Health inequalities in European welfare states

A controversial and puzzling finding from studies on health inequalities is that countries that have managed to reduce inequalities in social and economic conditions, itself powerful determinants of health, are not necessarily characterized by smaller inequalities in health. Fifteen years after the Black Report, a breakthrough in research comparing the magnitude of health inequalities across western European countries was made, providing the first comprehensive evidence on the unexpected patterning of health inequalities: relative inequalities in ill-health and mortality were not smaller in the Nordic welfare states than elsewhere in western Europe.1 Since then scholars have been puzzled by the issue of why affluent Nordic countries with advanced welfare state arrangements and egalitarian policies share large health inequalities with other western European countries. Subsequent studies looking at changes over time have not altered the picture.2–4 A number of viewpoints can be … Correspondence: Eero Lahelma, Department of Public Health, University of Helsinki, P.O.B. 41, 00014 University of Helsinki, Finland, e-mail: eero.lahelma{at}helsinki.fi