ArticlePDF Available

Policies and strategies to promote social equity in health. Background document to WHO - Strategy paper for Europe



This is the second in a series of discussion papers from the WHO Regional Office for Europe. The first covers concepts and principes of equity in relation to health, and should be read in conjunction with this paper (Whitehead 1990). The present paper sets out to develop the discussion further by outlining a strategic approach to promote greater equity in health between different social and occupational groups. This draws on the work of WHO advisory groups and associated litterature listed at the back, together with practical examples from industrialized countries where strategies have been put into action. The first part (section 1-9) of the paper outlines why equity is seen as a priority and distinguishes different policy levels for interventions. Specific equity aspects related to each policy level are then highlighted as well as some case studies. The second part of the paper (section 10-14) deals with putting policy into practice. Special attention is then paid to the need for comprehensive approaches to combat social and occupational inequities in health as illustrated in terms of a strategy matrix. Furthermore the democratice process within which healthy public policies are to be discussed and determined is discussed as well as organizational aspects as regards the implementation of an equity oriented health policy. Finally checklists are presented focusing upon how to make things happen.
Dahlgren, Göran & Margaret Whitehead
Policies and strategies
to promote social
equity in health
Background document to WHO – Strategy paper
for Europe
This working paper was originally published in print form in September 1991. The figure
“The Main Determinants of Health” has been revised in this version.
Arbetsrapport/Institutet för Framtidsstudier; 2007:14
ISSN: 1652-120X
ISBN: 978-91-85619-18-4
Former Working Papers:
Arbetsrapport/Institutet för Framtidsstudier; 2000:1- 2005:5, se
Arbetsrapport/Institutet för Framtidsstudier; 2005:7
Bäckman, Olof, Welfare States, Social Structure and the Dynamics of Poverty Rates. A
comparative study of 16 countries, 1980-2000.
Arbetsrapport/Institutet för Framtidsstudier; 2005:8
Nilsson, Anders & Felipe Estrada, Den ojämlika utsattheten. Utsatthet för brott bland fattiga
och rika 1984-2001.
Arbetsrapport/Institutet för Framtidsstudier; 2005:9
Esser, Ingrid, Continued Work or Retirement? Preferred Exit-age in Western European
Arbetsrapport/Institutet för Framtidsstudier; 2005:10
Abramsson, Marianne, Befolkningsfrågan i press och politik, 1994-2004.
Arbetsrapport/Institutet för Framtidsstudier; 2005:11
Duvander, Ann-Zofie, Ferrarini, Tommy & Sara Thalberg, Swedish parental leave and gender
equality. Achievements and reform challenges in a European perspective.
Arbetsrapport/Institutet för Framtidsstudier; 2005:12
Jans, Ann-Christin, Family relations, children and interregional mobility, 1970 to 2000.
Arbetsrapport/Institutet för Framtidsstudier; 2005:13
Ström, Sara, Childbearing and psycho-social work life conditions in Sweden 1991-2000.
Arbetsrapport/Institutet för Framtidsstudier; 2005:14
Lundberg, Urban, A Leap in the Dark. From a Large Actor to a Large Approach: The Joint
Committee of the Nordic Social Democratic Labour Movement and the Crisis of the Nordic
Arbetsrapport/Institutet för Framtidsstudier; 2005:15
Lindh, Thomas, Malmberg, Bo & Joakim Palme, Generations at War or Sustainable Social
Policy in Aging Societies?
Arbetsrapport/Institutet för Framtidsstudier; 2005:16
Gentile, Michael, Population Geography Perspectives on the Central Asian Republics.
Arbetsrapport/Institutet för Framtidsstudier; 2005:17
Malmberg, Bo, Lindh, Thomas & Max Halvarsson, Productivity consequences of workforce
ageing - Stagnation or a Horndal effect?
Arbetsrapport/Institutet för Framtidsstudier; 2005:18
Olofsson, Jonas, Stability or change in the Swedish Labour Market Regime?
Arbetsrapport/Institutet för Framtidsstudier; 2005:19
Hong, Ying & Diana Corman, Women´s Return to Work after First Birth in Sweden during
Arbetsrapport/Institutet för Framtidsstudier; 2005:20
Lindh, Thomas & Bo Malmberg, Demography and housing demand – What can we learn from
residential construction data?
