Neurological conditions and subsequent divorce risk in the Nordic countries: the importance of gender and both spouses' education.

BACKGROUND: Prior studies suggest that poor physical health, accompanied by functional disability, is associated with increased divorce risk. However, this association may depend on gender, the socioeconomic resources of the couple, as well as the social policy and social (in)equality context in which the illness is experienced. This study focuses on neurological conditions, which often have substantial functional consequences. METHODS: We used longitudinal population-wide register data from the years 2007-2016 (Denmark, Sweden) or 2008-2017 (Finland, Norway) to follow 2 809 209 married couples aged 30-64 for neurological conditions, identified using information on specialised healthcare for diseases of the nervous system and subsequent divorce. Cox regression models were estimated in each country, and meta-analysis used to calculate across-country estimates. RESULTS: During the 10-year follow-up period, 22.2% of couples experienced neurological conditions and 12.0% of marriages ended in divorce. In all countries, divorce risk was elevated among couples where at least one spouse had a neurological condition, and especially so if both spouses were ill. The divorce risk was either larger or similar for husband's illness, compared with wife's illness, in all educational categories. For the countries pooled, the weighted average HR was 1.21 (95% CI 1.20 to 1.23) for wives' illness, 1.27 (95% CI 1.25 to 1.29) for husbands' illness and 1.38 (95% CI 1.34 to 1.42) for couples where both spouses were ill. CONCLUSIONS: Despite some variation by educational resources and country context, the results suggest that the social consequences of illness are noticeable even in Nordic welfare states, with the husband's illness being at least as important as the wife's.

Health-related exit from employment before and during the COVID-19 pandemic in Norway: Analysis of population-wide register data 2013-2021.

People with health problems experience various labor market disadvantages, such as hiring discrimination and heightened risk of firing, but the impact of deteriorating economic conditions on health-related labor market mobility remains poorly understood. The strength of the downturn/crisis will most likely make a difference. During minor downturns, when few employees are made redundant, health-related exit may occur frequently since employers prefer to keep those with good health on the payroll. However, during major economic crises, when large-scale downsizing and firm closures abound, there will be less discretionary room for employers. Thus, some mechanisms that usually are damaging for people with health problems (e.g., seniority rules and negative connotations), can be neutralized, ultimately leading to smaller health differentials in labor market outcomes. The current study used population-wide administrative register data, covering the years 2013-2021, to examine health-related exit from employment (to unemployment/social assistance) before and during the COVID-19 pandemic in Norway. The pandemic spurred a major crisis on the Norwegian labor market and led to a record-high unemployment rate of 10.6 percent in March 2020. Restricting the analytical samples to labor market insiders, linear probability models showed that previous recipients of health-related benefits had a higher unemployment likelihood in the pre-crisis year 2019. The relative importance of poor health changed non-negligibly, however, during the COVID-19 pandemic. When identical statistical analyses were run on the crisis year 2020, health-related exit from employment was dampened. Yet, this labor market equalization was not followed by smaller health differentials in work income in 2021, mainly because people with good health retained or regained decent-paying jobs when the economic conditions improved again. In conclusion, major economic crises can lead to an equalization of labor market disadvantages for people with health problems, but health-related inequalities may reemerge when the economy recovers.

Widening educational inequalities in mortality in more recent birth cohorts: a study of 14 European countries.

BACKGROUND: Studies of period changes in educational inequalities in mortality have shown important changes over time. It is unknown whether a birth cohort perspective paints the same picture. We compared changes in inequalities in mortality between a period and cohort perspective and explored mortality trends among low-educated and high-educated birth cohorts. DATA AND METHODS: In 14 European countries, we collected and harmonised all-cause and cause-specific mortality data by education for adults aged 30-79 years in the period 1971-2015. Data reordered by birth cohort cover persons born between 1902 and 1976. Using direct standardisation, we calculated comparative mortality figures and resulting absolute and relative inequalities in mortality between low educated and high educated by birth cohort, sex and period. RESULTS: Using a period perspective, absolute educational inequalities in mortality were generally stable or declining, and relative inequalities were mostly increasing. Using a cohort perspective, both absolute and relative inequalities increased in recent birth cohorts in several countries, especially among women. Mortality generally decreased across successive birth cohorts among the high educated, driven by mortality decreases from all causes, with the strongest reductions for cardiovascular disease mortality. Among the low educated, mortality stabilised or increased in cohorts born since the 1930s in particular for mortality from cardiovascular diseases, lung cancer, chronic obstructive pulmonary disease and alcohol-related causes. CONCLUSIONS: Trends in mortality inequalities by birth cohort are less favourable than by calendar period. In many European countries, trends among more recently born generations are worrying. If current trends among younger birth cohorts persist, educational inequalities in mortality may further widen.

