The European Journal of Health Economics

, Volume 12, Issue 1, pp 61–77 | Cite as

Social health inequalities among older Europeans: the contribution of social and family background

  • Sandy Tubeuf
  • Florence Jusot
Original Paper


This analysis aims to get a step further in the understanding of the determining factors of social health inequalities, and to explore particularly the role played by parents’ social status and their vital status or age at death on the social health inequalities in adulthood among European older adults. The wealth-related health inequalities are measured using the popular concentration index. We then implement the decomposition method of the indices and evaluate the contribution of the various determinants of health introduced in interval regression models. Health is measured using self-assessed health and country-specific cut-points that correct observed differences in self-report due to cross-cultural differences in reporting styles. This paper uses data for ten European countries from the first wave of the 2004 SHARE. The study highlights significantly higher wealth-related health inequalities in the Netherlands, Denmark and Germany. These social inequalities of health in Europe are explained largely by individuals’ current social conditions, particularly wealth. Nevertheless, our analysis attests the existence of a long-term influence of initial conditions in childhood on health in middle-aged and beyond, independently of current social characteristics, which contribute to differences in health status across social groups. This article contributes to the identification of social determinants, which are important determinants of health and follows recommendations suggested to help ‘close the gap’ in various health inequities.


Concentration index Decomposition Europe Inequality Older adults 

JEL Classification

D63 I18 J14 



The authors thank Mark Dusheiko and participants in the conferences of the Health Economics Study Group and the College des Economists de la Santé for their comments. Two referees are also gratefully acknowledged for their reports, which strongly improved the paper.


