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TheinfluenceofgenderequalitypoliciesongenderinequalitiesinhealthinEurope
LaiaPalència1,2,3
,DavideMalmusi1,2,3
,DeborahDeMoortel4,LucíaArtazcoz
1,2,3,5,Mona
Backhans6,7,ChristopheVanroelen
4,8,CarmeBorrell
1,2,3,5
1-CIBERdeEpidemiologíaySaludPública(CIBERESP),Madrid,Spain
2-HealthInformationSystemsUnit,AgènciadeSalutPúblicadeBarcelona,Barcelona,Spain
3-Institutd'InvestigacióBiomèdicaSantPau(IIBSantPau),Barcelona,Spain
4-InterfaceDemography,DepartmentofSociology,VrijeUniversiteitBrussel,Belgium
5-DepartmentofExperimentalandHealthSciences,UniversitatPompeuFabra,Barcelona,
Spain
6-DepartmentofPublicHealthSciences,KarolinskaInstitutet,Stockholm,Sweden
7-CentreforEpidemiologyandCommunityHealth,Stockholmcountycouncil,Solna,Sweden
8-HealthInequalitiesResearchGroup(GREDS),UniversitatPompeuFabra,Barcelona,Spain
Addressforcorrespondence:CarmeBorrell
AgènciadeSalutPúblicadeBarcelona
PlaçaLesseps108023Barcelona;Spain
Tel:34-93-2027771;Fax:34-93-3686943
e-mail:cborrell@aspb.cat
Publishedon:SocialScience&Medicine;Volume117,September2014,Pages25–33
http://www.sciencedirect.com/science/article/pii/S027795361400447XAcknowledgements
ThisresearchwassupportedbytheEuropeanCommunity’sSeventhFramework
Programme(FP7/2007–2013,grantagreement278173):“Evaluatingtheimpactof
structuralpoliciesonhealthinequalitiesandtheirsocialdeterminantsandfostering
change(Sophie)”project;bythePlanNacionaldeInvestigaciónCientífica,Desarrolloe
InnovaciónTecnológica(I+D+I)andtheInstitutodeSaludCarlosIII-Subdirección
GeneraldeEvaluaciónyFomentodelaInvestigación(grantPI12/03114);andbythe
programIntensificacióndelaActividadInvestigadora(grantedtoCarmeBorrell)
fundedbytheInstitutodeSaludCarlosIIIandbytheDepartamentdeSalut,
GeneralitatdeCatalunya.
2
ABSTRACT
Fewstudieshaveaddressedtheeffectofgenderpoliciesonwomen’shealthand
genderinequalitiesinhealth.Thisstudyaimstoanalysetherelationshipbetweenthe
orientationofpublicgenderequalitypoliciesandgenderinequalitiesinhealthin
Europeancountries,andwhetherthisrelationshipismediatedbygenderequalityat
countrylevelorbyotherindividualsocialdeterminantsofhealth.
Amultilevelcross-sectionalstudywasperformedusingindividual-leveldataextracted
fromtheEuropeanSocialSurvey2010.Thestudysampleconsistedof23,782menand
28,655womenfrom26Europeancountries.Thedependentvariablewasself-
perceivedhealth.Individualindependentvariablesweregender,age,immigrant
status,educationallevel,partnerstatusandemploymentstatus.Themaincontextual
independentvariablewasamodificationofKorpi’stypologyoffamilypolicymodels
(Dual-earner,Traditional-Central,Traditional-Southern,Market-orientedand
Contradictory).OthercontextualvariablesweretheGenderEmpowermentMeasure
(GEM),tomeasurecountry-levelgenderequality,andtheGrossDomesticProduct
(GDP).Foreachcountryandcountrytypologytheprevalenceoffair/poorhealthby
genderwascalculatedandprevalenceratios(PR,womencomparedtomen)and95%
confidenceintervals(CI)werecomputed.MultilevelrobustPoissonregressionmodels
werefitted.
Womenhadpoorerself-perceivedhealththanmenincountrieswithtraditionalfamily
policies(PR=1.13,95%CI:1.07-1.21inTraditional-CentralandPR=1.27,95%CI:1.19-
1.35inTraditional-Southern)andinContradictorycountries(PR=1.08,95%CI:1.05-
1.11).Inmultilevelmodels,onlygenderinequalitiesinTraditional-Southerncountries
weresignificantlyhigherthanthoseinDual-earnercountries.
Genderinequalitiesinself-perceivedhealthwerehigher,womenreportingworseself-
perceivedhealththanmen,incountrieswithfamilypoliciesthatwerelessorientedto
genderequality(especiallyintheTraditional-Southerncountry-group).Thiswas
partiallyexplainedbygenderinequalitiesintheindividualsocialdeterminantsof
healthbutnotbyGEMorGDP.
Keywords:genderpolicies,genderequality,self-perceivedhealth,Europe
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INTRODUCTION
Genderinequalitiesaredifferencesbetweenmenandwomenthatsystematically
empoweronegroup(men)tothedetrimentoftheother(women).Intermsofhealth,
itiswellknownthatinindustrializedcountrieswomenlivelongerthanmen,butthey
oftendoitinworsehealth(Annandale&Hunt,2000;Espelt,etal.,2010).Gender
inequalitiesinhealtharisebecauseofinequalitiesinpower,statusandfinancial
resources(Arber&Khlat,2002)aswellasofthesexualdivisionofwork(Malmusi,et
al.,2012).
Genderinequalitiesinhealthareforthemostpartsociallyproduced,andassuchthey
canbeamelioratedthroughchangesinthegenderorder(Annandale&Hunt,2000).
Genderequalitypoliciesrefertothosepoliciespromotingequalitybetweenmenand
women,includingfamilypolicies(whichseektoincreasefamilywellbeingandpromote
reconciliationbetweenpaidworkandfamily),butalsootherssuchaspolicies
promotingequalopportunitiesinthelabourmarketorequalpoliticalrepresentation
(Borrell,etal.,2014).Thesepoliciesimpactgenderinequalitiesinhealththroughtheir
effectonsocialdeterminantsofhealth,suchasthedistributionofpower,income,paid
andunpaidwork,andmoreproximalpathwayssuchasdiscrimination,violence,
financialhardshiportimepressure.Consequently,gender-equalitypoliciesatthe
countrylevelareassumedtoaffectgenderinequalities.However,fewstudieshave
investigatedtheeffectoftheorientationofgenderpoliciesonwomen’shealthoron
genderinequalitiesinhealth(Borrell,etal.,2014).
Agenderpolicyregimeissaidtoentailalogicbasedontherulesandnormsabout
genderrelationsthatinfluencestheconstructionofpolicies(Sainsbury,1999).The
majorityofgenderpolicytypologiesproposedsofarhavebeenbaseduponcriticisms
toEsping-Andersen’s(Esping-Andersen,1990)“genderblind”classificationofwelfare
states(Sainsbury,1999).Korpi,etal.(2013)haveclassifiedcountriesintermsof
dimensionsoftheirfamilypoliciesthataffectthesituationofwomenwithrespect
topaidandunpaidwork.Thesefamilypolicymodelsarethereforebasedontheextent
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ofsexualdivisionofworktheyarepromotingandconstituteasummaryorproxy
measurefortheconfigurationofgenderequalitypoliciesinagivencountryorgroupof
countries.Somepolicymodelsaresupportiveofthetraditionalfamilymodel,with
menasbreadwinnersandwomenascaregivers,resultinginmorepublicsupporttothe
care-givingroleoffamilies,andabiggerorsmallerroleforthemarketinproviding
care.Otherpolicymodelsaremoresupportiveofthedual-earnermodel,whichrelies
toagreatextentontheprovisionofpublicservicesforcare,inturn,makingwomen
moreindependentfromtheirfamily.ThismodelismainlyrepresentedbytheNordic
countries,whichareusuallybetter-offintermsofgenderequitythantheothers.A
recentreviewhaspartiallysupportedthethesisthatintheNordiccountriesthe
socioeconomicpositionofwomenisbetterandgenderinequalitiesinhealthare
smaller,althoughtheneedforfurtherstudieswashighlighted(Borrell,etal.,2014).