Arbetsrapport/Institutet för Framtidsstudier; 2005:21
Amcoff, Jan, Rural Population Growth in Sweden in the 1990s: Unexpected Reality of Spatial-
Statistical Chimera
Arbetsrapport/Institutet för Framtidsstudier; 2006:1
Alm, Susanne, Drivkrafter bakom klassresan –kvantitativa data i fallstudiebelysning
Arbetsrapport/Institutet för Framtidsstudier; 2006:2
Duvander, Ann-Zofie, När är det dags för dagis? En studie om vid vilken ålder barn börjar
förskola och föräldrars åsikt om detta
Arbetsrapport/Institutet för Framtidsstudier; 2006:3
Johansson, Mats, Inkomst och ojämlikhet i Sverige 1951-2002
Arbetsrapport/Institutet för Framtidsstudier; 2006:4
Malmberg, Bo & Eva Andersson, Health as a factor in regional economic development
Arbetsrapport/Institutet för Framtidsstudier; 2006:5
Estrada, Felipe & Anders Nilsson, Segregation och utsatthet för egendomsbrott. - Betydelsen
av bostadsområdets resurser och individuella riskfaktorer
Arbetsrapport/Institutet för Framtidsstudier; 2006:6
Amcoff, Jan & Erik Westholm, Understanding rural change – demography as a key to the
Arbetsrapport/Institutet för Framtidsstudier; 2006:7
Lundqvist, Torbjörn, The Sustainable Society in Swedish Politics – Renewal and Continuity
Arbetsrapport/Institutet för Framtidsstudier; 2006:8
Lundqvist, Torbjörn, Competition Policy and the Swedish Model.
Arbetsrapport/Institutet för Framtidsstudier; 2006:9
de la Croix, David, Lindh, Thomas & Bo Malmberg, Growth and Longevity from the Industrial
Revolution to the Future of an Aging Society.
Arbetsrapport/Institutet för Framtidsstudier; 2006:10
Kangas, Olli, Lundberg, Urban & Niels Ploug, Three routes to a pension reform. Politics and
institutions in reforming pensions in Denmark, Finland and Sweden.
Arbetsrapport/Institutet för Framtidsstudier; 2006:11
Korpi, Martin, Does Size of Local Labour Markets Affect Wage Inequality? A Rank-size Rule of
Income Distribution
Arbetsrapport/Institutet för Framtidsstudier; 2006:12
Lindbom, Anders, The Swedish Conservative Party and the Welfare State. Institutional
Change and Adapting Preferences.
Arbetsrapport/Institutet för Framtidsstudier; 2006:13
Enström Öst, Cecilia, Bostadsbidrag och trångboddhet. Har 1997 års bostadsbidragsreform
förbättrat bostadssituationen för barnen?
Arbetsrapport/Institutet för Framtidsstudier; 2007:1
Nahum, Ruth-Aïda, Child Health and Family Income. Physical and Psychosocial Health.
Arbetsrapport/Institutet för Framtidsstudier; 2007:2
Nahum, Ruth-Aïda, Labour Supply Response to Spousal Sickness Absence.
Arbetsrapport/Institutet för Framtidsstudier; 2007:3
Brännström, Lars, Making their mark. Disentangling the Effects of Neighbourhood and School
Environments on Educational Achievement.
Arbetsrapport/Institutet för Framtidsstudier; 2007:4
Lindh, Thomas & Urban Lundberg, Predicaments in the futures of aging democracies.
Arbetsrapport/Institutet för Framtidsstudier; 2007:5
Ryan, Paul, Has the youth labour market deteriorated in recent decades? Evidence from
developed countries.
Arbetsrapport/Institutet för Framtidsstudier; 2007:6
Baroni, Elisa, Pension Systems and Pension Reform in an Aging Society. An Introduction to
the Debate.
Arbetsrapport/Institutet för Framtidsstudier; 2007:7
Amcoff, Jan, Regionförstoring – idé, mätproblem och framtidsutsikter
Arbetsrapport/Institutet för Framtidsstudier; 2007:8
Johansson, Mats & Katarina Katz, Wage differences between women and men in Sweden –
the impact of skill mismatch
Arbetsrapport/Institutet för Framtidsstudier; 2007:9
Alm, Susanne, Det effektiva samhället eller det goda livet? Svenska framtidsstudier om
arbetsliv och fritid från 1970- till 1990-tal.
