Power, Policy and Health in Rich Democracies

Comparative social scientists have offered rich insights into how macro-level political factors affect stratification processes such as class, gender and racial inequality. Medical sociologists, on the other hand, have long emphasized the importance of stratification for health and health inequalities at the individual level. Yet, only recently has research in either field attended to the macro-level factors that impact health. This dissertation contributes to the growing scholarship in that area by investigating the influence of public healthcare social policies, organized labor and Left party power on infant mortality, life expectancy at birth and life expectancy at age 65. I do so using the framework of power resources, a theory which has been only sparsely applied to the study of health.

The analyses include country-level pooled time series models of 22 rich democracies between 1960 and 2010. Data is drawn from the Comparative Welfare States dataset (Brady et al 2014), which provides information on indicators of welfare state development, its causes, and its consequences between the periods 1960 to 2011. I use fixed effects regression models to examine the influence on health of two forms of healthcare spending, six forms of non-health social welfare transfers and the triad of union density, Left parties and socialized medicine. I also supplement with a variety of alternatives to test the sensitivity of results to estimation technique.

Chapter 1 discusses the foundational literature on the social determinants of health and political economy of health. Chapter 2 focuses on the role of public healthcare effort and socialized medicine as predictors of countries' infant mortality and life expectancy at birth and at age 60. I show that socialized medicine (as represented by the ratio to total health spending) improves all population health outcomes in addition to, and adjusted for, the effect of healthcare effort (as represented by the ratio to GDP). Moreover, socialized medicine is a better predictor of population health than healthcare effort and its effect sizes are comparable to those of GDP per capita. Chapter 3 examines the association of infant mortality and life expectancy with old age-survivor transfers, incapacity transfers, family transfers, active labor market transfers, unemployment transfers, housing transfers and education transfers. For infant mortality, overall and educational spending matters, whereas for life expectancy, incapacity does. Family transfers matter only for life expectancy at birth. For all outcomes, unemployment transfers are beneficial and housing and aging-survivor benefits are not significant. Chapter 4 investigates the association of organized labor with infant mortality and life expectancy and devotes additional attention to the potential role of Left parties and social policy in this relationship. Results suggest that in nations where a greater proportion of the labor force is unionized, more lives are lost below the age of one and individuals live shorter lives. These results are contrary to the hypotheses generated by the theory of power resources and allied research.

This dissertation contributes to literatures in medical sociology, sociology of inequality and political sociology. This dissertation highlights the pertinence of power resources theory to the subject of health and further encourages its application to this relatively new domain. Additionally, by highlighting the importance of institutions and politics for health, it extends research on macro-level sources of inequality to the outcome of health and complements the existing emphasis in medical sociology on the fundamental, distal causes of health.