In recent decades, there has also been an interest inmeasuring gender equality at
country level and several indices summarizing the complexity of different gender
equalityindicatorshavebeendeveloped.ExamplesofthesearetheGenderInequality
Index -http://hdr.undp.org/en/statistics/gii/-, theGender-relatedDevelopment Index
and the Gender Empowerment Measure -http://hdr.undp.org/en/-, the Gender
Equality Index -http://eige.europa.eu/content/gender-equality-index- or the Gender
Gap Index -http://www.weforum.org/issues/global-gender-gap-). Most of these
indices include health-related indicators, so correlating them with inequalities in
healthcouldberedundant.Anindexthatdoesnotcontainanyhealthindicatoristhe
GenderEmpowermentMeasure(GEM)(UNDP,2009),whichisameasureofwomen’s
agency based on their participation and decision-making power in the political and
economicspheresandpowerovereconomicresources.
Recently,somestudieshavelookedattheeffectofgenderequalityatthecountry
levelongenderinequalitiesinhealth(Dahlin&Härkönen,2013;VandeVelde,etal.,
2013;VanTuyckom,etal.,2013;Wells,etal.,2012)andonehasconsideredtheeffect
oftheorientationofgenderpoliciesongendergapsinmortality(Backhans,etal.,
2012).AsinthestudybyBackhansetal.,wetakeintoaccountbothapolicytypology
andagenderequalityindicator,althoughinthepresentstudywefocusonself-
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perceivedhealth,whichisanindicatorgenerallyshowingwomentobedisadvantaged
comparedtomen.Moreover,thepresentstudynotonlyconsidersawiderrangeof
Europeancountries,includingsomeofEasternEurope,butalsothepotentialinfluence
ofindividual-levelsocialdeterminantsofhealth(bothasmediatorsandeffect
modifiers).Thus,theaimofthisstudyistogenerateevidenceontherelationship
betweentheorientationofpublicgenderequalitypoliciesandgenderinequalitiesin
healthinEuropeancountries,andtodeterminewhetherthisrelationshipismediated
bygenderequalityatcountrylevelorbyotherindividualsocialdeterminantsofhealth.
Ourhypothesisisthatcountrieswithmoreequitablegenderpolicieswillachievemore
equalityinhealth,becauseofthehighergenderequalityatboththecountryleveland
thelevelofindividualsocialdeterminantsofhealthsuchaseducationallevel,
employmentstatusorincome.
METHODS
Design,studypopulationandinformationsources
Amultilevelcross-sectionalstudywasperformed,usingindividual-leveldataonhealth,
genderandothersocialdeterminantsofhealth,andcountry-leveldataonfamilypolicy
modelsandGEMastheindicatorofgenderequality.Individualdatawasobtained
fromthe5throundoftheEuropeanSocialSurvey(2010).Thisisanacademically
drivencross-nationalsurveythatusesrepresentativesamplesofallpersonsaged15
andoverresidinginprivatehouseholdsinEuropeancountries
(http://www.europeansocialsurvey.org).Inthisstudyweuseddatafrom26countries
(Belgium,Bulgaria,Switzerland,Cyprus,CzechRepublic,Germany,Denmark,Estonia,
Spain,Finland,France,UnitedKingdom,Greece,Croatia,Hungary,Ireland,Lithuania,
Netherlands,Norway,Poland,Portugal,RussianFederation,Sweden,Slovenia,Slovakia
andUkraine).Individualdatawasavailableforanadditionalcountry(Israel),butwhich
didnotenterthestudyasnoneoftheclassificationsoffamilypolicyregimesincluded
it.Responseratesinthecountriesrangedfrom30.5%inGermanyto81.4%inBulgaria.
Finally,thestudysampleconsistedof23,782menand28,655women.
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Variables
Ourdependentvariablewasself-perceivedhealthmeasuredthroughthequestion:
“Howisyourhealthingeneral?Wouldyousayitisverygood,good,fair,bad,or,very
bad?”.Theanswerwasdichotomisedintogood(verygood,good)andpoor(fair,bad,
verybad)(Manor,etal.,2000).
Ourmainindependentvariablewasgendermeasuredasmanorwoman.Other
individualsocialdeterminantsofhealthusedwere:A)age,usedbothasacontinuous
variableforstandardisationandadjustmentandasacategoricalvariablefor
stratification(15-19,20-34,35-49,50-64,65+).B)Beinganimmigrantfromacountry
otherthananadvancedeconomyusingthedefinitionoftheInternationalMonetary
Fund(2013).Althoughthisvariablemaynotbeanimportantdeterminantofgender
inequalitiesinhealthitwasimportantforustoconsidertheintersectionsbetween
differentaxesofinequality.C)Educationallevel,measuredbytheInternational
StandardClassificationofEducation(ISCED),whichwemergedinto‘uptolower
secondaryeducation’(ISCED0,1or2),‘uppersecondaryandpost-secondarynon-
tertiaryeducation’(ISCED3,4or5)and‘tertiaryeducation’(ISCED6,7or8).D)
Partnerstatus,classifiedas:nevermarried;separated,divorcedorwidowed;
cohabitingbutnotmarried;ormarried.E)Employmentstatus:forthoseonpaidwork
occupationswereclassifiedasprofessional,servicesandmanualwork,usingthe
InternationalClassificationofOccupationsISCO-88.Otherstatusesoutofemployment
were:student,unemployed,disabledorretired,doinghouseworkorlookingafter
childrenorotherpersons(named“housework”inthetables),andothers.
Ourmainindependentvariableatthecontextuallevel,usedasaproxyfortypologies
ofcountrieswithdifferentgenderequalitypolicies,wasthetypologyoffamilypolicy
modelsinitiallydevelopedbyKorpi(2000),whichhasbeenrevisedrecently(Korpi
2010;Korpi,etal.,2013).Asstatedabove,thesefamilypolicytypologiesare
multidimensionalandareembeddedinawidersocialcontext,andtheyareusefulto
assesstheimpactofdifferentpoliciesonthesituationofmenandwomenin
employmentandalsoothereconomicoutcomes.Moreover,Korpi’sframework
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encompassesmanymoreEuropeancountriesthanotherexistingclassifications.Korpi
classifiedcountriesin3groups(Box1).ThefirstgroupconsistsofcountrieswithDual-
earnersupport,whicharecharacterisedbypolicyinstitutionsthatencouragewomen’s
continuouslabourforceparticipationandattempttoredistributecaringworkwithin
thefamily(Nordiccountries).ThesecondgroupiscountrieswithTraditionalfamily
policies,presumingthatwomenhavetheprimaryresponsibilityforcareathome.In
thesecountrieswomenenterpaidworkprimarilyassecondaryearners,whilecare
withinfamiliesissubsidizedbythestate(continentalEurope).AthirdgroupisMarket-
orientedcountries,characterizedbyastrongbreadwinnermodelinwhichthemarket
istheprincipalinstitutiongoverningindividuals’andfamilies’accesstoresources.