Arbetsrapport/Institutet för Framtidsstudier; 2007:10
Sevilla, Jaypee, Age structure and productivity growth
Arbetsrapport/Institutet för Framtidsstudier; 2007:11
Sevilla, Jaypee, Fertility and relative cohort size
Arbetsrapport/Institutet för Framtidsstudier; 2007:12
Steedman, Hilary, Adapting to Globalised Product and Labour Markets
Arbetsrapport/Institutet för Framtidsstudier; 2007:13
Bäckman, Olof & Anders Nilsson, Childhood Poverty and Labour Market Exclusion
ISSN: 1652-120X
ISBN: 978-91-85619-18-4
... Health and wellbeing are key elements of integration and resettlement [11]. The social determinants of health (SDH) lens offers a framework to consider the social, economic and cultural factors that impact health, and the influence of effective healthcare provision and access [12,13]. Through the analysis of interview data from 44 participants from refugee communities in rural South Australia, this paper seeks to show the ways in which social ties were important for participants' health. ...
... [which] are shaped by the distribution of money, power and resources at global, national and local levels' [13,60]. The SDH framework can help to outline the individual lifestyle factors (e.g., exercise, smoking), social and community networks, living and working conditions (e.g., education, work environment, housing) and general socioeconomic, cultural, and environmental conditions that affect health [12]. In the case of social capital and health for refugees in rural settings, the resources available through networks can be of assistance in providing emotional and practical support important for health, as well as facilitating access to other social determinants of health such as employment and housing and in encouraging healthy behaviours as well as accessing health services [61][62][63]. ...
Full-text available
Citation: Mwanri, L.; Miller, E.; Walsh, M.; Baak, M.; Ziersch, A. Abstract: Refugee resettlement significantly contributes to Australia's migration programs, with recent policy directives prioritising rural resettlement. As a result, the cultural diversity of populations of several Australian rural towns has substantially expanded. Newcomers may encounter challenges becoming part of closed social networks and accessing the resources they need for a healthy life in resettlement. However, there are also benefits that stem from positive integration for newcomers and for receiving populations. As part of a larger study, which aimed to explore facilitators and barriers to successful resettlement in a rural setting, the objective of this paper was to show how social ties were important for participants' health, both facilitating access to resources, including health services, and connecting people to health-promoting living conditions. In-depth individual interviews with 44 participants from refugee communities originally from Africa and SouthEast Asia, settled in a rural South Australian town, were conducted. Participants were invited to the study through snowball sampling via known connections between the researchers and key people within the communities. Interview transcripts were analysed using framework thematic analysis. The findings demonstrate how participants drew on connections within their cultural communities, reflecting collectivist cultural values. These social ties were key to enabling access to resources for health. These included emotional resources, such as a sense of belonging, as well as physical and practical resources, including food, housing, and/or accessing services. Several participants were also working towards a career in the health industry. Populations from refugee communities in rural towns are growing, not only with the continuation of new arrivals to these towns, but also as the settled populations expand their families and communities. Effective health service provision in these locations needs to serve these growing communities, and there is scope for services to tap into community networks to assist with this.
... It is all the more remarkable that place and its spatial dimensions are not explicitly taken into account in models of health determinants, and that a general framework on the interactions between place and health on multiple layers is still missing. While there are numerous models [14] on the (social) determinants of health [15,16], they do not explicitly consider the different spatial levels. This paper illustrates why this is needed and suggests a framework of spatial determinants of health. ...
Full-text available
Numerous studies and models address the determinants of health. However, in existing models, the spatial aspects of the determinants are not or only marginally taken into account and a theoretical discussion of the association between space and the determinants of health is missing. The aim of this paper is to generate a framework that can be used to place the determinants of health in a spatial context. A screening of the current first serves to identify the relevant determinants and describes the current state of knowledge. In addition, spatial scales that are important for the spatial consideration of health were developed and discussed. Based on these two steps, the conceptual framework on the spatial determinants of health was derived and subsequently discussed. The results show a variety of determinants that are associated with health from a spatial point of view. The overarching categories are global driving forces, policy and governance, living and physical environment, socio-demographic and economic conditions, healthcare services and cultural and working conditions. Three spatial scales (macro, meso and micro) are further subdivided into six levels, such as global (e.g., continents), regional (e.g., council areas) or neighbourhood (e.g., communities). The combination of the determinants and spatial scales are presented within a conceptual framework as a result of this work. Operating mechanisms and pathways between the spatial levels were added schematically. This is the first conceptual framework that links the determinants of health with the spatial perspective. It can form the working basis for future analyses in which spatial aspects of health are taken into account.
