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Welfare state regimes, unemployment and health: a comparative study of the relationship between unemployment and self-reported health in 23 European countries

Lookup NU author(s): Professor Clare Bambra



This is the authors' accepted manuscript of an article that has been published in its final definitive form by BMJ Group, 2009.

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Background: The relationship between unemployment and increased risk of morbidity and mortality is well established. However, what is less clear is whether this relationship varies between welfare states with differing levels of social protection for the unemployed. Methods: The first (2002) and second (2004) waves of the representative cross-sectional European Social Survey (37 499 respondents, aged 25–60 years). Employment status was main activity in the last 7 days. Health variables were self-reported limiting long-standing illness (LI) and fair/poor general health (PH). Data are for 23 European countries classified into five welfare state regimes (Scandinavian, Anglo-Saxon, Bismarckian, Southern and Eastern). Results: In all countries, unemployed people reported higher rates of poor health (LI, PH or both) than those in employment. There were also clear differences by welfare state regime: relative inequalities were largest in the Anglo-Saxon, Bismarckian and Scandinavian regimes. The negative health effect of unemployment was particularly strong for women, especially within the Anglo-Saxon (ORLI 2.73 and ORPH 2.78) and Scandinavian (ORLI 2.28 and ORPH 2.99) welfare state regimes. Discussion: The negative relationship between unemployment and health is consistent across Europe but varies by welfare state regime, suggesting that levels of social protection may indeed have a moderating influence. The especially strong negative relationship among women may well be because unemployed women are likely to receive lower than average wage replacement rates. Policy-makers’ attention therefore needs to be paid to income maintenance, and especially the extent to which the welfare state is able to support the needs of an increasingly feminised European workforce.

Publication metadata

Author(s): Bambra C, Eikemo T

Publication type: Article

Publication status: Published

Journal: Journal of Epidemiology & Community Health

Year: 2009

Volume: 63

Issue: 2

Pages: 92-98

Print publication date: 01/02/2009

Online publication date: 13/01/2009

Date deposited: 04/02/2017

ISSN (print): 0143-005X

ISSN (electronic): 1470-2738

Publisher: BMJ Group


DOI: 10.1136/jech.2008.077354


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