Korpi’sthreemaincategoriesweresubsequentlyexpandedthroughafourthanda
fifthmodel.Thefourthmodel,whichsimultaneouslyattemptstobothpreservehighly
gendereddivisionsoflabourandsupportforthedual-earnerfamily,hasbeenlabeled
“Contradictory”andismostclearlyrepresentedbyEasternEuropeanorTransition
countries(Boye,2011;Ferrarini&Sjoberg,2010).Finally,becausethesetofcountries
incontinentalEuropeisveryheterogeneousintermsofgenderpolicies,wehave
createdanewcategorywithallSouthernEuropeancountries(Traditional-Southern)
separatingthemfromothercontinentalcountrieswhicharenamedTraditional-
Central.Thecreationofsuchanadditionalcategoryforfamilypolicieshadalready
beensuggestedinearlierresearch(Thévenon,2011).
AdditionalindependentvariablesatthecontextuallevelaretheGEMof2009,which
attemptstomeasuretheextentofgenderinequalityacrosscountriesbasedonthe
proportionofseatsheldbywomeninnationalparliaments,percentageofwomenin
economicdecisionmakingpositionsandfemaleshareofincome(UNDP,2009).The
GrossDomesticProduct(GDP)of2010(WorldBank)wasusedasaconfounding
variableasgenderequalityscoresusuallytendtobehigherinmoreeconomically
advancedcountries.
Analyses
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Weightsderivedfromthesampledesignwereusedinallcalculations.Severalofthe
sampledesignsusedbycountriesparticipatingintheEuropeanSocialSurveywerenot
completelyrandom.Thedesignweightcorrectsfortheseslightlydifferentprobabilities
ofselection,therebymakingthesamplemorerepresentativeofa‘true’populationof
individualsaged15andoverineachcountry.
Age-standardisedprevalence(using10-yearagegroupsandstandardisedbythedirect
method(Rué&Borrell,1993)beingthetotalsampleweightedbycountrythe
referencepopulation)ofpoorself-perceivedhealthwascalculatedbygenderforeach
countryandtypology.Prevalenceratios(PR)ofpoorself-perceivedhealthinwomen
comparedtomenwerecalculatedbyfittingPoissonregressionmodelswithrobust
variance(Zou,2004)adjustedbyageineachcountryandineachcountrytypology(in
thiscasealsoadjustingbycountry).Ineachcountrytypology,PRofpoorself-perceived
healthinwomencomparedtomenwerealsocalculatedstratifyingbyeachsocial
determinantofhealthconsidered.Finally,todetermineifgenderinequalitiesvaried
accordingtocountrytypology,multilevel(Diez-Roux,2000)robustPoissonregression
modelswerefitted.Amodelwithrandominterceptandgenderslope,includingthe
typologyasapredictorofthegenderslopewasconductedtoseeifgenderinequalities
variedbycountrytypologygroup(model1).Thismodelwassubsequentlyaugmented
byaddingindividualvariables(model2),thenGEM(model3)andthenGDP(model4)
aspredictorsofthegenderslopetodetermineifthesevariablesmediatedtheeffectof
thecountrytypologyongenderinequalitiesinself-perceivedhealth.
AllanalyseswereperformedusingStata11.2forWindows,exceptthemultilevel
analyseswhichwereperformedusingHLM6.02.
RESULTS
ThedescriptionofthestudysamplebycountrytypologycanbefoundinTable1.
Severalpatternswerepresentinallcountrytypologies:womenhadpoorerhealththan
men;thepercentageofwomenwithlowereducationallevelwashigherthanamong
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men;womeninthesampleweremoreoftenseparated,divorcedorwidowedthan
men;womenweremoreoftenemployedintheservicessectororinhouseworkthan
menwhilemenweremoreofteninmanualjobs.
Prevalenceofpoorhealthrangedfrom16.6%formeninGreeceto68.4%forwomen
intheRussianFederation(Table2).Statisticallysignificantgenderinequalitiesinhealth
werenotobservedinDual-earnerorMarket-orientedcountries,whereaswomenhad
ahigherprobabilityofhavingpoorhealththanmeninTraditional-Centralcountries
(PR=1.13,95%CI:1.07-1.21),Traditional-Southerncountries(PR=1.27,95%CI:1.19-
1.35)andContradictorycountries(PR=1.08,95%CI:1.05-1.11).Thereweresome
outlierssuchasSwedenamongtheDual-earnercountries,withaPRof1.45,the
NetherlandsamongtheTraditional-Centralcountries,withaPRof1.31,andBulgariain
thegroupofContradictorycountrieswithaPRof1.33.
Genderinequalitiesvariedslightlywhenstratifyingbydifferentindividual-levelsocial
determinantsofhealth(Table3).InTraditional-Southerncountriestheywerepresent
inallagegroupsover35yearswithPRvaluesofaround1.30,whileinContradictory
countriestheywerepresentinthe20to64agerangeandespeciallynotableinthe20
to34agegroup.InTraditional-CentralandMarket-orientedcountries,thoughmodest,
inequalitiesweresignificantonlyintheoldestgroup.Incountriesofboththe
Traditionaltypologiesgenderinequalitiesseemedmoremarkedamongthosewith
lowereducation(PR=1.19inTraditional-Centraland1.26inTraditional-Southern).In
Dual-earnercountriesinequalitieswerefoundamongstudents(PR=1.51,95%CI:1.07-
2.15),alsointhesetypologiesinequalitiesseemedmorenotableamongpeoplenot
marriedbutcohabiting(PR=1.33inTraditional-Centraland1.64inTraditional-
Southerncountries).ExceptforMarket-orientedcountries,inequalitieswerehigherfor
thoseworkinginservices,butwereonlysignificantforTraditional-Centraland
Contradictorycountries.Inequalitieswereespeciallymarkedamongthoseinmanual
occupationsinTraditional-Southerncountries(PR=1.43,95%CI:1.15-1.78)andMarket-
orientedcountrieswheretheywerealmoststatisticallysignificant(PR=1.43,95%CI:
0.98-2.10).InContradictorycountriesgenderinequalitieswerefoundforthethree
categoriesofworkers.
10
Figure1presentstheresultsofthemultilevelmodels.Beforeadjustmenttherewere
genderinequalitiesinTraditional-Central(PR=1.12),Traditional-Southern(PR=1.27)
andContradictorycountries(PR=1.21).OnlyinequalitiesinTraditional-Southern
countriesweresignificantlyhigherthanthoseinDual-earnercountries(reference
category).WhenadjustingforGEMorforGEMandGDP,estimatesdidnotchange
muchbutgenderinequalitiesinTraditional-Southerncountriesceasedtobe
statisticallydifferentfromthoseobservedinDual-earnercountries.After
additionaladjustmentforindividualvariablesinequalitiesdiminishedslightlyin
Traditional-Southerncountries(PRfrom1.26to1.20)andContradictorycountries(PR
from1.16to1.09),meaningthatindividualvariablesexplainedabout23%and44%of
theinequalitiesobservedinthesecountries,respectively.