... The first tier is represented by the individual determinants; the second is represented by individual proximal, behaviors and lifestyles; the third is represented by social networks; the fourth is known as intermediaries, as is the case with living and working conditions; and, finally, the tier of distal or macro determinants comprises the society's economic, cultural and environmental conditions. (9) Although it is recognized that SDH can influence the occurrence of diarrhea, it is believed that mothers or caregivers with high self-efficacy can minimize this problem in childhood, because according to Bandura, (10) individuals with high self-efficacy have individual beliefs about the ability to organize and take a certain action to achieve a successful result. In this sense, a study carried out in Fortaleza showed that children whose mothers or caregivers had high self-efficacy were less likely to have diarrhea. ...
... In the hilly areas, communities can count up to 100-300 households, each originating from much smaller origin villages, which increases the risk of zoonotic pathogen spillover between animals, as well as animals and humans. Socio-economic status is a major determinant of health, with those with fewer resources at increased risk of disease, including zoonoses [44]. As poor households depend on each other, the division of communities and households negatively affects mutual assistance and solidarity, increasing the risk of zoonotic disease. ...
Full-text available
Background It remains unclear how human and animal displacement impacts zoonotic disease risk with little contextualized primary data available. This study investigates zoonotic disease dynamics in populations regularly displaced due to slow onset disasters and annual monsoons in the Indus Delta in Sindh province in southeast Pakistan. Methods Using a case study methodology, semi-structured key informant interviews and focus group discussions with 35 participants, as well as observational studies were conducted in seven communities in Thatta district. Results Key factors affecting zoonotic disease dynamics in environmental displacement in Thatta identified in the study include disasters and loss of forage, a lack of veterinary and healthcare access, and socio-economic status. Animal and human health are an important consideration in displacement disrupting communities and livelihoods, affecting safety, health, and food security. Displacement results in a poverty spiral whereby the displaced find themselves at continuous peril from poverty and disaster, with zoonotic disease dynamics shifting based on environmental changes, and an expectation of future movement and loss. Conclusion The precarious conditions generated through the disruption of communities and livelihoods makes environmentally displaced populations vulnerable to zoonotic disease. To prevent further displacement and disease, broader political economy issues need to be addressed, and comprehensive assistance provided to support sustainable livelihoods.
... Shorter-term future orientation is not only important when providing information on personal lung cancer risk and screening results, but in the delivery of behaviour change techniques to invoke quit attempts and cessation. When taking into account the competing influences and wider social determinants of health [43] that can act as barriers to achieving distal goals, short-term attainable goals with high quality goal setting, are viewed to be more achievable and can thus lead to instant results [44,45]. This short-term orientation may strengthen an individual's perceptions of both their self-efficacy for reducing risk and the response-efficacy of smoking cessation for their health; perceptions that the EPPM proposes There were limitations to our study. ...
Full-text available
Background: Optimising smoking cessation services within a low radiation-dose computed tomography (LDCT) lung cancer screening programme has the potential to improve cost-effectiveness and overall efficacy of the programme. However, evidence on the optimal design and integration of cessation services is limited. We co-developed a personalised cessation and relapse prevention intervention incorporating medical imaging collected during lung cancer screening. The intervention is designed to initiate and support quit attempts among smokers attending screening as part of the Yorkshire Enhanced Stop Smoking study (YESS: ISRCTN63825779). Patients and public were involved in the development of an intervention designed to meet the needs of the target population. Methods: An iterative co-development approach was used. Eight members of the public with a history of smoking completed an online survey to inform the visual presentation of risk information in subsequent focus groups for acceptability testing. Three focus groups (n = 13) were conducted in deprived areas of Yorkshire and South Wales with members of the public who were current smokers or recent quitters (within the last year). Exemplar images of the heart and lungs acquired by LDCT, absolute and relative lung cancer risk, and lung age were shown. Data were analysed thematically, and discussed in stakeholder workshops. Draft versions of the intervention were developed, underpinned by the Extended Parallel Processing Model to increase self-efficacy and response-efficacy. The intervention was further refined in a second stakeholder workshop with a patient panel. Results: Individual LDCT scan images of the lungs and heart, in conjunction with artistic impressions to facilitate interpretation, were considered by public participants to be most impactful in prompting cessation. Public participants thought it important to have a trained practitioner guiding them through the intervention and emphasising the short-term benefits of quitting. Presentation of absolute and relative risk of lung cancer and lung age were considered highly demotivating due to reinforcement of fatalistic beliefs. Conclusion: An acceptable personalised intervention booklet utilising LDCT scan images has been developed for delivery by a trained smoking cessation practitioner. Our findings highlight the benefit of co-development during intervention development and the need for further evaluation of effectiveness.
