Functional disability among middle-aged and elderly Europeans: socioeconomic patterning, burden and policies

ABSTRACT- The share of elderly population is increasing across all high-income countries. As long as such increase is not offset by improving in the health status and functional disability of older adults, there will be grave consequences for healthcare and welfare systems. The objective of this thesis is twofold: First, to determine what are the socioeconomic factors associated with the onset of functional disability and what is the associated burden for families and the healthcare system. Second, to evaluate the effectiveness of a set of policies that may prevent or mitigate the burden of functional disability either on individuals, families or in the countries’ healthcare systems. We found that functional disability is unequally distributed and hits earlier women and those with a lower socioeconomic status in terms of education and economic resources. This implies a higher burden for families through informal care that might amplify existing social inequalities. Additionally, functional disability imposes a burden on healthcare system that may be reduced through policies that aim to tackle the existing health inequalities. One such a policy may be tobacco control policies. We found that tobacco control policies, in particular tax increases and smoke-free policies, have reduced smoking prevalence among the middle-aged and older Europeans, especially among the lowest educated. Therefore, they can decrease inequalities in smoking-related diseases and subsequently in functional disability. They would also reduce the disability burden for low socioeconomic status families since quitting at old ages can still bring significantly health gains. We also found that an unemployment subsidy targeted to middle-aged disadvantaged workers who find strong difficulties to return to the labour market have positive effects in terms of mental health and hospitalizations related to work. This shows that some social policies whose primary objective is not related with health can have significant health effects, notably on the worse-off. Lastly, we analyse how an incipient long-term care system in a relatively aged country, Spain, can help to mitigate the burden that increasing functional disability imposes on the healthcare systems. Results show how public long-term care system strongly interacts with the healthcare system, giving room to increase the efficiency in the allocation of resources between the two systems. In particular, results show that long-term care benefits can reduce the non-scheduled use of healthcare services by disabled older adults, potentially saving healthcare resources. In conclusion, the process and burden of disability in Europe is unequally distributed, affecting earlier and more severely to those socioeconomically disadvantaged. However, there are health and social policies that may decrease the social gap in disability and ease its burden on the healthcare system