Gendered health consequences of unemployment in Norway 2000-2017: a register-based study of hospital admissions, health-related benefit utilisation, and mortality.

BACKGROUND: The existing literature indicates that unemployment leads to deteriorated mental and somatic health, poorer self-assessed health, and higher mortality. However, it is not clear whether and to what extent the health consequences of unemployment differ between men and women. According to social role theory, women can alternate between several roles (mother, wife, friend, etc.) that make it easier to deal with unemployment, whereas the worker role is more important for men, and unemployment could therefore be more harmful to them. Thus, gender differences in the health consequences of unemployment should decrease as society grows more gender equal. Accordingly, this study examines changes over time in the gendered health consequences of unemployment in Norway.  METHODS: Linked Norwegian administrative register data, covering the period from 2000 to 2017, were analysed by means of linear probability models and logistic regression. Four health outcomes were investigated: hospitalisation, receiving sick pay, disability benefit utilisation, and the likelihood of mortality. Two statistical models were estimated: adjusted for (1) age, and (2) additional sociodemographic covariates. All analyses were run split by gender. Three different unemployment cohorts (2000, 2006, and 2011) that experienced similar economic conditions were followed longitudinally until 2017. RESULTS: The empirical findings show, first, that hospital admission is somewhat more common among unemployed males than among unemployed females. Second, receiving sick pay is much more common post-unemployment for men than for women. Third, excess mortality is higher among unemployed males than among unemployed females. Fourth, there is no gender component in disability benefit utilisation. There is a remarkable pattern of similarity when comparing the results for the three different unemployment cohorts (2000; 2006; 2011). Thus, the gendered health consequences of unemployment have hardly changed since the turn of the century. CONCLUSION: This paper demonstrates that the health consequences of unemployment are serious, gendered, and enduring in Norway.

Nordic research on health inequalities: A scoping review of empirical studies published in Scandinavian Journal of Public Health 2000-2021.

AIMS: An important task for the Scandinavian Journal of Public Health is to address health inequality topics. This scoping review characterises Nordic empirical studies within this research field, published 2000-2021 by the Scandinavian Journal of Public Health. METHODS: Original empirical research studies using data from Denmark, Finland, Iceland, Norway and/or Sweden, which linked differences in health or health-related aspects to socioeconomic positions, immigrant status, family structures and/or residential areas, were included in the review. The initial search in the Web of Science article database resulted in 294 possibly relevant articles, and 171 were judged to comply with our criteria. RESULTS: Only one study was based on qualitative data, while all others used either surveys or register data, or both in combination. A wide variety of outcomes was addressed. Most studies had a social causation design, but 16 studies analysed health-related mobility processes and four reported intervention results. The most common statistical method was logistic regression. Poisson, Cox and ordinary least squares regression were less used. Few studies engaged explicitly with health inequality theories or with rigorous causality designs. CONCLUSIONS: The empirical health inequality studies published by the Scandinavian Journal of Public Health are rich sources for knowledge on a large array of health and health-related inequalities in Nordic countries. Drawbacks are underuse of qualitative data, few theoretical discussions and lack of studies assessing effects of interventions and policies.

COVID-19 and the Nordic Paradox: a call to measure the inequality reducing benefits of welfare systems in the wake of the pandemic.

The Nordic Paradox of inequality describes how the Nordic countries have puzzlingly high levels of relative health inequalities compared to other nations, despite extensive universal welfare systems and progressive tax regimes that redistribute income. However, the veracity and origins of this paradox have been contested across decades of literature, as many scholars argue it relates to measurement issues or historical coincidences. Disentangling between potential explanations is crucial to determine if widespread adoption of the Nordic model could represent a sufficient panacea for lowering health inequalities, or if new approaches must be pioneered. As newfound challenges to welfare systems continue to emerge, evidence describing the benefits of welfare systems is becoming ever more important. Preliminary evidence indicates that the COVID-19 pandemic is drastically exacerbating social inequalities in health across the world, via direct and indirect effects. We argue that the COVID-19 pandemic therefore represents a unique opportunity to measure the value of welfare systems in insulating their populations from rising social inequalities in health. However, COVID-19 has also created new measurement challenges and interrupted data collection mechanisms. Robust academic studies will therefore be needed-drawing on novel data collection methods-to measure increasing social inequalities in health in a timely fashion. In order to assure that policies implemented to reduce inequalities can be guided by accurate and updated information, policymakers, academics, and the international community must work together to ensure streamlined data collection, reporting, analysis, and evidence-based decision-making. In this way, the pandemic may offer the opportunity to finally clarify some of the mechanisms underpinning the Nordic Paradox, and potentially more firmly establish the merits of the Nordic model as a global example for reducing social inequalities in health.

