TY - JOUR A1 - Hurrelmann, Klaus A1 - Rathmann, Katharina A1 - Richter, Matthias T1 - Welche Wohlfahrtspolitik fördert die Gesundheit?: Der ungeklärte Zusammenhang von ökonomischer und gesundheitlicher Ungleichheit JF - Das Gesundheitswesen N2 - In allen hochentwickelten Ländern hat sich in den letzten 30 Jahren der Gesundheitsstatus der Bevölkerung deutlich verbessert. Ein wesentlicher Grund dafür ist die gestiegene wirtschaftliche Prosperität. Diese ist heute aber ungleicher verteilt als vor 3 Jahrzehnten. Die Unterschiede in der Verfügbarkeit materieller Ressourcen und die Diskrepanzen im sozioökonomischen Status hängen eng mit der Gesundheitslage der Bevölkerung zusammen. Ländervergleiche zeigen, dass eine auf ökonomische Gleichheit ausgerichtete Wohlfahrtspolitik, wie sie für die skandinavischen Länder typisch ist, mit relativ günstigen gesundheitlichen Indikatoren korreliert. Bisher ist allerdings nicht geklärt, wie ökonomische Ungleichheit und gesundheitliche Lage zusammenhängen. Als besonders unklar erweist sich in neueren Studien der Zusammenhang von ökonomischer und gesundheitlicher Ungleichheit. In diesem Beitrag geben wir einen Überblick zu den vorliegenden länderübergreifenden Analysen. Diese zeigen, dass die skandinavischen Länder dank ihrer intensiv umverteilenden Wohlfahrtspolitik zwar das höchste Ausmaß von ökonomischer, aber nicht von gesundheitlicher Gleichheit erreichen. Wir entwickeln auf der Basis dieser überraschenden Erkenntnis Vorschläge für künftige empirische Untersuchungen. Die Vorschläge gehen von der Annahme aus, dass in wohlhabenden Gesellschaften mit hohem Reichtum nicht mehr nur materielle, sondern verstärkt immaterielle Lebensbedingungen über die Verteilung gesundheitlicher Ungleichheit entscheiden. Als entscheidender Parameter wird die Verfügbarkeit von gesundheitsfördernden, „salutogenen” Potenzialen und Kompetenzen des Selbstmanagement in benachteiligten Gruppen der Bevölkerung postuliert. KW - ökonomische Ungleichheit KW - gesundheitliche Ungleichheit KW - Wohlfahrtspolitik KW - Skandinavisches Gesundheitsparadoxon KW - Förderung salutogener Potenziale Y1 - 2011 U6 - https://doi.org/10.1055/s-0030-1265195 SN - 1439-4421 VL - 73 IS - 6 SP - 335 EP - 343 PB - Thieme CY - Stuttgart ER - TY - JOUR A1 - Richter, Matthias A1 - Rathmann, Katharina A1 - Nic Gabhainn, S. A1 - Zambon, A. A1 - Boyce, W. A1 - Hurrelmann, Klaus T1 - Welfare state regimes, health and health inequalities in adolescence: A multilevel analysis in 32 countries JF - Sociology of Health and Illness N2 - Comparative research on health and health inequalities has recently started to establish a welfare regime perspective. The objective of this study was to determine whether different welfare regimes are associated with health and health inequalities among adolescents. Data were collected from the ‘Health Behaviour in School-aged Children’ study in 2006, including 11- to 15-year-old students from 32 countries (N = 141,091). Prevalence rates and multilevel logistic regression models were calculated for self-rated health (SRH) and health complaints. The results show that between 4 per cent and 7 per cent of the variation in both health outcomes is attributable to differences between countries. Compared to the Scandinavian regime, the Southern regime had lower odds ratios for SRH, while for health complaints the Southern and Eastern regime showed high odds ratios. The association between subjective health and welfare regime was largely unaffected by adjusting for individual socioeconomic position. After adjustment for the welfare regime typology, the country-level variations were reduced to 4.6 per cent for SRH and to 2.9 per cent for health complaints. Regarding cross-level interaction effects between welfare regimes and socioeconomic position, no clear regime-specific pattern was found. Consistent with research on adults this study shows that welfare regimes are important in explaining variations in adolescent health across countries. Y1 - 2012 U6 - https://doi.org/10.1111/j.1467-9566.2011.01433.x SN - 1467-9566 VL - 34 IS - 6 SP - 858 EP - 879 PB - Wiley-Blackwell CY - Hoboken (NJ) [u.a.] ER - TY - JOUR A1 - Hurrelmann, Klaus A1 - Rathmann, Katharina A1 - Richter, Matthias T1 - Health inequalities and welfare state regimes: a research note JF - Journal of Public Health N2 - Aim Comparative research on health and health inequalities has recently begun implementing a welfare regime perspective. The aim of the study was to review the existing evidence for identifying the determinants of health and health inequalities in highly developed welfare states and to develop a theoretical model for future research approaches. Subject A welfare state regime typology is applied to comparatively analyse (1) the relationship between the level of economic prosperity in a society and its respective level of overall population health and (2) the nature of the corresponding relationship between economic inequalities and health inequalities in different groups of countries. Results Although the Social Democratic welfare states have a relatively equal distribution of material wealth as well as the highest levels of population health, they are not characterised by the smallest levels of health inequality. Rather, with