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An institutional theory of welfare state effects on the distribution of population health

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Abstract

Social inequalities in health endure, but also vary, through space and time. Building on research that documents the durability and variability of health inequality, recent research has turned towards the welfare state as a major explanatory factor in the search for causes of health inequality. With the aims of (i) creating an organizing framework for this new scholarship, (ii) developing the fundamental-cause approach to social epidemiology and (iii) integrating insights from social stratification and health inequalities research, we propose an institutional theory of health inequalities. Our institutional theory conceptualizes the welfare state as an institutional arrangement – a set of ‘rules of the game’ – that distributes health. Drawing on the institutional turn in stratification scholarship, we identify four mechanisms that connect the welfare state to health inequalities by producing and modifying the effects of the social determinants of health. These mechanisms are: redistribution, compression, mediation and imbrication (or overlap). We describe how our framework organizes comparative research on the social determinants of health, and we identify new hypotheses our framework implies.

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Acknowledgements

This article is part of the HiNEWS project – Health Inequalities in European Welfare States funded by the NORFACE (New Opportunities for Research Funding Agency Cooperation in Europe) Welfare State Futures programme (grant reference:462-14-110). For more details on NORFACE see www.norface.net/11.

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Authors and Affiliations

  1. Department of Sociology, Harvard University, 33 Kirkland Street, Cambridge, 02138, MA, USA

    Jason Beckfield

  2. Department of Geography, Centre for Health and Inequalities Research (CHIR), Centre for Health and Inequalities Research (CHIR), Durham University, Durham, DH1 3LE, UK

    Clare Bambra

  3. Department of Sociology and Political Science, Norwegian University of Science and Technology, 7491 Trondheim, Norway

    Terje A Eikemo & Courtney McNamara

  4. Centre for Primary Care and Public Health, Queen Mary, University of London, Yvonne Carter Building, 58 Turner Street, London, E1 2AB, UK

    Tim Huijts

  5. Chair of Sociology of Health and Healthcare Systems, University of Siegen, Adolf-Reichwein-Straße 257068, Siegen, Germany

    Claus Wendt

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  1. Jason Beckfield
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  2. Clare Bambra
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  3. Terje A Eikemo
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  6. Claus Wendt
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Correspondence to Jason Beckfield.

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Beckfield, J., Bambra, C., Eikemo, T. et al. An institutional theory of welfare state effects on the distribution of population health. Soc Theory Health 13, 227–244 (2015). https://doi.org/10.1057/sth.2015.19

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