Disputation: Maria Forslund

Avhandlingens titel: "From the cradle to the grave - in sickness and in health?: The welfare state and health outcomes"
Tid: 17 mars, 10.00
Plats: Hörsal D, Södra huset, Stockholms universitet

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Keywords: welfare state, sickness cash benefits, social policy, healthcare, primary care quality, cumulative dis/advantage, life course, health, self-rated health, life expectancy, mortality, socioeconomic position, education, health literacy

Abstract

Sickness, whether manifested through actual sickness or through fear of sickness, is a part of human life. Sickness cash benefits was one of the earliest social security programs implemented in modern welfare states. Previous research on how sickness benefits are associated with health outcomes has emphasized the significance of income. Sickness is a social risk in terms of income loss, and sickness benefits has the potential to compensate such losses. Just as cash benefits are an essential part of the welfare state, so are public services. Public services, and healthcare in particular, are crucial for health outcomes. Yet, comparative research on healthcare is just beginning to take off in research. This thesis extends previous research in two ways. First, the thesis considers the impact of sickness cash benefits and healthcare for health outcomes, as well as the interplay between cash and care. Secondly, the thesis applies a life course perspective aligning comparative welfare state research and cumulative dis/advantage theory. The thesis thereby contributes with new knowledge, empirically as well as theoretically, which together provides a comprehensive assessment of important links between the welfare state and population health. 

Study I examines the relationship between sickness benefits and life expectancy at age 65 in 15 OECD countries, 1960–2015. The study is novel as it applies a life course perspective on sickness benefits, combining cumulative dis/advantage theory and a comparative welfare state approach. It adds to previous research by focusing on the cumulative access cohorts have had to sickness benefits during their time active in the labour market. The results support previous research showing that universal coverage of sickness benefits appears to be associated with lower mortality. 

Study II analyses the relationship between primary care and inequalities in self-rated health based on educational attainment in 24 countries 2002–2018. Previous research has pointed to an increasing educational gradient in health over the last decades. Primary care has been argued to be especially important when aiming to reduce such health inequalities. The results show that in countries where primary care is of higher quality, the educational gradient in self-rated health is lower. 

Study III analyses the interplay between healthcare resources and sickness benefits in relation to premature mortality in a sample of 14 countries for the time period 1980–2011. The study lends support to there being an interaction effect between healthcare and sickness benefits. Although healthcare and sickness benefits are two different aspects of the welfare state, future research should consider the interplay between cash and care.  

Taken together, the thesis demonstrates the importance of considering how different aspects of the welfare state and separate policy programmes works in conjunction. The thesis further emphasizes the importance of using a life course approach in analysing health outcomes of the welfare state and social policy.