DISCUSSION
Thisstudyhasfoundgenderinequalitiesinself-perceivedhealthincountrieswith
TraditionalfamilypoliciesandincountrieswithContradictoryfamilypolicies.However,
onlygenderinequalitiesinTraditional-Southerncountriesweresignificantlydifferent
fromthoseinDual-earnercountries.Theindividualsocialdeterminantsofhealth
consideredseemtoplayarole,thoughmodest,inexplainingthesehigherinequalities.
Genderinequalitiesinhealthbycountrytypology
Inthisstudy,genderinequalitiesinhealthwerenotfoundincountrieswithDual-
earnerorMarket-orientedpolicies.AprevioussystematicreviewhasshownthatDual-
earnercountries(Nordic)seembestatpromotingwomen’shealth(Borrell,etal.,
2014).Welfarestatepoliciesmaycontributetogenderdifferencesingeneralhealth
beingsmaller,ornon-existent.Inthesecountriesthereisastronginvolvementofthe
state(mainlythroughservices)inthecareofchildren,theelderlyandthehelpless
(Sainsbury,1999),whilefathersarestimulatedtotakeamoreactivepartincaringfor
theirminorchildren,whichcanbeassumedtorelievewomenfromcareworkand
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strengthentheiroccupationalcommitment(Korpi,etal.,2013).ComparedtotheDual-
earnercountries,countrieswithMarket-orientedpoliciesareattheoppositeendof
thepublic-supportspectrum(Thévenon,2011).Howeverwedidnotfindgender
inequalitiesinhealthinthesecountries,coincidingwiththefindingbyBambraetal.
(Bambra,etal.,2009)ofreversedgenderinequalitiesinself-ratedhealthintheUK.
Theauthorsofthatstudyalsohighlightedhowchallengingtheseresultswerefor
welfarestateregimetheory.Wemustpointoutthatinourstudy,inMarket-oriented
countriesgenderinequalitieswerelargeandalmoststatisticallysignificantamong
manualworkers,possiblybecausetheyarenotabletoaffordtheservicesforfamilies
offeredbythemarket.InTraditional-CentralandContradictorycountrieswomentend
tohaveahigherprevalenceofadversegeneralhealth,comparedtomen.
Contradictorycountrieshaveahighfemaleparticipationinthelabourmarket,
inheritedfromthecommunistera,andstillhavemuchmorepublicservicesfor
dependentpeoplethan(some)Traditionalcountries.Itshouldbenotedhowever,that
theyareveryconservativeinthegenderbalanceofpoweratthefamilylevel,andthus
combineahighfemaleparticipationinpaidworkwithatraditionaldivisionof
housework.Traditional-Centralcountrieshavehighlevelsoftraditionalfamilysupport
wherewomenareresponsiblefordomesticandfamilyworkandenterthelabour
marketmostlyassecondaryearners.Inprinciplethiscouldreinforcethehypothesis
thatwomen’spoorerhealthcouldberelatedtotheirlackofpower,statusand
financialresources.
Finally,Traditional-Southerncountriespresentsignificantlyhigherinequalities
comparedtoDual-earnercountries.Traditional-Southerncountriesarecharacterized
byastrong‘‘familialism’’,withafamily/kinshipsolidaritymodelbasedonan
asymmetricalgenderdivisionofwork,lowfemaleparticipationinthelabourmarket,
theessentialroleofwomenbeingprovidingcarewithinkinships,limitedprovisionof
careservicesandlowfinancialfamilysupportbythestate.Womenareentitledtoa
relativelyshortpaidperiodofchild-relatedleaveandthereislessextensiveprovision
ofchildcareservicesthanothercountries,whilefathers’specificentitlementto
paternityleavehasonlyrecentlybeenincorporatedandisverylimited(Thévenon,
2011).Inadditionithasbeenarguedthat,inthecontextofthecurrenteconomic
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crisis,womenhavebeenpushedintothelabourmarket,whichmayaddtotheir
greaterdomesticworkload,duetominimalchildcaresupportandmen’slimited
contributiontohousework(Artazcoz,etal.,2013).Someofthesecountries(Spain,
GreeceandPortugal)alsohadlongperiodsoffascistgovernmentsduringthe
twentiethcenturywithhighrepressiondirectedattheworkingclass,regressivefiscal
policies,underdevelopedwelfarestates,andasignificantroleoftheCatholicChurch
thatreliedonwomenforthecareoffamilymembersandactivelypromotedthe
traditionalfamilymodel(Navarro&Shi,2001).Theexistinggenderinequalitiesin
healthinTraditional-Southerncountriesareconsistentwiththosefoundinother
studies(Bambra,etal.,2009),whilestudieslookingatdifferenthealthindicatorssuch
asdepression,havealsofoundthatgenderdifferencesweregreaterinEasternand
SouthernEuropeanCountriesandsmallestinNordiccountries(VandeVelde,etal.,
2010).
Wehavefoundcertainoutlier-countries,inwhichinequalitieswerehigherthaninthe
restoftheirgroup.ThishappenedforexamplefortheNetherlands.TheDutchwelfare
statehassometimesbeenclassifiedasasocial-democraticone(Bambra,2007).
However,ontheotherhand,Dutchwomenhavehighsharesofrelativelyprecarious
part-timework.AnothercountrywithhighgenderinequalitieswasSweden,mainly
duetotheverygoodhealthreportedbySwedishmen.Itseemsthatthiscountry,
althoughoneofthemostegalitarianintheworld,hasoneofthemoststronglygender
segregatedlabourmarkets(Stenmark,2010),withwomenmorelikelytoworkinthe
publicsector,inpart-timeemploymentandwithlowerwages.Moreover,ithasbeen
unabletosignificantlyaltertheunevendistributionofpowerintheeconomicsectoras
opposedtothepoliticalsectorwhereahighdegreeofgenderequityhasbeen
reached,andunabletofulfillthepoliticalgoalofsharedparentalresponsibilities
(Svensson&Gunnarsson,2012).Nevertheless,asotherNordiccountriesmayalso
sharesomeofthesefeatures,thisfindingdeservesconfirmationandfurther
explorationinmoredetailedstudies.
Individualsocialdeterminantsasmediatorsandeffectmodifiers
13
Inequalities inTraditional-SouthernandContradictorycountries fell slightlywhenwe
controlled for individual-level mediators. In Traditional-Southern countries, in fact,
inequalitieswereespeciallyhighinolderpeople, inthosenotmarriedbutcohabiting
andinmanualworkers.Apreviousstudyfoundthatinmanualclasses,unmarriedbut
cohabitingwomenhadworsehealththanmarriedandcohabitingwomen(Artazcoz,et
al., 2011). It couldbe that cohabitantsmore frequentlyhave relationshipsofpoorer
quality andwith greater instability compared tomarried couples and thatmarriage
qualityaffectswomenmore thanmen. InTraditional-SoutherncountriesCatholicism
historically had a very important role (Ferrera, 1996), this could be a reason why
marriageseemstobemoreimportantherethaninothertypologies.
Regardinggenderinequalitiesbyemploymentstatusgenderinequalitiestendedtobe
lowerinprofessionalworkersthaninotheroccupationalcategories;afactthatdiffers
fromtheresultsofthestudybyCampos-Sernaetal.(2013)whichfoundthatgender
inequalitiesintheexposuretowork-relatedpsychosocialhazardswerepresentinthe
majorityofwelfarestateregimesbutweremoreimportant inmangers/professionals
thaninclerk/service/shopandmanualworkers.
