Policies which increase support to families where both parents are earners decrease infant mortality, while those that increase support to traditional male earner/female stays at home families do not. Further, more generosity in the basic state pension is more effective than the generosity of earnings-related pensions at reducing excess mortality in old age. These are the conclusions of authors of an Article in this week's Social Determinants of Health Special Issue of The Lancet, written by Professor Olle Lundberg, Stockholm University/Karolinska Institutet, Sweden, and colleagues.
While all rich nations have welfare support programmes, their design and generosity vary between nations and these differences are reflected in the variety in poverty rates, especially among children and elderly people. The authors analysed infant mortality rates and old-age excess mortality rates in relation to social policy characteristics and generosity, for 18 OECD* countries during 1970-2000 for family policies and 1950-2000 for pension policies.
They found that increased generosity in family policies that support dual-earner families is linked with lower infant mortality rates, whereas the generosity in family policies that support more traditional families with gainfully employed men and homemaking women is not. An increase by one percentage point in dual-earner support lowers infant mortality by 0•04 deaths per 1000 births. Generosity in basic security type of pensions is linked to lower old-age excess mortality, whereas the generosity of earnings-related income security pensions is not. An increase by one percentage point in basic security pensions is associated with a decrease in the old age excess mortality by 0•02 for men as well as for women.
The authors conclude: "The ways in which social policies are designed, as well as their generosity, are important for health because of the increase in resources that social policies entail. Hence, social policies are of major importance for how we can tackle the social determinants of health."
In an accompanying Comment, Dr Steinar Westin, Norwegian University of Science and Technology, Norway, says: "Targeting of 'the truly needy' may seem economically attractive, but implies stigmatisation and 'more tests of the poor'. Furthermore, economic research shows that universal welfare programmes might be more effective in achieving sustained alleviation of poverty because such programmes are more likely to retain political support among voters."
Professor Olle Lundberg, Stockholm University/Karolinska Institutet, Sweden T) +46 733 99 75 59 E) Olle.Lundberg@chess.su.se
Dr Steinar Westin, Norwegian University of Science and Technology, Norway T) + 47 90 69 25 60 E) steinar.westin@ntnu.no
Notes to editors: OECD= Organisation for Economic Co-operation and Development
Full Article, Comment, Editorial: http://press.thelancet.com/welfare.pdf
Journal
The Lancet