Panel Paper:
Inequality and Health in Local Contexts – an Ecological Study from Finland
Tuesday, June 14, 2016
:
12:30 PM
Clement House, 7th Floor, Room 02 (London School of Economics)
*Names in bold indicate Presenter
Most inequality research on the relationship between inequality and health has focused on cross-country variation. Findings based on smaller geographical and governmental units are mixed. We add to this discussion by using longitudinal register-based data on Finnish municipalities. Finland has 313 municipalities, ranging from small towns to big metropolitan cities and enormous but very sparsely populated arctic areas. We take advantage of changes in inequality to model the effects of inequality on health while controlling for the inherent heterogeneity of municipalities.
We use mixed-effect regression models to assess how changes in municipal Gini index and in the share of people living in relative poverty were linked to health in Finnish municipalities between 1995 and 2013. During this period both income inequality and relative poverty have changed dramatically in Finland due to changes in personal income taxation, Nokia-led high tech boom and subsequent economic collapse after 2008. The effects of these drivers of inequality have caused considerable regional variation. Mixed-effect models allow us to differentiate between health outcome differences due to inherent characteristics of specific municipalities and those that result from increasing (or decreasing) local inequality.
In this study the Gini index and relative poverty measure two different dimensions of inequality. The Gini index calculated for each municipality measures the distance between the richest and poorest households within the municipality. Insofar as people are expected to compare their standards of living with those of their peers in the municipality where they live, this measure can be taken as an operationalization of the so-called “stress theory”. The effects of the municipal Gini coefficient are deemed to reflect negative emotions such as shame and distrust, which may be associated with disadvantage and perceptions of disadvantage that are claimed to be directly linked to depression. The relative poverty rate calculated for each municipality using the national poverty threshold indicates the number of persons whose ability to participate in society is compromised according to a national standard. This measure can be used to test the validity of the so-called “materialist theory”.
While the Gini index measures the distances within the municipality, the relative poverty shows the share of people in the municipality who are left behind from all the others in the country. We measure health outcomes with an age-standardized morbidity index. The indicator is an index describing the health or ill health of the population of a specific municipality in relation to the average for the country's total population (=100).
Our data is derived from a national indicator data bank Sotkanet. This database combines resources from Statistics Finland, Eurostat, the National Institute for Health and Welfare and other sources for open source use, allowing for reproducible research.
