Variation in perceived health across gender, working status, educational level, and regional health care expenditure in Spain (2014-2017).

A gender perspective was used to analyze whether and how education, unemployment, and per capita public health expenditure were associated with perceived health among the Spanish population between the years 2014 and 2017. Using multilevel methodologies (looking at year, individual, and region) and linear and logistic specifications, we analyzed longitudinal microdata files from the Survey on Living Conditions. The results suggest that women with lower educational levels tend to report worse health than their more educated counterparts. On the other hand, women's bad health was not associated with unemployment, unlike men's. Regional per capita public health expenditure was not associated with perceived health in either men or women.

Long term unemployment, income, poverty, and social public expenditure, and their relationship with self-perceived health in Spain (2007-2011).

BACKGROUND: There is scant research that simultaneously analyzes the joint effects of long-term unemployment, poverty and public expenditure policies on poorer self-perceived health during the financial crisis. The aim of the study is to analyze the joint relationship between long-term unemployment, social deprivation, and regional social public expenditure on one side, and self-perceived health in Spain (2007-2011) on the other. METHODS: Longitudinal data were extracted from the Survey on Living Conditions, 2007-2010 and 2008-2011 (9105 individuals and 36,420 observations), which were then used to estimate several random group effects in the constant multilevel logistic longitudinal models (level 1: year; level 2: individual; level 3: region). The dependent variable was self-perceived health. Individual independent interest variables were long and very long term unemployment, available income, severe material deprivation and regional variables were per capita expenditure on essential public services and per capita health care expenditure. RESULTS: All of the estimated models show a robust association between bad perceived health and the variables of interest. When compared to employed individuals, long term unemployment increases the odds of reporting bad health by 22% to 67%; very long-term unemployment (24 to 48 months) increases the odds by 54% to 132%. Family income reduces the odds of reporting bad health by 16% to 28% for each additional percentage point in income. Being a member of a household with severe material deprivation increases the odds of perceiving one's health as bad by between 70% and 140%. Regionally, per capita expenditure on essential public services increases the odds of reporting good health, although the effect of this association was limited. CONCLUSIONS: Long and very long term unemployment, available income and poverty were associated to self-perceived bad health in Spain during the financial crisis. Regional expenditure on fundamental public services is also associated to poor self-perceived health, although in a more limited fashion. Results suggest the positive role in health of active employment and redistributing income policies.

Multilevel analysis of income, income inequalities and health in Spain.

The aim of this study is to test the influence of personal income (absolute income hypothesis), income inequalities and welfare (relative income hypothesis) on health. A multilevel cross-sectional logit model is used with two alternative specifications of the dependent variable: self-perceived health and chronic illnesses, and six specifications of the income inequality: three positive and three normative. This study incorporates lagged values of the regional variables and interactions between the individual and the regional variables. The data is drawn from the Spanish Life Conditions Survey for 2007 and consists of 28,023 individuals over 16 from 17 autonomous communities. The results support the absolute income hypothesis that a higher level of personal income is correlated with a lower probability of negative health outcomes. The relative income hypothesis results are mixed with only some indicators showing a significant relationship with health. The results also indicate that being a man, being married, working and having a high level of education are related to improved health. This study emphasizes the importance both of the health variable and of the specification of income inequality, and contributes to augmenting the limited empirical evidence available in Spain on the influence of income and income inequalities on the health of the population.