The role of the social democratic welfare state regime in reducing socioeconomic inequalities in health: Results from comparative studies on British, Finnish, and Japanese civil servants

The importance of politics and macroeconomic structures on socioeconomic inequalities in health has been increasingly recognized. It has been hypothesized that social policies and politics influence population health through welfare state structures, labor markets, and economic inequalities. We have conducted a series of international comparative studies among British, Finnish and Japanese civil servants. Britain, Finland and Japan are examples of the liberal, social democratic, and conservative welfare state regimes, respectively. International comparisons of countries representing different welfare state regimes may provide further understanding of the relations between policies, politics, social structures and health. Inequalities in physical and mental health by socioeconomic status (SES) were observed in all three cohorts but the magnitude and patterns of health inequalities differed: for physical health, the generally observed patterns of SES inequalities in health (i.e. the higher the SES, the better the health.) were observed in all cohorts and the health inequalities were somewhat smaller in the Finnish cohort than in other 2 cohorts. For mental health, similar patterns of SES inequalities were observed in the British and Japanese cohorts but the reverse was true for the Finnish cohort (i.e. the higher the SES, the poorer the health.). SES inequalities in psychosocial stress at work were somewhat smaller in the Finnish cohort than in the other 2 cohorts. Work-family balances and mental health were better in the Finnish cohort than in the other 2 cohorts. Finnish employees had smaller SES inequalities in work characteristics which seems to contribute to smaller SES inequalities in health. These results may be partly due to social democratic welfare state regime with an emphasis on universal and egalitarian policies in Finland. In contrast, no consistent patterns of SES inequalities in health risk behaviours such as cigarette smoking, physical activity and alcohol drinking were observed in our study. International differences in cultural characteristics may also explain the international differences in health inequalities. Our international comparative studies on cultures, structures and health is now underway and could contribute to the literature in this area. Pathways from policies and politics to social structures and cultures and through that to health are complex and there is always a time lag from health promoting or damaging factors to their health effects. Evidence is still lacking as to how political, economic, cultural and other factors shape our health and, in particular, health inequalities. We should avoid making social epidemiology research too politicized, but policies and politics do contribute to social determinants of health.