Genderhealthinequalitiesinmanualclassesexistedinallcountrytypologiesexceptin
Dual-EarnerandTraditional-Central.KorpiarguedthatDual-earnerpoliciesappearto
be more efficient in terms of getting women without tertiary education into
employment(Korpi,etal.,2013).PerhapsinTraditionalcountriesthereisaselection
processwhereby onlywomen in financial strain enter the labourmarket asmanual
workers. Another possibility could be that in Traditional-Southern countries a
disproportionate number of femalemanualworkers are employed in poorer quality
jobs. InContradictory countries it seems that the sourcesof gender inequality could
differ from those in Traditional countries as inequalities were mostly observed in
youngwomenandinthethreegroupsofworkers.Thiscouldreflectthedoubleburden
of family and paid work for women since in these countries although women’s
engagementinthelabourmarketishighthereisalowemphasisonpoliciesenabling
womentocombinemotherhoodwithpaidwork(Thévenon,2011).
14
Thereweresurprisinglylargegenderinequalitiesingeneralhealthamongstudentsin
Dual-earnercountries.Someauthorshavepointedoutthatthelonghistoryoffocusing
ongenderequalityinthosecountriesmeansthatyoungergenerationsaretakingitfor
granted(Sümer,2009).Futurestudieswillhavetoconfirmthisresult.Itisalso
remarkablethatinthesecountriesgenderinequalitiesarehigheramongservice
workers.Thelatterdifferencecouldwellbeexplainedbythedifferenttypesofservice
jobsthatmenandwomenperform,especiallyregardingpay,butalsocareerprospects
andworkingenvironment–withwomenbeinginpublicsectorhealthandcaringjobs
andmeninprivatesectorjobs,primarilyinsales.
Theroleofcountrylevelgenderequality
Inthisstudytheindicatorofgenderequalitydidnotmediatetheeffectofthecountry
typologyoninequalities.Somestudieshavefoundthatdifferentmeasuresofgender
equalitywereassociatedwithgenderinequalitiesincertainhealthoutcomes(Van
Tuyckom,etal.,2013;Varkey,etal.,2010;Wells,etal.,2012),thoughothershavenot
(Dahlin&Härkönen,2013;Grittner,etal.,2012)andsomehavefoundthattheyhave
aneffectonlyincertainsocialsubgroups(Schaap,etal.,2009;VandeVelde,etal.,
2013).Asshownintheabove-mentionedreview,instudiesperformedintheUnited
States,genderequalityatthestatelevelhasalsobeenassociatedwithbetterhealth
outcomesinwomenandlowergenderinequalitiesinhealth(Borrell,etal.,2014).In
ourmodels,thoughnotsignificant,thedirectionoftherelationshipindicatedthat
higherGEM-levelswererelatedtolowerhealthinequalityatthecountrylevel(results
notshown).However,theGEMdidnotmediatetheeffectofpolicytypology.One
possibilityisthat,astheindicatorwassignificantlycorrelatedwiththecountry
typology(resultsnotshown),thetypologysomehowcapturedtheinequalitiesbetter
thantheindexdid.Anotherpossibilitycouldbethatourindicator,theGEM,ismainlya
measureofpoweroragency,whilethepathwaythroughwhichthetypologyactsisa
differentone.
Limitations
15
Thisstudyhascertainlimitations.Inthefirstplace,toourknowledge,noneofthe
existinggenderregimetypologiesincludedallthecountriesthatwereavailableinour
data.Forthatreasonweoptedforusingafamilypolicytypology.However,asstated
previously,thefamilypolicymodelcanbeseenasanindicatorofthedegreetowhich
country-levelpoliciessupportwomen’slabourforceparticipationwhichaffects
women’sself-perception,identityandbargainingpositionwithinthefamily(Backhans,
etal.,2011)andpromotesgenderequality.Inaddition,itseemsthereisacertain
heterogeneityamongtheavailabletypologiesastowherecountriesareclassified.For
example,withintheContradictorytype,someauthorshaveassertedthatcountries
suchasSloveniaorEstoniaareevolvingtowardsaDual-earnertype(Ferrarini&
Sjoberg,2010).Inaddition,Hungaryseemstobeanoutlierinitsgroupsinceit
providesmuchmorecomprehensivesupporttoparentswithyoungchildrenand
SlovakiaappearstobecomparabletomostSouthernEuropeancountries(Thévenon,
2011).Weperformedasensitivityanalysiswithoutthesecountriesandresultshardly
changed(resultsnotshown).
Also,itisworthmentioningthatwefoundlargebetween-countryinequalitiesin
people’sself-perceivedhealth.Infactpoorhealthwashighlyprevalentinsome
SoutherncountriesandinmostEasterncountries.Thisresulthasbeenreportedby
earliercomparativestudies(Carlson,1998;Eikemo,etal.,2008).Apossible
explanationforthisfindingcouldbedifferencesinwealthbutalsocountrydifferences
inpeople'sperceptionofpoorhealth(Jurges,2007).However,althoughitmayhavean
effectontheactuallevelsofself-perceivedhealth,wedonotexpectittohaveabig
effectongenderinequalities.
Finally,itisnecessarytocommentthattheeconomicrecessionthatstartedattheend
of2008hashaddifferentialeffects(anddifferentialtiming)inmanyofthesecountries.
Probably,theimpactofbudgetcutsonpublicgenderequalitypolicieshasbeen
greaterinSouthernEuropeancountries,butthesehavemainlybeenappliedsince
2010.
CONCLUSIONS
16
Genderinequalitiesinself-perceivedhealthwerehigherincountrieswithfamily
policiesthatwerelessorientedtogenderequality,especiallythoseinSouthern
Europe.Thiswaspartiallyexplainedbygenderinequalitiesintheindividualsocial
determinantsofhealthincludedinthisstudybutnotbythecountry-levelgender
equalitymeasureused(GEM).
17
TABLESANDFIGURES
Box1.TypologiesofcountriesaccordingtoKorpi’sfamilypoliciesmodel(Korpietal.2013;
FerrariniandSjöberg2013).
Typology Countries CharacteristicsDual-earner Denmark Publicpoliciesenableatransferofchildcarefromthe
familytothepublicsectorandstimulatefathersto
takemoreactivepartincaringfortheirminor
children.
Finland
Norway
Sweden
Traditional-Central Belgium Thesecountrieshavetraditionalfamilypolicieswith
highsupporttoallfamilies,asforexample:child
allowancesforminorchildren,part-timeday-care
services,homecareallowancesormarriagesubsidies.
Germany
France
Netherlands
Traditional-Southern
Cyprus Thesecountrieshaveresidualfamilypolicieswithlack
ofsupporttofamiliesandrelyonunpaidhelp.Spain,
GreeceandPortugalhavehadalongperiodorright-
wingdictatorship.
Spain
Greece
Portugal
Market-oriented Switzerland Absenceofstrongactiontosupporthouseholds,the
marketistheprincipalinstitutiongoverning
individuals’andfamilies’accesstoresources
UnitedKingdom
Ireland
Contradictory Bulgaria Simultaneouslyattemptstobothpreserveahighly
gendereddivisionofdomesticlabourandsupportthe
dual-earnerfamily.Consistofformersocialist
countrieswherefamilypolicieshavechangedafterthe
transition(beforetheyweremoresupportingto
women’slabourforceparticipation).