respect to health equality, conservative countries seem to perform better than social democracies. We propose a comprehensive theoretical model that takes into account different factors on the structural (macro), organisational (meso) and individual (micro) level in order to contribute to a better understanding of this important challenge for public health policy and practice. Conclusion Future research will require an appropriate theoretical model with the potential to explain health and health inequalities in different types of welfare states. On the basis of this model, future research should test the hypothesis that in highly developed countries not only economic, but also social, cultural and lifestyle factors are important in determining health outcomes in different segments of the population. KW - Welfare state KW - Health inequalities KW - Economic inequalities KW - Social determinants of health KW - Scandinavian paradox KW - Health-sensitive public policy Y1 - 2011 UR - urn:nbn:de:0168-ssoar-216295 U6 - https://doi.org/http://nbn-resolving.de/urn:nbn:de:0168-ssoar-216295 SN - 1613-2238 VL - 19 IS - 1 SP - 3 EP - 13 PB - Springer CY - Berlin [u.a.] ER - TY - JOUR A1 - Hurrelmann, Klaus A1 - Rathmann, Katharina A1 - Ottova, Veronika A1 - de Looze, Margarethe A1 - Levin, Kate A1 - Molcho, Michael A1 - Elgar, Frank A1 - Nic Gabhainn, Saoirse A1 - van Dijk, Jitse P. A1 - Richter, Matthias T1 - Macro-level determinants of young people’s subjective health and health inequalities: A multilevel analysis in 27 welfare states JF - Maturitas N2 - Objectives Cross-national studies have rarely focused on young people. The aim of this study is to investigate whether macro-level determinants are associated with health and socioeconomic inequalities in young people's health. Study design Data were collected from the Health Behaviour in School-aged Children (HBSC) study in 2006, which included 11- to 15-year old adolescents from 27 European and North American countries (n = 134,632). This study includes national income, health expenditure, income inequality, and welfare regime dummy-variables as macro-level determinants, using hierarchical regression modelling. Main outcome measure Psychosomatic health complaints and socioeconomic inequalities in psychosomatic health complaints. Results Adolescents in countries with higher income inequality and with liberal welfare tradition were associated with more health complaints and a stronger relationship between socioeconomic status and macro-level determinants compared to adolescents from countries with lower income inequality or the Social Democratic regime. National income and health expenditure were not related to health complaints. Countries with higher national income, public health expenditure and income inequality showed stronger associations between socioeconomic status and psychosomatic health complaints. Conclusion Results showed that macro-level characteristics are relevant determinants of health and health inequalities in adolescence. KW - Macro-level determinants KW - Adolescents KW - Subjective health KW - Health inequality KW - HBSC Y1 - 2015 U6 - https://doi.org/10.1016/j.maturitas.2015.01.008 SN - 0378-5122 VL - 80 IS - 4 SP - 414 EP - 420 PB - Elsevier CY - Amsterdam [u.a.] ER - TY - JOUR A1 - Hurrelmann, Klaus A1 - Rathmann, Katharina A1 - Moor, Irene A1 - Kunst, Anton E. A1 - Dragano, Nico A1 - Pförtner, Timo-Kolja A1 - Elgar, Frank J. A1 - Kannas, Lasse A1 - Baška, Tibor A1 - Richter, Matthias T1 - Is educational differentiation associated with smoking and smoking inequalities in adolescence? A multilevel analysis across 27 European and North American countries JF - Sociology of Health & Illness N2 - This study aims to determine whether educational differentiation (i.e. early and long tracking to different school types) relate to socioeconomic inequalities in adolescent smoking. Data were collected from the WHO-Collaborative 'Health Behaviour in School-aged Children (HBSC)' study 2005/2006, which included 48,025 15-year-old students (Nboys = 23,008, Ngirls = 25,017) from 27 European and North American countries. Socioeconomic position was measured using the HBSC family affluence scale. Educational differentiation was determined by the number of different school types, age of selection, and length of differentiated curriculum at the country-level. We used multilevel logistic regression to assess the association of daily smoking and early smoking initiation predicted by family affluence, educational differentiation, and their interactions. Socioeconomic inequalities in both smoking outcomes were larger in countries that are characterised by a lower degree of educational differentiation (e.g. Canada, Scandinavia and the United Kingdom) than in countries with higher levels of educational differentiation (e.g. Austria, Belgium, Hungary and The Netherlands). This study found that high educational differentiation does not relate to greater relative inequalities in smoking. Features of educational systems are important to consider as they are related to overall prevalence in smoking and smoking inequalities in adolescence. KW - HBSC KW - Adolescence KW - Educational differentiation KW - Multilevel analysis KW - Socioeconomic