Associations between labour market expenditures and self-rated health: A pooled multi-level analysis of 20 European countries, by Jongnam Hwang, Edwin Ng, Patricia O’Campo and Carles Muntaner. Presented at the 7th European Public Health Conference: "Mind the gap: Reducing inequalities in health and health care". Glasgow, 20th to 22nd November 2014.

1. Associations between labour market expenditures
and self-rated health: A pooled multi-level
analysis of 20 European countries
Jongnam Hwang1, Edwin Ng1, Patricia O’Campo1,2, Carles Muntaner3
1Centre for Research on Inner City Health, St. Michael’s Hospital, Toronto, Canada
2Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
3Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada

2. Background
 Existing studies find that the relationship between
unemployment and poor health varies across different
welfare states (Bambra & Eikemo, 2008).
 Attempts to explain inter-regime differences infer that levels
of social protection might have a moderating effect.
 Labour market interventions are important forms of social
protection that protect workers, promote employment, and
stimulate efficient labour markets.
 More work is needed to examine the health effects of labour
market interventions.
Source: Bambra, C., & Eikemo, T. (2008). Welfare state regimes, unemployment and health: a comparative study of the relationship between
unemployment and self-reported health in 23 European countries. JECH.

3. Labour market expenditures
 Active labour market policy expenditures
: help unemployed people back to work
• Job placement services, benefit administration and
labour market programmes (i.e.,training, job creation)
 Passive labour market policy expenditures
: provide financial assistance
• Unemployment compensation, early retirement for
labour market reasons

4. Research questions
1. Do labour market expenditures affect self-rated health?
If so, how - through active measures that support
unemployed workers to return back to work or passive
measures that provide financial assistance?
2. Do labour market expenditures affect the self-rated
health of men and women differently?

5. Data source and methods
 Data source
• European Social Survey (ESS) rounds 2 (2004) and 4 (2008)
• Organisation for Economic Co-operation Development
(OECD) statistics
• World Bank Statistics
 Methods
• A pooled sampled cross sectional design
• Multi-level analysis
 A total of 20 countries were selected
 Working-aged respondents, 15-64 (n=42,542) were
included

6. Countries by welfare regime typology
Scandinavian Anglo-Saxon Bismarckian Eastern Southern
Denmark
United
Kingdom
Austria
Czech
Republic
Italy
Finland Ireland Belgium Hungary Portugal
Norway France Poland Spain
Sweden Germany Slovenia
Luxembourg
Netherlands
Switzerland

7. Variables definition
 Dependent variable
• Individual self-rated health
(Excellent/very good/good vs. Fair/bad)
 Macro level independent variables
• Active labour market policy expenditures (% of GDP)
• Passive labour market policy expenditures (% of GDP)

8. Results
 Active expenditures by gender
Model1 Men Women
OR (95% CI) p-value OR (95% CI) p-value
0.48(0.30-0.77) <0.01* 0.53(0.31-0.88) 0.02
Model2* Men Women
OR (95% CI) p-value OR (95% CI) p-value
0.49(0.26-0.89) 0.02 0.60(0.35-1.05) 0.07
*Individual factors (age, education, employment status) and macro –social factors (welfare regimes, GDP growth and GDP
per capita) included

9. Results
 Passive expenditures by gender
Model3 Men Women
OR (95% CI) p-value OR (95% CI) p-value
0.73(0.54-0.98) 0.04 0.78(0.57-1.08) 0.13
Model 4* Men Women
OR (95% CI) p-value OR (95% CI) p-value
0.76(0.53-1.10) 0.15 0.78(0.57-1.08) 0.14
*Individual factors (age, education, employment status) and macro –social factors (welfare regimes, GDP growth and GDP
per capita) included

10. Results
 Active expenditures are associated with less likelihood of
bad self-rated health in men, but not in women in the fully
adjusted model.
 Passive expenditures are not associated with bad self-rated
health in both men and women in the fully adjusted model.

11. Conclusions
 As welfare regimes devote a larger share of their economy
to active labour market policies, self-rated health tends to
improve steeply.
 Encouraging opportunities for unemployed workers to re-enter
the workforce through active expenditures would
likely improve population levels of self-rated health,
especially in men.
 Future work will consider cross-level interactions (i.e.,
educational levels and employment status).