peers).

  • The concept of a "social policy hypothesis" suggests that social policies might explain this disadvantage.

  • The study uses cross-sectional time-series analysis from 1970 to 2010 to examine the correlation between welfare state generosity and life expectancy across 18 high-income countries.

Key Findings

  • Findings indicate a strong positive correlation between welfare state generosity and life expectancy:

    • An increase in overall welfare generosity is associated with:

      • 0.17 year increase in life expectancy at birth (p < 0.001).

      • 0.07 year increase in life expectancy at age 65 (p < 0.001).

  • The most significant effects are from pension benefits:

    • 0.439 years increase in life expectancy at birth (p < 0.001).

    • 0.199 years increase for life expectancy at age 65 (p < 0.001).

  • Approximation shows US life expectancy could be 3.77 years longer if it matched the average social policy generosity of the other OECD countries.

US Mortality Disadvantage

  • Historical context reveals a growing gap in life expectancy:

    • 1960: US ranked 15th (69.8 years) among OECD nations, while Scandinavian countries led (Norway: 73.8 years).

    • 2010: US dropped to last (78.7 years) behind Japan (83.0 years).

  • Similar trend observed in infant mortality rates.

  • The health performance of the US worsened notably from the 1980s onwards.

Contributing Factors

Lifestyle Factors

  • Although the US has lower smoking rates currently, historical consumption has impacted health negatively.

  • Dietary habits and obesity levels contribute to mortality, with average calorie intake at 3770 per day.

  • Alcohol consumption patterns show tentative evidence of heavier drinking among younger adults.

Healthcare System

  • The US spends significantly more on healthcare (18% of GDP) compared to countries with social insurance systems (around 6% in the UK).

  • Access to healthcare is often market-dependent, with around 10% of Americans lacking insurance and millions under-insured.

Institutional Explanations

  • Welfare states are critical in shaping societal inequalities and health outcomes:

    • Stratification: How welfare states organize social relations affecting health.

    • Social Determinants of Health: Enhanced welfare can lessen the need for market resources.

    • Endogeneity Bias: Studies suggest social policy impacts health outcomes, making robust conclusions difficult.

Methodology

Research Design

  • Employed fixed-effects models adjusting for autocorrelation.

  • Dependent variable: life expectancy at birth, and four measures of welfare state:

    1. Overall benefit generosity.

    2. Unemployment insurance.

    3. Sickness insurance.

    4. Pension benefits.

  • Included controls for GDP per capita, population aged 65+, and public and private social expenditure.

Analysis and Results

  • Results showed consistent positive correlations between welfare measures and life expectancy.

  • Analysis estimated the US could have 5.56 years longer life expectancy if aligning with Nordic welfare states.

Conclusion

  • The analysis indicates the US's mortality disadvantage partially stems from inadequate welfare state provisions.

  • Calls for further research to investigate individual-level data related to social policy effects on health outcomes.

  • Emphasizes the need for more comprehensive data to understand the complex interactions between welfare states and population health.