Full-text available
En las últimas décadas se ha escrito mucho acerca de la vulnerabilidad y sus correlatos con el Trabajo Social en cuanto a planificación, prevención y atención a la ciudadanía en el ámbito sanitario. El objeto de esta revisión bibliográfica es la descripción de la cuantificación de los ítems que conforman la variable de vulnerabilidad social en los procesos de hospitalización de personas adultas. Metodología: Aplicando las palabras clave “vulnerabilidad social”, determinantes sociales de la salud”, “población adulta”, “ítems” y “escala” se identificaron 2369 artículos en diferentes bases de datos (Scopus, Web of Science, DialNet, Academic Search Ultimate, CINAHL, Psichodoc y PubMed). Resultados: Se consideraron relevantes para nuestro estudio 154 artículos, y mediante su análisis se cuantificaron 33 ítems o factores relacionados con la vulnerabilidad social en el ámbito de la hospitalización, siendo los más prevalentes la situación económica, el nivel educativo, el acceso a la sanidad, inestabilidad / situación de la vivienda y el apoyo social. Conclusión: La vulnerabilidad es un término dinámico y complejo que engloba diferentes factores sociales los cuales impactan en el proceso de la hospitalización en adultos/as y se deben tener en cuenta en la práctica del Trabajo Social en el ámbito sanitario.
Das Bewegungsverhalten der Bevölkerung in Deutschland zeigt einen deutlichen Bedarf an Maßnahmen zur Bewegungsförderung über die gesamte Lebensspanne. Bereits gewonnene Erkenntnisse zum Zusammenhang zwischen dem Bewegungsverhalten und der Ungleichheit in der Bevölkerung zeigen, dass es einen Bedarf an Projekten zur Prävention und Gesundheitsförderung durch Bewegung gibt, welche die gesundheitliche Ungleichheit adressieren und somit die Gesundheit von vulnerablen Gruppen stärken. Im Rahmen dieser Dissertation wurde untersucht, wie Bewegungsförderung auf ganzheitlicher Ebene, also individuumsbezogen und auch strukturell gelingen kann. Im Rahmen von drei wissenschaftlichen Untersuchungen wurde diesbezüglich die Verwendung des Capability-Ansatzes, ursprünglich aus der Gesundheitsökonomie nach Amartya Sen (1993) stammend, hinsichtlich seiner Tauglichkeit als ganzheitlicher theoretischer Ansatz in der Bewegungsförderung bei verschiedenen Projekten über die Lebensspanne untersucht. In einer systematischen Literaturübersicht stellt Artikel I den aktuellen Forschungsstand zu Messmethoden von Capabilities bezüglich Gesundheits- bzw. Bewegungsverhalten dar. Hierbei wurde untersucht, ob bereits Messinstrumente bestehen, welche im Rahmen von Projekten angewandt werden können, um einen Vergleich über Settings hinweg anstellen zu können. Identifizierte Messinstrumente wurden hinsichtlich ihrer Entwicklung sowie deren Validität und Reliabilität begutachtet. Artikel II untersucht im Rahmen eines partizipativen Ansatzes die Verwendung des Capability-Ansatzes im Rahmen von partizipativen Projekten des Capital4Health Verbunds. Der Verbund zielt auf die Entwicklung von Handlungsmöglichkeiten für einen aktiven Lebensstil in verschiedenen Settings über die gesamte Lebensspanne. Hierfür wurde der sogenannte Capability-Cycle basierend auf einem bereits bestehenden Capability-Modell der Gesundheitsförderung entwickelt. Unter Anwendung des Modells wurden 4 Projekte hinsichtlich der Umsetzung des Capability-Ansatzes untersucht. Durch die Verwendung des Capability-Cycle konnte ein Vergleich der empirischen Projekte hinsichtlich der Projektumsetzung, entstandener Umwandlungsfaktoren als Projekt Outcome sowie projektspezifischer Evaluationsergebnisse durchgeführt werden. Die Erkenntnisse zeigen, dass trotz eines gemeinsamen theoretischen Rahmenkonzeptes die empirischen Projekte den Capability-Ansatz unterschiedlich interpretiert und umgesetzt haben. Dies ist teilweise abhängig von den unterschiedlichen sportwissenschaftlichen Disziplinen sowie den disziplinspezifischen bestehenden theoretischen Rahmenkonzepten, welche in die Projektarbeit einfließen. Die dadurch gewonnenen Erkenntnisse des Vergleichs wurden anschließend genutzt, um Empfehlungen für die Verwendung des Capability-Ansatzes in der Gesundheits- und Bewegungsförderung zu entwickeln, welche zukünftigen Projekten zur Verfügung stehen, die den Capability-Ansatz als theoretisches Rahmenkonzept verwenden möchten. Durch die empirisch entwickelten Richtlinien können neue Projekte von den bisherigen Erkenntnissen profitieren und es kann gleichzeitig eine Vergleichbarkeit