CzechRepublic
Estonia
Croatia
Hungary
Lithuania
Poland
RussianFederation
Slovenia
Slovakia
Ukraine
18
Table1.Distributionofthestudysampleinrelationtotheotherindividualvariablesunderstudyformenandwomen,ineachcountrytypology(%). Dual-earner Traditional-Central Traditional-South Market-oriented Contradictory Men Women Men Women Men Women Men Women Men WomenN 3,243 3,256 4,014 4,278 3,456 4,369 3,018 3,486 9,006 12,017Self-perceivedhealth Good 73.6 71.3 68.5 65.4 72.4 64.2 79.4 77.8 57.4 48.8Poor 26.4 28.7 31.4 34.5 27.6 35.8 20.5 22.2 42.3 51.0missing 0.0 0.0 0.1 0.1 0.0 0.0 0.1 0.0 0.2 0.2Age 15-19 7.2 8.5 8.2 6.5 6.6 4.6 7.5 7.9 6.8 7.920-34 20.2 19.5 18.7 20.8 22.9 22.0 26.0 21.8 25.9 21.835-49 25.1 23.8 25.3 28.6 25.5 26.5 25.4 27.9 24.2 27.950-64 26.0 24.7 27.2 25.8 22.1 24.8 22.5 24.4 26.4 24.465+ 21.5 23.5 20.4 18.3 22.8 21.9 18.4 17.9 16.2 17.9missing 0.0 0.0 0.2 0.0 0.1 0.2 0.2 0.1 0.5 0.1Borninalow-incomecountry No 95.3 94.8 92.8 92.7 93.5 92.9 89.0 91.9 94.9 94.3Yes 4.2 4.8 6.9 6.9 6.4 7.1 10.0 7.7 4.6 5.3missing 0.5 0.4 0.3 0.4 0.1 0.0 1.0 0.4 0.5 0.4Educationallevel Uptolowersecondary 25.4 28.8 27.0 31.1 51.4 54.3 33.1 35.2 21.0 21.9Uppersecondary 50.1 42.9 51.2 48.8 32.8 31.1 48.3 45.6 60.1 54.9Tertiary 24.3 27.8 21.4 19.8 15.7 14.6 16.6 17.3 18.6 23.0missing 0.2 0.5 0.4 0.3 0.1 0.0 2.0 1.9 0.3 0.2Partnerstatus Nevermarried 28.2 28.6 26.5 21.1 29.8 21.0 33.4 26.5 28.2 19.3Separated/divorced/widowed 5.5 12.4 8.0 16.2 6.0 16.9 7.9 15.7 8.7 23.7Notmarriedcohabiting 17.0 15.6 11.3 12.1 5.4 4.9 9.0 9.6 8.1 8.0Married 49.1 43.3 54.2 50.5 58.7 57.2 49.6 48.1 54.7 48.6
19
Dual-earner Traditional-Central Traditional-South Market-oriented Contradictory Men Women Men Women Men Women Men Women Men Womenmissing 0.1 0.1 0.0 0.0 0.1 0.0 0.1 0.1 0.3 0.4Employmentstatus Professionalpaidwork 29.5 27.4 27.6 25.8 15.6 11.2 22.1 20.1 17.7 19.2Servicespaidwork 6.6 16.4 7.5 14.6 10.3 15.6 7.7 16.9 7.0 13.9Manualpaidwork 20.1 5.1 19.0 5.8 23.2 9.6 22.1 5.1 26.3 8.1Student 11.0 13.9 9.9 9.0 8.4 7.6 11.2 10.0 10.6 9.0Unemployed 5.0 3.6 4.4 4.5 11.2 10.2 10.9 5.6 9.7 6.9Disabled/retired 25.7 27.9 27.2 21.9 28.7 21.1 22.3 20.4 25.2 31.0Housework 0.7 4.4 1.7 16.1 0.6 23.4 1.6 20.3 0.9 10.2Others 0.9 1.1 2.0 1.7 1.3 1.1 1.1 1.2 0.9 0.6missing 0.5 0.2 0.7 0.6 0.7 0.2 1.0 0.4 1.7 1.1
20
Table2.Numberofcases,age-standardisedprevalenceofpoorhealthandprevalenceratioofpoorhealthcomparingwomenwithmen,ineachcountryandcountrytypology.GenderEmpowermentMeasure(GEM)bycountry.
Countrytypologyandcountry Men Women PR 95%CI GEM N % N % Dual-earner Denmark 809 24.7 767 22.2 0.89 (0.75-1.05) 0.896Finland 911 33.1 967 32.3 0.98 (0.87-1.09) 0.902Norway 805 24.0 743 25.0 1.05 (0.88-1.24) 0.906Sweden 718 17.9 779 26.3 1.45 (1.20-1.75) 0.909Total* 3.243 23.8 3.256 26.5 1.05 (0.98-1.14) -Traditional-Central Belgium 820 21.8 884 25.3 1.15 (0.98-1.35) 0.874Germany 1.556 39.2 1.475 42.4 1.08 (0.99-1.18) 0.852France 802 31.2 926 34.3 1.11 (0.96-1.28) 0.779Netherlands 836 22.8 993 29.8 1.31 (1.12-1.53) 0.882Total* 4.014 33.8 4.278 37.0 1.13 (1.07-1.21) -Traditional-Southern Cyprus 482 21.4 593 28.6 1.33 (1.11-1.60) 0.603Spain 927 32.5 958 42.6 1.28 (1.14-1.44) 0.835Greece 1.189 16.6 1.526 22.7 1.39 (1.19-1.63) 0.677Portugal 858 33.9 1.292 40.7 1.21 (1.09-1.34) 0.753Total* 3.456 30.2 4.369 38.6 1.27 (1.19-1.35) -Market-oriented Switzerland 772 17.2 734 18.8 1.12 (0.91-1.38) 0.822UnitedKingdom 1.057 28.3 1.365 27.9 0.98 (0.86-1.12) 0.790Ireland 1.189 16.9 1.387 18.5 1.11 (0.92-1.32) 0.722Total* 3.018 26.3 3.486 26.5 1.04 (0.95-1.15) -Contradictory Bulgaria 1.064 26.0 1.370 34.8 1.33 (1.20-1.48) 0.613CzechRepublic 1.190 39.7 1.196 39.3 0.97 (0.88-1.07) 0.664Estonia 722 52.1 1.071 50.3 0.96 (0.88-1.04) 0.665Croatia 720 37.9 921 38.0 0.98 (0.87-1.11) 0.618Hungary 715 45.1 846 50.2 1.09 (1.00-1.20) 0.590Lithuania 603 48.1 1.074 53.8 1.10 (0.96-1.25) 0.628Poland 841 37.8 910 41.2 1.08 (0.97-1.21) 0.631RussianFederation 1.064 58.3 1.531 68.4 1.18 (1.10-1.27) 0.556Slovenia 651 39.6 750 42.8 1.08 (0.96-1.21) 0.641Slovakia 717 39.6 1.136 41.1 0.99 (0.86-1.14) 0.663Ukraine 719 61.6 1.212 67.7 1.12 (1.02-1.22) 0.461Total* 9.006 52.0 12017.0 61.0 1.08 (1.05-1.11) -
*ageandcountrystandardised
21
Table3.Prevalenceratio(PR)and95%confidenceinterval(95%CI)ofpoorhealthaccordingtogender(womencomparedtomen)globallyand
stratifyingbyotherindividualsocialdeterminantsofhealth,adjustingbyageandcountryineachcountrytypology.