Disentangling the dynamics of social assistance: A linked survey-Register data cohort study of long-term social assistance recipients in Norway.

Social assistance is a means-tested benefit that is supposed to be a short-term, temporary economic support. Understanding why some individuals are in repeated or continuous need of social assistance is thus of obvious policy relevance, but the dynamics of social assistance receipt remain poorly understood. In 2005, a survey among long-term recipients of social assistance in Norway collected data on (a) childhood disadvantages, (b) health status, (c) health behaviors, (d) psychological resources, and (e) social ties, in addition to basic sociodemographic information. This rich survey data has been linked with tax register data from 2005-2013, enabling us to explore the detailed characteristics of long-term social assistance recipients who are unable to reach financial self-sufficiency. Results from linear probability models show that surprisingly few of the 28 explanatory variables are statistically associated with social assistance dynamics, with two important exceptions: People with drug problems and immigrants both have a much higher probability of social assistance receipt. Yet overall, it is challenging to 'predict' social assistance dynamics, indicating that randomness most likely plays a non-negligible role. The 28 explanatory variables do a far better job in predicting both labor market success (employment), labor market preparation (work assessment allowance), and labor market withdrawal (disability benefit utilization). Thus, there seems to be something distinctive about the processes leading to continued social assistance recipiency, where randomness could be a more influential force.

Is There Less Labor Market Exclusion of People With Ill Health in "Flexicurity" Countries? Comparative Evidence From Denmark, Norway, the Netherlands, and Belgium.

Higher employment rates among vulnerable groups is an important policy goal; it is therefore vital to examine which social policies, or mix of policies, are best able to incorporate vulnerable groups - such as people with ill health - into the labor market. We examine whether 2 "flexicurity" countries, Denmark and the Netherlands, have less labor market exclusion among people with ill health compared to the neighboring countries of Norway and Belgium. We analyze the 2 country pairs of Denmark-Norway and the Netherlands-Belgium using OLS regressions and propensity score kernel matching of EU-SILC panel data (2010-2013). Both unemployment and disability likelihood is remarkably similar for people with ill health across the 4 countries, despite considerable social policy differences. There are 3 possible explanations for the observed cross-national similarity. First, different social policy combinations could lead toward the same employment outcomes for people with ill health. Second, most policy instruments are located on the supply side, and demand side reasons for the observed "employment penalty" (e.g., employer skepticism/discrimination) are often neglected. Third, it is too demanding to hold (full-time) employment for a sizeable proportion of those who have poor health status.

Socioeconomic inequalities in health during the Great Recession: A scoping review of the research literature.

Aims: The so-called 'Great Recession' in Europe triggered widespread concerns about population health, as reflected by an upsurge in empirical research on the health impacts of the economic crisis. A growing body of empirical studies has also been devoted to socioeconomic inequalities in health during the Great Recession. The aim of the current study is to summarise this health inequality literature by means of a scoping review. Methods: We have performed a scoping review of the research literature (English language) published in the years 2012-2017. Only empirical papers with (a) health status measured on the individual level, (b) information on socioeconomic position (i.e. employment status, educational level, income/wealth, and/or occupational class), and (c) data from European countries in both pre- and post-crisis years were considered relevant. In total, 49 empirical studies fulfilled these inclusion criteria. Results: The empirical findings in the 49 included studies predominantly show that socioeconomic inequalities in health either increased or remained stable from pre- to post-crisis years. Two-thirds (65%) of the studies found evidence of either increasing or partially increasing health inequalities. Thus, people in lower socioeconomic strata fared worse overall in terms of health during the Great Recession, compared to people with higher socioeconomic status. Conclusions: The Great Recession in Europe tends to be followed by increasing socioeconomic inequalities in health. Policymakers should take note of this finding. Widening socioeconomic inequalities in health is a major cause of concern, in particular if health deterioration among 'vulnerable groups' is caused by accelerating cumulative disadvantages.

Are immigrants and descendants with ill health more prone to unemployment? Evidence from 18 European countries.