von Projekten ermöglicht werden. Um die Verwendung des Capability-Cycle als Evaluationsrahmen auch außerhalb des Capital4Health Verbunds zu überprüfen, wurde in Artikel 3 das Projekt „Bewegung als Investition in Gesundheit (BIG) retrospektiv in einer systematischen Literaturanalyse untersucht. Das Projekt entstand im Jahr 2005 mit dem Ziel, Frauen „in schwierigen Lebenslagen“ (so die von den Teilnehmerinnen selbst gewählte Beschreibung) zu befähigen, sich für ihre eigene Gesundheit einzusetzen, und damit die bewegungsbezogene gesundheitliche Chancengleichheit innerhalb kommunaler Settings Hierfür wurde eine systematische Literaturanalyse aller bisherigen BIG-Publikationen (n=37) durchgeführt und hinsichtlich genannter Ergebnisse analysiert. Alle Ergebnisse wurden nach deren Ebene, sprich Multiplikatoren oder Zielgruppe sowie den einzelnen Elementen des Capability-Cycle eingebettet. Hierbei zeigte sich, dass durch die Verwendung des Capability-Cycle eine ganzheitliche Betrachtung der erzielten Ergebnisse sowohl auf der Verhaltens- als auch auf der Verhältnisebene möglich ist. Durch die vorliegende Dissertationsschrift, konnte die Verwendung des Capability-Ansatzes insbesondere in der Gesundheitsförderung durch Bewegung geprüft und weiterentwickelt werden. Die vorliegenden Ergebnisse zeigen, dass der Capability-Ansatz für die Anwendung in der Gesundheits- und Bewegungsförderung eine Grundbasis bildet, welche verschiedene Sichtweisen (Empowerment und Ungleichheitsforschung, sowie das Verhalten selbst) mit einbezieht. In der Zukunft sollte der Ansatz daher in Interventionen weiter Anwendung finden, um diese spezifisch an die Zielgruppen anzupassen und dabei beeinflussende individuelle und strukturelle Faktoren sowie Multiplikatoren und deren Handlungsmöglichkeiten zu beachten.
Full-text available
Background Education is expected to bring about positive behavioral changes that could lead to better health, especially parental education is one of the most important factors for a child’s health and development. However, the role of parental education on optimal infant and young child feeding (IYCF) practices in Bangladesh is inconclusive. The objective of this review is to summarize how parental education is associated with IYCF practices in Bangladesh. Method This review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. A systematic literature search was conducted in PubMed, Web of Science, Embase, and Google Scholar. Record searching, study selection and data extraction was performed using Endnote online and Covidence software, respectively. The Newcastle-Ottawa scale was used for quality assessment of the included studies. Results Out of 414 initial hits, 34 studies were included for this review. Of the included studies, 32 were cross-sectional, one was a randomized controlled trial, and one was a retrospective cohort. Most of the studies (n=24) were nationally representative whereas 10 studies had populations from district and sub-district level. Included studies considered different IYCF related indicators, including breastfeeding (n=22), complementary feeding (n=8), both breastfeeding and complementary feeding (n=2), both breastfeeding and bottle feeding (n=1), and pre-lacteal feeding (n=1). Parental education was found positively associated with complementary feeding practices. However, the role of parental education on breastfeeding, in general, was ambiguous. High parental education was associated with bottle-feeding practices and no initiation of colostrum. Conclusion Public health interventions need to focus not only on non- and/or low educated parents regarding complementary feeding but also on educated mothers on initiation of colostrum and proper breastfeeding practices. Registration This systematic review is registered to PROSPERO ( with registration ID: CRD42022355465
Full-text available
The aim of this article is to study how the ideas of a sustainable society have developed and adapted to Swedish politics. It starts with the assumption that new ideas have a greater possibility to make a difference if they adapt to the political culture, and if important actors make the ideas their own. This issue is studied for the years 1988-2004. One conclusion is that social democratic welfare ideology has given its imprint in the rhetoric of a sustainable society. Another conclusion is that the ideas has been obtained in party ideology from left to right and been adapted to traditional ideological differences.