Dual-earner Traditional-Central Traditional-Southern Market-oriented Contradictory PR 95%CI PR 95%CI PR 95%CI PR 95%CI PR 95%CI 1.05 (0.98-1.14) 1.13 (1.07-1.21) 1.27 (1.19-1.35) 1.04 (0.95-1.15) 1.08 (1.05-1.11)
Age 15-19 1.45 (0.93-2.26) 1.37 (0.88-2.13) 0.59 (0.22-1.60) 1.09 (0.55-2.16) 1.2 (0.84-1.71)
20-34 1.13 (0.86-1.48) 1.21 (0.99-1.48) 1.04 (0.76-1.43) 1.29 (0.95-1.74) 1.23 (1.08-1.39)
35-49 1.00 (0.83-1.22) 1.09 (0.94-1.26) 1.36 (1.12-1.66) 0.96 (0.78-1.19) 1.11 (1.03-1.20)
50-64 1.07 (0.93-1.22) 1.09 (0.98-1.21) 1.32 (1.16-1.52) 0.9 (0.75-1.07) 1.08 (1.03-1.13)
65+ 1.02 (0.92-1.14) 1.18 (1.07-1.29) 1.24 (1.16-1.33) 1.16 (1.00-1.34) 1.02 (0.99-1.06)
Borninlow-incomecountry
No 1.04 (0.96-1.12) 1.14 (1.07-1.22) 1.26 (1.18-1.35) 1.08 (0.97-1.19) 1.09 (1.05-1.12)
Yes 1.44 (0.98-2.12) 1.03 (0.82-1.29) 1.29 (0.91-1.82) 0.7 (0.47-1.05) 1 (0.90-1.11)
Education
Uptolowersecondary 1.09 (0.97-1.22) 1.19 (1.07-1.33) 1.26 (1.18-1.35) 0.99 (0.87-1.13) 1.05 (1.00-1.11)
Uppersecondary 1.05 (0.94-1.18) 1.07 (0.99-1.17) 1.14 (0.94-1.39) 1.11 (0.94-1.30) 1.09 (1.04-1.13)
Tertiary 1.01 (0.82-1.24) 1.01 (0.84-1.22) 1.24 (0.95-1.63) 1.07 (0.78-1.46) 1.1 (1.01-1.20)
Cohabiting
Nevermarried 0.95 (0.82-1.09) 1.07 (0.91-1.25) 1.08 (0.85-1.37) 1.13 (0.93-1.38) 1.04 (0.93-1.15)
Separated/divorced/widowed 0.92 (0.74-1.15) 1.01 (0.89-1.14) 1.10 (0.97-1.24) 1.02 (0.85-1.23) 1.02 (0.96-1.08)
Notmarriedcohabiting 1.20 (0.95-1.51) 1.33 (1.07-1.65) 1.64 (1.18-2.28) 1.09 (0.77-1.54) 1.15 (1.01-1.31)
Married 1.05 (0.94-1.17) 1.12 (1.03-1.22) 1.29 (1.19-1.40) 0.98 (0.85-1.13) 1.1 (1.06-1.15)
Employmentstatus
Professionalpaidwork 1.02 (0.82-1.28) 1.02 (0.86-1.21) 1.18 (0.86-1.62) 0.80 (0.59-1.10) 1.26 (1.12-1.41)
Servicepaidwork 1.33 (0.94-1.89) 1.29 (1.00-1.65) 1.32 (0.95-1.84) 0.90 (0.62-1.29) 1.24 (1.07-1.43)
Manualpaidwork 1.08 (0.81-1.43) 1.13 (0.92-1.39) 1.43 (1.15-1.78) 1.43 (0.98-2.10) 1.33 (1.21-1.45)
Student 1.51 (1.07-2.15) 1.15 (0.78-1.68) 1.01 (0.49-2.10) 1.20 (0.68-2.10) 1.13 (0.86-1.49)
Unemployed 1.29 (0.92-1.82) 1.18 (0.91-1.54) 1.22 (0.95-1.56) 0.97 (0.67-1.41) 1.1 (0.97-1.26)
Disabledorretired 1.00 (0.92-1.10) 1.17 (1.09-1.27) 1.29 (1.20-1.39) 1.03 (0.92-1.16) 0.98 (0.95-1.01)
Housework 1.06 (0.41-2.78) 0.96 (0.66-1.39) 1.11 (0.69-1.78) 0.81 (0.48-1.37) 1.28 (0.98-1.68)
Others 0.99 (0.48-2.03) 2.01 (1.11-3.64) 1.15 (0.65-2.04) 1.37 (0.48-3.88) 1.02 (0.64-1.64)
22
Figure1.Multilevelassociationsbetweengenderandself-perceivedhealthineachcountrytypology(PR:prevalenceratiosand95%CI:95%confidenceintervals).Note:*=significantlydifferentfromdual-earner(p<0.05).
Figure1a.Emptymodel
Figure1c.Individualvariables+GEM
Figure1b.Individualvariables
Figure1d.Individualvariables+GEM+GDP
23
REFERENCES
Annandale,E.,&Hunt,K.(2000).Genderinequalitiesinhealth.OpenUniversityPress
Buckingham.
Arber,S.,&Khlat,M.(2002).Introductionto'socialandeconomicpatterningof
women'shealthinachangingworld.'.SocialScience&Medicine,54(5),643-647.
Artazcoz,L.,Cortes,I.,Borrell,C.,Escriba-Aguir,V.,&Cascant,L.(2011).Social
inequalitiesintheassociationbetweenpartner/maritalstatusandhealthamong
workersinspain.SocialScience&Medicine,72(4),600-607.
Artazcoz,L.,Cortes,I.,Puig-Barrachina,V.,Benavides,F.G.,Escriba-Aguir,V.,&Borrell,
C.(2013).Combiningemploymentandfamilyineurope:Theroleoffamilypolicies
inhealth.EuropeanJournalofPublicHealth,
Backhans,M.,Burström,B.,Leon,A.P.,&Marklund,S.(2012).Isgenderpolicyrelated
tothegendergapinexternalcauseandcirculatorydiseasemortality?Amixed
effectsmodelof22OECDcountries1973--2008.BMCPublicHealth,12(1),969.
Backhans,M.C.,Burstrom,B.,&Marklund,S.(2011).Genderpolicydevelopmentsand
policyregimesin22OECDcountries,1979-2008.InternationalJournalofHealth
Services,41(4),595-623.
Bambra,C.(2007).‘Siftingthewheatfromthechaff’:ATwo-dimensionaldiscriminant
analysisofwelfarestateregimetheory.SocialPolicy&Administration,41(1),1-28.
24
Bambra,C.,Pope,D.,Swami,V.,Stanistreet,D.,Roskam,A.,Kunst,A.etal.(2009).
Gender,healthinequalitiesandwelfarestateregimes:Across-nationalstudyof13
europeancountries.JournalofEpidemiology&CommunityHealth,63(1),38-44.
