Inequality of Opportunities in Health in Europe : Why So Much Difference Across Countries ?

Among inequalities in health, those which are explained by circumstances during childhood or parents' characteristics are recognized as inequalities of opportunities in health and are considered as the most unfair. Tackling health inequalities in later life and improving the underlying socioeconomic determinants for older people is at the core of the European Union healthy-ageing strategy. We use the 2004 Survey on Health Ageing and Retirement in Europe and examine the influence of social and family background on the probability of reporting a good self-assessed health in adulthood using logistic models in ten European countries. The comparison of the odds ratios associated with family background without and with adjustment for individual educational level and occupation allows assessing the direct influence of family background and its influence through the determination of individual social status. Using the Gini index, we evaluate the magnitude of inequalities of opportunities in health, regardless of the mechanism of transmission and consider it in comparison with several indicators of economic and sanitary conditions. Inequalities of opportunity are more marked in Mediterranean and Germanic countries than in Nordic and Benelux countries. For instance, they are twice more important in Spain than in Sweden. Whereas they are mainly explained by social reproduction in most countries a direct effect of fathers' occupation on adult health remains in Belgium, Germany, Italy and Spain. There are country-specific protective social backgrounds: son of agricultural workers in Belgium, and son of technicians or fathers in armed forces in Spain. Parents' longevity has a significant protective effect on adult health. Differences in inequalities of opportunities in health between European countries emphasize the importance of policies reducing either social reproduction or intergenerational reproduction of health.