Full-text available
The study analyzes three generations of future studies on work life and leisure, performed at the Secretariat and later the Swedish Institute for Future Studies. The ideal types of Tore Frängsmyr, “The efficient society” and “The good life”, are used as analytical tools. The primary information consists of program declarations and reports from projects in the 1970- 1980- and 1990s. In the 1970s the original plan to produce a final report failed, and the analyses here show that differences in terms of the ideal types here used could explain the failure. While in one of the reports studied, the focus is on how Sweden is to maintain a high export ratio and a prominent position in international competition, the two other reports are written from an explicit Marxist perspective and discuss how the sharp split between work and leisure in modern capitalist societies could be remedied. That is, while the first report is focused on “The efficient society”, the two latter deal exclusively with a version of “The good life”. The final report from the project of the 1980s is characterized by a reserved, but still in some sense accepting, attitude towards the high-technological society. Utopian thoughts of a completely different society are non-existing, but the discussion mainly focuses on ways to make high-technological society as tolerable as possible to humans. In terms of the here used terminology the report can be said to deal with “The good life” within the realms of “The efficient society”. In the final report from the 1990s the point of departure is that industrial society is being replaced by a new post-industrial one. Unlike in earlier projects here studied, the entire discussion of driving forces behind societal development is on the structural level. The possibilities of individuals to shape their future seem small or non-existing. Neither are consequences at the individual level of structural development in focus. It’s is diffi
Full-text available
The paper argues that the Swedish ‘neo-liberal’ party (Moderaterna) has adapted its policies because of the popularity of the ‘universal’ Swedish welfare state. The party has come to accept that the modern welfare state is irreplaceable. We furthermore argue that the party’s moderate electoral platform in 2006 is earnest. In the “short run” the party can only hope to achieve incremental changes and it recognises this. Simultaneously however, the party in the “long run” wants to gradually change society. Over time the party in its rhetoric and ideological statements has emphasised the short and the long run differently. These differences between the ‘neo-liberal’ 1980s and 2006 should not conceal that the mechanism of welfare popularity largely remains the same. The party’s actual policy proposals tend to suggest incremental changes only in both periods.
Among the most central questions at the intersection of demography and economics is the impact of large scale demographic processes on long-run economic performance. The classical version of this inquiry, occupying thinkers from Malthus towards those from the mid-to-late 20th century, had to do with whether rapid population growth threatened economic growth. This classical inquiry has been superseded by more sophisticated questioning in which the focus on growth rate of the aggregate population has been replaced by focus on the growth rates of age-specific population sub-groups. Disaggregating the effects of population growth by age-group is generally accepted to be a fundamental improvement over classical inquiry because people’s economic roles and contributions vary by age: the young are net consumers and beneficiaries of human capital investments, adults are net producers and savers, and the old are (at least in theory or to a greater degree than adults) net consumers. Thus the economic consequences of rapid growth in the population size of the young and the elderly could potentially have a depressing impact on growth, while rapid growth in the population size of adults could stimulate growth. The demographic transition brings with it a three stage process in which a baby boom cohort moves through the population’s age pyramid. The life cycle of this cohort creates a first stage in which there is rapid growth in youth population, then a second stage in which there is rapid growth in the adult population, and finally a third stage in which there is rapid growth in the elderly population. The first and third stages can be thought of as the challenging stages since economies must confront the challenge of providing for large dependent populations. However, the second stage can be thought of as a demographic gift or dividend stage since growth in the productive adult population can potentially boost economic growth. The traditional mechanisms for the demog
Traditionally, pension systems aim to fulfill a number of functions which include income security and consumption smoothing in old age, as well as income redistribution. The main rationale for pension reform lies in the interaction between current demographic trends (e.g. increasing old age dependency ratios) and the design of existing pension systems (particularly, the so called Pay-As-You-Go public systems). Under certain conditions, population aging can in fact undermine the ability of a pension system to fulfill those very aims for which it was created, putting pensioners at risks of higher poverty and inequality, besides creating large fiscal pressures on governments and threaten economic growth. In the literature, we find two main approaches to this debate. On the one hand, economic theory helps us formalize the mechanisms through which aging affects a pension system, given its possible features (e.g. type of benefit offered, degree of actuarial fairness or type of financing); it also helps us quantify costs or returns associated to different pension designs and, consequently, to different pension reform options. On the other hand, the policy debate is centered on models of reform which take from concrete country experiences; overall, it focuses mostly on whether funding pensions (i.e. privatizing and individualizing retirement savings, away from Pay-As-You-Go systems) is the best option for reducing many of the negative economic impacts associated to population aging. After having illustrated both sides of the debate – the theoretical and the empirical - our paper makes two main claims. Firstly, the debate should be re-framed away from whether funding is the best option for pension reform in the face of population aging, towards a redefinition of the problem which rather focus on the type of benefit offered, its coverage, its eligibility conditions and actuarial design (as this controls important behavioral and efficiency implications). Secondly, an
