Recommodification and the social determinants of health: unemployment benefits, pensions and health inequalities in Sweden and England, 1991-2011

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Abstract

Background

‘Recommodification’ describes the withdrawal of previously extended social welfare, making living standards more dependent on market position. Since health is influenced by living standards, recommodification is expected to be associated with increased health inequalities.

Aim

This study investigates the recommodification of two policy domains: unemployment insurance and pensions, and their link to health inequalities between 1991 and 2011.

Methods

Two case studies were used. Using data from Health Survey for England and the Swedish Study of Income and Living Conditions, the magnitudes of health inequalities between the employed and unemployed, and between high and low educated pensioners, were computed. The magnitudes were then associated with net replacement rates of pensions and unemployment benefits.

Results

Recommodification had a stronger association with health inequalities in Sweden than in England, and a stronger association with health inequalities between the employed and unemployed than in the retired population.

Conclusion

The relationship between decommodification is not linear, but is shaped by other factors in the social context. However, recommodification has a positive or negligible association with health inequalities. In no case was there a negative association between recommodification and health inequalities.

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