OBJECTIVE: Previous research has established that both ill health and minority status are associated with unemployment. Less is known, however, about the interplay between having ill health and being from minority background. The present study examines whether immigrants and descendants with ill health are particularly prone to unemployment during an economic downturn in Europe. DESIGN: The European Union Statistics on Income and Living Conditions (EU-SILC) cross-sectional data material is utilized, and linear probability models are estimated. The analysis is run for countries in which the two minority samples are acceptably large (N ≥ 100), resulting in 18 included European countries. The year 2011 is chosen because it is possible to identify both immigrants and descendants in EU-SILC due to a module on intergenerational transfer of disadvantages. RESULTS: The results indicate - as expected - that both ill health and minority status are independently related to higher unemployment likelihood. Immigrants and descendants with ill health, however, are not particularly likely to be unemployed. This finding is robust to a number of sensitivity tests, and the empirical pattern is very similar across the 18 included countries. CONCLUSION: Both minority status and ill health are associated with high unemployment probability in Europe. However, there does not seem to exist a 'double disadvantage' for immigrants and descendants with ill health, which is in line with a human capital perspective on how employers evaluate potential employees. Both a non-native-sounding name and bad health status are interpreted as a risk factor, but there is no reason to expect ill health to lower the productivity level more if the applicant is a descendant or immigrant.

Health Effects of Unemployment in Denmark, Norway and Sweden 2007-2010: Differing Economic Conditions, Differing Results?

This article investigates short-term health effects of unemployment for individuals in Denmark, Norway, and Sweden during an economic downturn (2007-2010) that hit the Scandinavian countries with diverging strength. The longitudinal part of the European Union Statistics on Income and Living Conditions (EU-SILC) data material is analyzed, and results from generalized least squares estimation indicate that Denmark is the only Scandinavian country in which health status deteriorated among the unemployed. The individual-level (and calendar year) fixed-effect results confirm the negative relationship between unemployment and health status in Denmark. This result is robust across different subsamples, model specifications, and changes in both the dependent and independent variable. Health status deteriorated especially among women and people in prime working age (30-59 years). There is, however, only scant evidence of short-term health effects among the recently unemployed in Norway and Sweden. The empirical findings are discussed in light of: (1) the adequacy of the unemployment insurance system, (2) the likelihood of re-employment for the displaced worker, and (3) selection patterns into and out of employment in the years preceding and during the economic downturn.

Unemployment and health selection in diverging economic conditions: Compositional changes? Evidence from 28 European countries.

UNLABELLED: Unemployment and health selection in diverging economic conditions: Compositional changes? Evidence from 28 european countries. INTRODUCTION: People with ill health tend to be overrepresented among the unemployment population. The relationship between health and unemployment might, however, be sensitive to the overall economic condition. Specifically, the health composition of the unemployment population could change dramatically when the economy takes a turn for the worse. METHODS: Using EU-SILC cross sectional data from 2007 (pre-crisis) and 2011 (during crisis) and linear regression models, this paper investigates the relationship between health and unemployment probabilities under differing economic conditions in 28 European countries. The countries are classified according to (i) the level of and (ii) increase in unemployment rate (i.e. >10 percent and doubling of unemployment rate = crisis country). RESULTS: Firstly, the unemployment likelihood for people with ill health is remarkably stable over time in Europe: the coefficients are very similar in pre-crisis and crisis years. Secondly, people with ill health have experienced unemployment to a lesser extent than those with good health status in the crisis year (when we pool the data and compare 2007 and 2011), but only in the countries with a high and rising unemployment rate. CONCLUSION: The health composition of the unemployment population changes significantly for the better, but only in those European countries that have been severely hit by the current economic crisis.

Unemployment in Scandinavia during an economic crisis: cross-national differences in health selection.

Are people with ill health more prone to unemployment during the ongoing economic crisis? Is this health selection more visible among people with low education, women, or the young? The current paper investigates these questions in the Scandinavian context using the longitudinal part of the EU-SILC data material. Generalized least squares analysis indicates that people with ill health are laid off to a higher degree than their healthy counterparts in Denmark, but not in Norway and Sweden. Additionally, young individuals (<30 years) with ill health have a higher probability of unemployment in both Norway and Sweden, but not in Denmark. Neither women with ill health, nor individuals with low educational qualifications and ill health, are more likely to lose their jobs in Scandinavia. Individual level (and calendar year) fixed effects analysis confirms the existence of health selection out of employment in Denmark, whereas there is no suggestion of health selection in Sweden and Norway, except among young individuals. This finding could be related to the differing labor market demand the three Scandinavian countries have experienced during and preceding the study period (2007-2010). Another possible explanation for the cross-national differences is connected to the Danish "flexicurity" model, where the employment protection is rather weak. People with ill health, and hence more unstable labor market attachment, could be more vulnerable in such an arrangement.