Gesundheit und soziale Ungleichheit
Health inequalities by socio-economic status (SES) persist even in the most advanced and egalitarian welfare states (Beckfield, Olafsdottir, & Bakhtiari, 2013; Elo, 2009): Inan analysis of health inequalities by level of education in 25 EU member states for the year 2010, adults with a degree at the lower secondary level had 2.8 times higher odds of reporting poor or very poor general health than adults with a tertiary degree. The odds ratio for reporting a long-standing illness was 1.5 (European Commission, 2013, Table 3.1). These marked and systematic inequalities in health are a societal challenge in their own right—but the importance of the issue does not end there: While causality can be difficult to establish, research also indicates that bad health is an important proximate cause of other major social problems such as economic inactivity, long-term unemployment, and involuntary early retirement (e.g., Heisig, 2015; Herbig, Dragano, & Angerer, 2013).
One of the most striking findings of extant research is that systematic inequalities in physical and mental health exist already very early in life: the health of young children shows a clear association with family background and the relationship grows stronger over the course of childhood and adolescence (Case, Lubotsky, & Paxson, 2002; Currie,2009; Reinhold & Jürges, 2012; Seyda & Lampert, 2010). Moreover, childhood and even in utero circumstances continue to predict health outcomes and mortality much later in life, even after accounting for individuals’ own educational attainment and socioeconomic resources in adulthood (Galobardes, 2004; Gluckman, Hanson, Cooper, &Thornburg, 2008; Hayward & Gorman, 2004; Montez & Hayward, 2014). Thus, health chances and life expectancy are strongly tied to the ‘lottery of birth’ (e.g., Heckman,2011).
The links between socioeconomic background and health further suggest that health plays a crucial role in the intergenerational transmission of economic advantage (Case et al., 2002; Corak, 2013; Currie, 2009). In his 2006 presidential address to the Population Association of America, Alberto Palloni (2006, p. 609) even speculated that the importance of childhood health for the intergenerational transmission of inequality is ‘comparable to the effects of variables and factors to which we routinely give more attention’ such as educational attainment. Palloni called for greater efforts to understand the link between social background and health, a plea that, more than ten years later, has lost nothing of its force.
Against this background, the research group seeks to better understand the complex life course processes that link social background to physical and mental health and that underlie the well-documented cross-sectional associations between health and other dimensions of social inequality. The overarching research questions of the group are: Which channels link family background to health at different stages of the life course? How do health inequalities affect inequalities in other domains such as educational and labor market attainment? How do these other dimensions in turn affect social inequalities in health? And: To what extent are these relationships moderated by public policy and other institutional factors?
The group will draw on a variety of theoretical and empirical approaches to answer these overarching questions, but its unifying theme is that it seeks to understand health inequalities within a comparative life course framework (Ben-Shlomo, Mishra, & Kuh,2014; Corna, 2013; Mayer, 2009). More specifically, the core work of the group will pursue the following main objectives:
1. to provide a comprehensive and detailed picture of the mechanisms that link social background to health in (early) adulthood by using a variety of longitudinal data sources to accurately measure mediating channels such as childhood poverty, family instability, and health behaviors,
2. to zero in on the dynamic processes that underlie SES-related differences in health by studying the incidence and consequences of adverse health events and of potential triggers of health problems such as (parental) unemployment or divorce, paying attention to behavioral responses (’coping’), and
3. to address the shortage of comparative work on the link between social background and health to gain novel and important insights about the moderating influence of national-level factors such as social policy, health care systems, and income inequality.