Prof. Dr. Klaus Hurrelmann: “Reducing Health Inequalities – What Do We Really Know About Successful Strategies?”, Conference May 2009, Berlin Health Inequalities in Welfare States The Need for a More Health Sensitive Public Policy Klaus Hurrelmann, Sebastian Duwe, David Gleicher, Katharina Rathmann, Naomi Woods, Matthias Richter Hertie School of Governance, Berlin, and University of Bielefeld

Prof. Dr. Klaus Hurrelmann: “Reducing Health Inequalities – What Do We Really Know About Successful Strategies?”, Conference May 2009, Berlin In almost all countries, the health of rich people with good education and active participation in the labour force is improving much more quickly than that of the poor with low educational level and weak participation in the labour force. Increasing economic inequalities with growing income gaps between the rich and the poor run parallel to this trend. 2

Prof. Dr. Klaus Hurrelmann: “Reducing Health Inequalities – What Do We Really Know About Successful Strategies?”, Conference May 2009, Berlin Health problems are closely related to income and wealth linequalites in all highly developed countries. This is true for infant mortality and life expectancy and many other health indicators. 3

Prof. Dr. Klaus Hurrelmann: “Reducing Health Inequalities – What Do We Really Know About Successful Strategies?”, Conference May 2009, Berlin Interdependence of income inequality and infant mortality in welfare states. (Wilkinson and Pickett 2009, 82) 4

Prof. Dr. Klaus Hurrelmann: “Reducing Health Inequalities – What Do We Really Know About Successful Strategies?”, Conference May 2009, Berlin Interdependence of income inequality and life expectancy in welfare states. (Wilkinson and Pickett 2009, 82) 5

Prof. Dr. Klaus Hurrelmann: “Reducing Health Inequalities – What Do We Really Know About Successful Strategies?”, Conference May 2009, Berlin It is not only income inequality which leads to health inequality, but also the inequality of resources held by different parts of the population due to systematic over- and under-investments across a wide range of community infrastructure. 6

Prof. Dr. Klaus Hurrelmann: “Reducing Health Inequalities – What Do We Really Know About Successful Strategies?”, Conference May 2009, Berlin The quality of life and the economic productivity of the whole country is reduced if significant parts of the population are excluded from welfare resources that are available for the majority. Inequalities are condidered to be unfair. Therefore, effective policy strategies fo reduce health inequalities should be part of comprehensive welfare policy approaches. 7

Prof. Dr. Klaus Hurrelmann: “Reducing Health Inequalities – What Do We Really Know About Successful Strategies?”, Conference May 2009, Berlin Different states have different levels of health of their population and they also have different levels of health inequality. The analysis of divergent structures of policy strategies is an important tool to learn about the possibility to influence the determinants of health inequalities. 8

Prof. Dr. Klaus Hurrelmann: “Reducing Health Inequalities – What Do We Really Know About Successful Strategies?”, Conference May 2009, Berlin Welfare state regime types are highly significant predictors of health indicators. They are influenced by the traditional path to organize the societal Infrastructure and they influence the quality of the welfare of the whole population. Obviously, shared policy characteristics of a given welfare regime type do exist. 9

Prof. Dr. Klaus Hurrelmann: “Reducing Health Inequalities – What Do We Really Know About Successful Strategies?”, Conference May 2009, Berlin Typologies are able to explain the relatively high degree of social and economic inequalities in most of the Social Democratic regimes. Contrary to expectation, however, they are not able to explain why this regime does not always turn out to have the healthiest population, at least not with reference to all health indicators applied. We have to search for more refined explanatory models. 10

Prof. Dr. Klaus Hurrelmann: “Reducing Health Inequalities – What Do We Really Know About Successful Strategies?”, Conference May 2009, Berlin Explanatory Model 1 Politics Time in government by different political traditions Electoral support for different political traditions, measured by Power resources suppor-ting each political tradition Labour Market Active population Participation of women in the labour force Rate of men’s unemployment Rate of women’s unemployment Welfare State Public health expenditure Public health care coverage Economic inequality Health outcomes Navarro et al.2006,

Prof. Dr. Klaus Hurrelmann: “Reducing Health Inequalities – What Do We Really Know About Successful Strategies?”, Conference May 2009, Berlin Explanatory Model 2 Organisation of the Societal Infrastructure Quality of Population Welfare Health Status of the Population Health Sensitive Public Policy Including intersectoral coordination, high political power for public health and health care policy 12

Prof. Dr. Klaus Hurrelmann: “Reducing Health Inequalities – What Do We Really Know About Successful Strategies?”, Conference May 2009, Berlin The welfare state regime type sets the stage for the architecture of public policy. The degree of „health sensitivity“ of this public policy influences the health outcome via two paths: First, indirectly, by determining the overall welfare of the population and, second, directly, by shaping the institutions and organizations which are responsible for health care. 13

Prof. Dr. Klaus Hurrelmann: “Reducing Health Inequalities – What Do We Really Know About Successful Strategies?”, Conference May 2009, Berlin In using the term „Health Sensitive Public Policy“ we invoke the wider European notion of social policy which includes not only health care but labour policy, social security, social housing, criminal justice, education policy, unemployment insurance, etc. as constitutional elements of welfare policy. 14

Prof. Dr. Klaus Hurrelmann: “Reducing Health Inequalities – What Do We Really Know About Successful Strategies?”, Conference May 2009, Berlin Health Sensitive Public Policy recognizes that welfare and health policy follow strong path dependencies. Therefore, states with different welfare traditions need specific strategies to reduce health inequalities. This is only possible if they implement pragmatic policy mixes. 15