inequality KW - Socioeconomic status KW - Tobacco smoking Y1 - 2016 VL - 38 IS - 7 SP - 1005 EP - 1025 ER - TY - JOUR A1 - Rathmann, Katharina A1 - Ottová-Jordan, Veronika A1 - Hurrelmann, Klaus A1 - Richter, Matthias T1 - Makro-strukturelle Determinanten der Gesundheit und gesundheitlichen Ungleichheit von Jugendlichen in 27 Wohlfahrtsstaaten: Eine Mehrebenenanalyse JF - Zeitschrift für Soziologie der Erziehung und Sozialisation N2 - Dieser Beitrag untersucht die Relevanz makro-struktureller Merkmale für die Gesundheit und sozioökonomische Ungleichheit in der Gesundheit von Jugendlichen in hochentwickelten Wohlfahrtsstaaten. Datenbasis ist die internationale "Health Behaviour in School-aged Child-ren (HBSC)"-Studie 2005/06. Sie umfasst 11- bis 15-jährige Jugendliche in 27 europäischen und nordamerikanischen Länder (n=134.632), die in fünf Wohlfahrtsstaatsregimes (sozialde-mokratisch, konservativ, liberal, süd- und osteuropäisch) zusammengefasst wurden. In hierar-chischen Regressionsmodellen wurden für die psychosomatische Beschwerdelast als gesund-heitliche Zielgrößee individuelle (familiärer Wohlstand) und makro-strukturelle Determinanten (Einkommensungleichheit, Ausgaben für das Gesundheitssystem, Regime-Dummies) unter Kontrolle des nationalen Wohlstands analysiert. Im liberalen Regime und damit in Ländern mit hoher Einkommensungleichheit fallen die Beschwerderate und sozioökonomische Un-gleichheiten in der Beschwerdelast am höchsten aus. Der gesellschaftliche Wohlstand und die Ausgaben für das Gesundheitssystem sind dagegen nicht mit den Beschwerden assoziiert KW - Subjektive Gesundheit KW - multiple Beschwerden KW - Jugendliche KW - sozioökonomischer Status KW - Wohlfahrtsstaatregime KW - makro-strukturelle Determinanten KW - HBSC Y1 - 2016 SN - 1436-1957 VL - 36 IS - 4 SP - 356 EP - 381 PB - Beltz Juventa ER - TY - JOUR A1 - Richter, Matthias A1 - Hurrelmann, Klaus T1 - Life course influences on health and health inequalities: A socialisation perspective JF - Zeitschrift für Soziologie der Erziehung und Sozialisation N2 - This paper reviews life course approaches applied in epidemiology, sociology and psychology and proposes a theoretical framework that integrates the concept of socialisation. We argue that the paradigmatic principles of interdisciplinary life course research (human agency, timing in lives, linked lives and historical context) provide a strong basis for a more holistic and theory-driven view of the life course and its interdependent pathways. The ´agency within structure´ paradigm on which these principles are based is an essential part of socialisation theory. We emphasize that socialisation theory has the potential to act as a theoretical link between social science and epidemiology, because it offers a multi-causal framework to illuminate the association between social structure and health across the life course. In order to better understand the development of health and health inequalities in a life course perspective, an interdisciplinary approach is required. The increased attention to socialisation principles might open new dialogue and empirical research perspectives for health sociology and epidemiology. Keywords: ageing, health, life course, social inequalities, socialisation theory Y1 - 2016 SN - 1436-1957 VL - 3 SP - 264 EP - 280 PB - Beltz Juventa ER - TY - JOUR A1 - Rathmann, Katharina A1 - Pförtner, Timo-Kolja A1 - Hurrelmann, Klaus A1 - Osorio, Ana M. A1 - Bosakova, Lucia A1 - Elgar, Frank J. A1 - Richter, Matthias T1 - The great recession, youth unemployment and inequalities in psychological health complaints in adolescents: a multilevel study in 31 countries JF - International Journal of Public Health N2 - Objectives Little is known about the impact of recessions on young people’s socioeconomic inequalities in health. This study investigates the impact of the economic recession in terms of youth unemployment on socioeconomic inequalities in psychological health complaints among adolescents across Europe and North America. Methods Data from the WHO collaborative ‘Health Behaviour in School-aged Children’ (HBSC) study were collected in 2005/06 (N = 160,830) and 2009/10 (N = 166,590) in 31 European and North American countries. Logistic multilevel models were used to assess the contribution of youth unemployment in 2009/10 (enduring recession) and the change in youth unemployment (2005–2010) to adolescent psychological health complaints and socioeconomic inequalities in complaints in 2009/10. Results Youth unemployment during the recession is positively related to psychological health complaints, but not to inequalities in complaints. Changes in youth unemployment (2005–2010) were not associated with adolescents’ psychological health complaints, whereas greater inequalities in complaints were found in countries with greater increases in youth unemployment. Conclusions This study highlights the need to tackle the impact of increasing unemployment on adolescent health and health inequalities during economic recessions. KW - Subjective health KW - Health inequalities KW - Recession KW - Youth unemployment KW - Adolescence KW - Multilevel analysis Y1 - 2016 U6 - https://doi.org/10.1007/s00038-016-0866-0 SN - 1661-8556 VL - 61 IS - 7 SP - 809 EP - 819 ER -