Association for Public Policy Analysis & Management

Despite converging living standards and a commitment to universal health care provision, countries in the EU exhibit high health gradients in education, income and occupational status. Even in a relatively egalitarian country like Sweden, a person from the lowest quintile of income distribution has a life expectancy on average 7 years shorter than that of a person from the richest fifth, and these differences have widened over time. While a situation with no health inequality is hard to imagine due selection effects (healthier individuals achieving better social standing), variation in the steepness of this gradient across the EU suggests that country factors might play a role in shaping the heath gradients. Studying how the steepness of this gradient and the underlying factors (population structure, education, occupation and income) vary across countries has a potential to inform policy makers on social and economic policies that might reduce within-country health inequality and improve population health.

In our paper, we employ a semi-parametric decomposition approach to study the extent to which demographic structure of the population can explain the observed variation in health inequality across the EU. Until now, the approach has been mainly applied to study cross-national variation in income inequality. We use the Survey on Income and Living Conditions in Europe (EU-SILC) with information on self-assessed health for adults over 16. To date, we find that differences in the population structure account for up to one third of the variation in income-related health inequality. We further assess the relative effects of different components of demographic factors and find large variation across countries.