  1. 1.
    Mackenbach, J.P., Bos, V., Andersen, O., Cardano, M., Costa, G., Harding, S., et al.: Widening socioeconomic inequalities in mortality in six western European countries. Int. J. Epidemiol. 32, 830–837 (2003)CrossRefGoogle Scholar
  2. 2.
    Hernandez-Quevedo, C., Jones, A., Lopez, A.N., Rice, N.: Socio-economic inequalities in health: a comparative longitudinal analysis using the European community household panel. Soc. Sci. Med. 63(1246), 1262 (2007)Google Scholar
  3. 3.
    Masseria, C., Mossalios, E., Allin, S.: Measurement of socioeconomic inequality of health in 10 European countries: an exploratory analysis of SHARE using three approaches. European Commission–Research Note LSE (2006)Google Scholar
  4. 4.
    Evans, R.G., Barer, M.L., Marmor, T.R.: Why are some people healthy and others not? The determinants of health of populations (social Institutions and social change). de Gruyter, New York (1994)Google Scholar
  5. 5.
    Marmot, M., Wilkinson, R.: Social determinants of health. Oxford University Press, Oxford (1999)Google Scholar
  6. 6.
    Wagstaff, A., van Doorslaer, E., Watanabe, N.: On decomposing the causes of health sector inequalities with an application to malnutrition inequalities in Vietnam. J. Econ. 112(1), 207–223 (2003)Google Scholar
  7. 7.
    van Doorslaer, E., Koolman, X.: Explaining the differences in income-related health inequalities across European countries. Health Econ. 13(7), 609–628 (2004)CrossRefGoogle Scholar
  8. 8.
    Jusot, F., Tubeuf, S., Trannoy, A.: Tel père, tel fils: L’influence de l’origine sociale et familiale sur la santé des descendants en Europe. In: Attias-Donfut C, Sirven N (eds) Famille et vieillissement en Europe—Enquête Share. Retraite et Société 11, 63–85 (2009)Google Scholar
  9. 9.
    Lefranc, A., Pistolesi, N., Trannoy, A.: Le revenu selon l’origine sociale. Economie Statistique 371, 49–82 (2004)CrossRefGoogle Scholar
  10. 10.
    Case, A., Fertig, A., Paxson, C.: The lasting impact of childhood health and circumstance. J. Health Econ. 24, 365–389 (2005)CrossRefGoogle Scholar
  11. 11.
    Currie, J., Hyson, R.: Is the impact of health shocks cushioned by socioeconomic status? The case of birth weight. Am. Econ. Rev. 89(2), 2455–2550 (1999)CrossRefGoogle Scholar
  12. 12.
    Elstad, J.I.: Childhood adversities and health variations among middle-aged men: a retrospective lifecourse study. Eur. J. Pub. Health 15(1), 51–58 (2005)CrossRefGoogle Scholar
  13. 13.
    Hyde, M., Jakub, H., Melchior, M., Van Oort, F., Weyers, S.: Comparison of the effects of low childhood socioeconomic position and low adulthood socioeconomic position on self-rated health in four European studies. J. Epidemiol. Commun. Health 60, 882–886 (2006)CrossRefGoogle Scholar
  14. 14.
    Melchior, M., Lert, F., Martin, M., Ville, I.: Socioeconomic position in childhood and in adulthood and functional limitations in midlife: data from a nationally-representative survey of French men and women. Soc. Sci. Med. 63(11), 2813–2824 (2006)CrossRefGoogle Scholar
  15. 15.
    Melchior, M., Berkman, L.F., Kawachi, I., Krieger, N., Zins, M., Bonenfant, S.: Lifelong socioeconomic trajectory and premature mortality (35–65 years) in France: findings from the GAZEL cohort study. J. Epidemiol. Commun. Health 60, 937–944 (2006)CrossRefGoogle Scholar
  16. 16.
    Power, C., Hertzman, C.: Social and biological pathways linking early life and adult disease. Br. Med. Bull. 53(1), 210–221 (1997)Google Scholar
  17. 17.
    Trannoy, A., Tubeuf, S., Jusot, F., Devaux, M.: Inequality of opportunities in health in France: a first pass. Health Economics, Jul 8. [Epub ahead of print] (2009)Google Scholar
  18. 18.
    Bourdieu, P.: Power and ideology in education. In: Karabel, J., Halsey, A.H. (eds.) Cultural reproduction, social reproduction. Oxford University Press, Oxford (1977)Google Scholar
  19. 19.
    Marks, G.: Declining inequality? The changing impact of socio-economic background and ability on education in Australia. Br. J. Sociol. 54(4), 453–471 (2003)CrossRefGoogle Scholar
  20. 20.
    Lefranc, A., Pistolesi, N., Trannoy, A.: The link between inequality of opportunity for income acquisition and income inequality: the French example 1977–1993. Mimeo (2007)Google Scholar
  21. 21.
    Rosa-Dias, P.: Inequality of opportunities in health: evidence from a UK cohort study. Health Econ. 18(9), 1057–1074 (2009)CrossRefGoogle Scholar
  22. 22.
    Lefranc, A., Pistolesi, N., Trannoy, A.: Inequality of opportunities vs inequality of outcomes: are Western societies all alike? Rev. Income Wealth 54(4), 513–546 (2006)CrossRefGoogle Scholar
  23. 23.
    Jürges, H.: True health vs response styles: exploring cross-country differences in self-reported health. Health Econ. 16(2), 163–178 (2007)CrossRefGoogle Scholar
  24. 24.
    van Doorslaer, E., Jones, A.: The determinants of self-reported health inequalities: validation of a new approach to measurement. J. Health Econ. 22, 61–87 (2003)CrossRefGoogle Scholar
  25. 25.
    Börsch-Supan, A., Brugiavini, A., Jürges, H., Mackenbach, J.P., Siegrist, J., Weber, G.: Health, ageing and retirement in Europe—first results from the Survey of Health, Ageing and Retirement in Europe. MEA, Mannheim (2005)Google Scholar
  26. 26.
    Idler, E.L., Benyamini, Y.: Self-rated health and mortality: a review of twenty-seven community studies. J. Health Social Behav. 38, 21–37 (1997)CrossRefGoogle Scholar
  27. 27.
    Kerkhofs, M., Lindeboom, M.: Subjective health measures and state dependent reporting errors. Health Econ. 4, 221–235 (1995)CrossRefGoogle Scholar
  28. 28.
    Groot, W.: Adaptation and scale of reference bias in self-assessments of quality of life. J. Health Econ. 19, 403–420 (2000)CrossRefGoogle Scholar
  29. 29.
    Sadana, R., Colin, D.M., Lopez, A.D., Murray, C.J.L., Moessgaard Iburg, K.M. Comparative analyses of more than 50 household surveys on health status. Summary Measures of Population Health. World Health Organization (2003)Google Scholar
  30. 30.
    Garcia Gomez, P., Lopez, A.N. Regional differences in socio-economic health inequalities in Spain 1973/74–2003. 2007Google Scholar
  31. 31.
    Lecluyse, A., Cleemput, I.: Making health continuous: implications of different methods on the measurement of inequality. Health Econ. 15(1), 99–104 (2006)CrossRefGoogle Scholar
  32. 32.
    Olsen, K., Dahl, S.A.: Health differences between European countries. Soc. Sci. Med. 64(8), 1665–1678 (2007)CrossRefGoogle Scholar
  33. 33.
    Baclet, A. Les seniors: des revenus plus faibles pour les plus âgés, compensés par un patrimoine plus élevé. Les revenus et le patrimoine des ménages. 2006 edn. France: INSEE, pp. 25–37 (2006)Google Scholar
  34. 34.
    Jusot, F.: The shape of the relationship between mortality and income in France. Annales d’Economie et de Statistique 83–84, 89–122 (2006)Google Scholar
  35. 35.
    van Doorslaer, E., Wagstaff, A., Bleichrodt, H., Calonge, S., Gerdtham, U.G., et al.: Income-related inequalities in health: some international comparisons. J. Health Econ. 16, 93–112 (1997)CrossRefGoogle Scholar
  36. 36.
    Marmot, M., Friel, S., Bell, R., Houweling, T., Taylor, S.: On behalf of the commission on social determinants of health. Closing the gap in a generation: health equity through action on the social determinants of health. Lancet 372, 1661–1669 (2008)CrossRefGoogle Scholar
  37. 37.
    Epstein, D., Jimenez-Rubio, D., Smith, P.C., Suhrcke, M.: Social determinants of health: an economic perspective. Health Econ. 18(5), 495–502 (2009)CrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  1. 1.Academic Unit of Health Economics, Leeds Institute of Health SciencesUniversity of LeedsLeedsUK
  2. 2.LEGOSUniversité Paris-DauphineParis Cedex 16France

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