Education and health across lives, cohorts, and countries : a study of cumulative (dis)advantage in Germany, Sweden, and the United States

Defence date: 4 May 2017Examining Board: Professor Hans-Peter Blossfled, European University Institute (Supervisor); Professor Fabrizio Bernardi, European University Institute; Professor Johan Mackenback, Erasmus Medical Centre, University of Rotterdam; Professor Johan Fritzell, CHESS, University of StockholmAccording to the cumulative (dis)advantage hypothesis, social disparities in health increase over the life course. Evidence on this hypothesis is largely limited to the U.S. context. The present dissertation draws on recent theoretical and methodological advances to test the cumulative (dis)advantage hypothesis in two other contexts – Sweden and West Germany. Three empirical studies examine the core association between socioeconomic position and health (a) from a life-course perspective considering individual change, (b) from a cohort perspective considering socio-historical change, and (c) from a comparative perspective considering cross-national differences. The analyses are based on large-scale longitudinal data from the Swedish Level of Living Survey, the German Socio-economic Panel Study, the Health and Retirement Study, and the Survey of Health, Ageing and Retirement in Europe. The key analytical constructs are education as a measure of socioeconomic position and self-rated health, mobility limitations, and chronic conditions as measures of health. The results show large differences within countries and between countries in the age patterns and cohort patterns of change in health inequality. In the U.S., educational gaps in health widen strongly over the life course, and this divergence intensifies across cohorts. In Sweden, health gaps are much smaller, widen only moderately with age, and remain stable across cohorts. In Germany, health gaps widen with age and across cohorts, but these patterns pertain only to men. Taken together, these findings show that health inequality across lives and cohorts is mitigated in Western European welfare states, which target social inequality in health-related resources. In the U.S. context, which is characterized by a lack of social security, unequal access to health care, and large social disparities in quality of living, health inequality increases across lives and cohorts.Chapter 2 ‘Cumulative disadvantage in an egalitarian country? Socioeconomic Health Disparities over the Life Course in Sweden' of the PhD thesis draws upon an earlier version published as an article 'Cumulative advantage in an egalitarian country? : socioeconomic health disparities over the life course in Sweden' (2016) in the journal ‘Journal of health and social behavior