There is nowadays a widespread sense that things have gone badly wrong for young workers in advanced economies, and that the difficulty is caused by a fall in their appeal to employers. It is tempting to attribute the problem to a trend in labour demand that favours older, more experienced workers over younger, less experienced ones. The same line of interpretation has been widely favoured for the other major dimension of employee skill: educational attainment. The contemporary fall in the pay of less educated workers, as compared to more educated ones, in the US and the UK in particular, has been widely attributed to the spread of information technology and globalisation, both of which are taken to raise the productivity of more educated workers relative to less educated ones. An influential account of developments in the US claims that ‘relative demand shifts favouring more skilled workers are … essential to understanding longer-run changes in the US wage structure’ (Katz and Autor 1999: 1513). The same factors might had similar effects in the experience dimension of skill, thereby impairing labour market prospects for young workers. The validity of these propositions has however been contested. Doubts have been raised concerning the existence of skill-bias in technical change (Card and DiNardo 2002). Some commentaries deny the existence of an underlying trend unfavourable to youth (OECD 2002: 20-29). This paper investigates the evidence concerning trends in youth relative pay and employment in developed economies since the mid-1970s, focusing on structural change on the demand-side of the labour market. It improves on previous research by including more countries, and by controlling for macroeconomic fluctuations, which affect youth employment particularly keenly. It then considers the growth of educational participation, as a further, supply-side, influence that complicates the interpretation of changes in youth outcomes.
One subject that has received ample attention in recent years is the potential negative effects of spatial concentrations of disadvantage on participation in society, particularly in terms of labour market participation and educational careers. This study contributes to the literature on the effects of neighbourhood and school on individual educational outcomes by examining whether and to what extent adolescent educational achievement is determined by neighbourhood and school population characteristics. By using an unusually rich administrative data set of leaving certificates for around 26,000 upper secondary school students who were registered as residing in any of the three metropolitan areas of Sweden in the school year 2004, cross-classified multilevel analyses show that characteristics attributable to upper secondary schools matter much more for the variability in achievement than do neighbourhoods. There are also indications of contextual effects at each level (particularly among boys with an immigrant background) that operate above and beyond the impact of observed individual-level background attributes. Since the estimated effects of concentrations of (dis)advantage and immigrant density at neighbourhood and school level point in different directions, this study demonstrates the benefits of analysing the effects of neighbourhood and school on individual educational outcomes at the same time.
This study examines labour supply responses to spousal sickness absence (SSA) using a Swedish longitudinal panel data, from 1996-2002. The overall results present an evidence of a decrease in labour supply in response to spousal sickness absence. The effect on labour supply increases with spousal earnings level. Women react stronger than men, and more often respond to current shorter term SSA, whereas men mostly react to longer term SSA.
This paper contributes to the important policy related literature on income and health by providing a detailed investigation of the family income/child health relationship using matched parent–child survey data from the Swedish Survey of Living Conditions (ULF). This study differs from previous work in the field in a number of respects. First, we focus on both physical as well as on the psychosocial health of the child. Second, we focus on the parent’s socioeconomic background as well as on the liquidity constraint problems the household faces. We find little evidence of an income gradient or effect on children’s physical and psychosocial health. However, our study suggests that the occurrence of liquidity constraints in the household increases the likelihood of the child having a lower psychosocial health status.
The questions addressed in this paper are: (i) does wage inequality increase with local population size, and if so, (ii) what are possible factors behind this increase? In a cross-section analysis of Swedish local labour markets using unique full population data, the article shows that urban scale, i.e. size of local population, has significant positive effects on wage inequality. Testing for potential explanations, labour market diversification, human capital, migration, age structure and employment are shown to be significantly associated with inequality. Given these effects, the article raises the question of how to understand and incorporate scale effects into models of long-term change in wage inequality.