Borrell,C.,Palencia,L.,Muntaner,C.,Urquia,M.,Malmusi,D.,&O'Campo,P.(2014).
Influenceofmacrosocialpoliciesonwomen'shealthandgenderinequalitiesin
health.EpidemiologicReviews,36(1),31-48.
Boye,K.(2011).Workandwell-beinginacomparativeperspective-theroleoffamily
policy.EuropeanSociologicalReview,27(1),16-30.
Campos-Serna,J.,Ronda-Pérez,E.,Moen,B.E.,Artazcoz,L.,&Benavides,F.G.(2013).
Welfarestateregimesandgenderinequalitiesintheexposuretowork-related
psychosocialhazards.Internationaljournalofoccupationalandenvironmental
health,19(3),179-195)
Carlson,P.(1998).Self-perceivedhealthineastandwesteurope:Anothereuropean
healthdivide.SocialScience&Medicine,46(10),1355-1366.
Dahlin,J.,&Härkönen,J.(2013).Cross-nationaldifferencesinthegendergapin
subjectivehealthineurope:Doescountry-levelgenderequalitymatter?Social
Science&Medicine,98,24-28.
Diez-Roux,A.V.(2000).MultilevelanalysisinpublichealthresearchAnnualReviewof
PublicHealth,21,171-192.
25
Eikemo,T.A.,Bambra,C.,Judge,K.,&Ringdal,K.(2008).Welfarestateregimesand
differencesinself-perceivedhealthineurope:Amultilevelanalysis.SocialScience
&Medicine,66(0277-9536;11),2281-2295.
Espelt,A.,Font-Ribera,L.,Rodriguez-Sanz,M.,Artazcoz,L.,Ferrando,J.,Plaza,A.etal.
(2010).Disabilityamongolderpeopleinasoutherneuropeancityin2006:Trends
ingenderandsocioeconomicinequalities.JournalofWomen'sHealth,19(5),927-
933.
Esping-Andersen,G.(1990).ThethreeworldsofwelfarecapitalismPolitypress
Cambridge.
Ferrarini,T.,&Sjoberg,O.(2010).Socialpolicyandhealth:Transitioncountriesina
comparativeperspective.InternationalJournalofSocialWelfare,19,S60-S88.
Ferrera,M.(1996).The'southernmodel'ofwelfareinsocialeurope.Journalof
EuropeanSocialPolicy,6(1),17-37.
Grittner,U.,Kuntsche,S.,Graham,K.,&Bloomfield,K.(2012).Socialinequalitiesand
genderdifferencesintheexperienceofalcohol-relatedproblems.Alcoholand
Alcoholism,47(5),597-605.
InternationalMonetaryFund.(2013).Worldeconomicoutlook,april2013:Hopes,
realitiesandrisks.Washington,DC:
Jurges,H.(2007).Truehealthvsresponsestyles:Exploringcross-countrydifferencesin
self-reportedhealth.HealthEconomics,16(2),163-178.
26
Korpi,W.(2000).Facesofinequality:Gender,class,andpatternsofinequalitiesin
differenttypesofwelfarestates.SocialPolitics:InternationalStudiesinGender,
State&Society,7(2),127-191.
Korpi,W.(2010).Classandgenderinequalitiesindifferenttypesofwelfarestates:the
socialCitizenshipIndicatorProgram(SCIP).InternationalJournalofSocialWelfare,
19,S14-S24.
Korpi,W.,Ferrarini,T.,&Englund,S.(2013).Women'sopportunitiesunderdifferent
familypolicyconstellations:Gender,class,andinequalitytradeoffsinwestern
countriesre-examined.SocialPolitics:InternationalStudiesinGender,State&
Society,20(1),1-40.
Korpi,W.,Ferrarini,T.,&Englund,S.(2009).Egalitariangenderparadiselost?re-
examininggenderinequalitiesindifferenttypesofwelfarestates.EMPLOY-
FAMNETworkshopinberlin,may,11-12.
Malmusi,D.,Artazcoz,L.,Benach,J.,&Borrell,C.(2012).Perceptionorrealillness?
howchronicconditionscontributetogenderinequalitiesinself-ratedhealth.The
EuropeanJournalofPublicHealth,22(6),781-786.
Manor,O.,Matthews,S.,&Power,C.(2000).Dichotomousorcategoricalresponse?
analysingself-ratedhealthandlifetimesocialclass.InternationalJournalof
Epidemiology,29(1),149-157.
Navarro,V.,&Shi,L.(2001).Thepoliticalcontextofsocialinequalitiesandhealth
InternationalJournalofHealthServices,31(1),1-21.
27
Rué,M.,&Borrell,C.(1993).Losmétodosdeestandarizacióndetasas.RevisionesDe
SaludPública,3,263-295.
Sainsbury,D.(1999).Genderandwelfarestateregimes.NewYork:OxfordUniversity
Press.
Schaap,M.M.,Kunst,A.E.,Leinsalu,M.,Regidor,E.,Espelt,A.,Ekholm,O.etal.
(2009).Femaleever-smoking,education,emancipationandeconomic
developmentin19europeancountries.SocialScience&Medicine,68(7),1271-
1278.
Stenmark,H.(2010).Gendersegregationintheswedishlabourmarket:Historical,
sociologicalandrationalchoiceinstitutionalismastoolsforunderstanding
inequalityandwhyitstillexists.LinköpingUniversity,DepartmentofManagement
andEngineering(IEI),PoliticalScience,MasterThesis.
Sümer,S.(2009).Thescandanaviangenderregime:Mythorreality?in:European
genderregimesandpolicies:Comparativeperspectives.Farnham,UK:Ashgate
PublishingLimited.
Svensson,E.,&Gunnarsson,A.(2012).Genderequalityintheswedishwelfarestate.
Feminists@law,2(1)
Thévenon,O.(2011).FamilypoliciesinOECDcountries:Acomparativeanalysis.
PopulationandDevelopmentReview,37(1),57-87.
UNDP.(2009).Humandevelopmentreport2009.overcomingbarriers:Humanmobility
anddevelopment.PalgraveMacmillan.
28
VandeVelde,S.,Huijts,T.,Bracke,P.,&Bambra,C.(2013).Macro-levelgender
equalityanddepressioninmenandwomenineurope.SociologyofHealth&
Illness,35(5),682-698.
VandeVelde,S.,Bracke,P.,&Levecque,K.(2010).Genderdifferencesindepressionin
23europeancountries.cross-nationalvariationinthegendergapindepression.
SocialScience&Medicine,71(2),305-313.
VanTuyckom,C.,VandeVelde,S.,&Bracke,P.(2013).Doescountry-contextmatter?
Across-nationalanalysisofgenderandleisuretimephysicalinactivityineurope
EuropeanJournalofPublicHealth,23(3),452-457.
Varkey,P.,Kureshi,S.,&Lesnick,T.(2010).Empowermentofwomenandits
associationwiththehealthofthecommunity.JournalofWomen'sHealth,19(1),
71-76.
Wells,J.C.,Marphatia,A.A.,Cole,T.J.,&McCoy,D.(2012).Associationsofeconomic
andgenderinequalitywithglobalobesityprevalence:Understandingthefemale
excess.SocialScience&Medicine,75(3),482-490.
Zou,G.(2004).Amodifiedpoissonregressionapproachtoprospectivestudieswith
binarydataAmericanJournalofEpidemiology,159(7),702-706.
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