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Inequality of Opportunities in Health and the Principle of Natural Reward: Evidence from European Countries

Health and Inequality

ISBN: 978-1-78190-553-1, eISBN: 978-1-78190-554-8

Publication date: 30 December 2013


This chapter aims to quantify and compare inequalities of opportunity in health across European countries considering two alternative normative ways of treating the correlation between effort, as measured by lifestyles, and circumstances, as measured by parental and childhood characteristics, championed by Brian Barry and John Roemer. This study relies on regression analysis and proposes several measures of inequality of opportunity. Data from the Retrospective Survey of SHARELIFE, which focuses on life histories of European people aged 50 and over, are used.

In Europe at the whole, inequalities of opportunity stand for almost 50% of the health inequality due to circumstances and efforts in Barry scenario and 57.5% in Roemer scenario. The comparison of the magnitude of inequalities of opportunity in health across European countries shows considerable inequalities in Austria, France, Spain and Germany, whereas Sweden, Poland, Belgium, the Netherlands and Switzerland present the lowest inequalities of opportunity. The normative principle on the way to treat the correlation between circumstances and efforts makes little difference in Spain, Austria, Greece, France, Czech Republic, Sweden and Switzerland, whereas it would matter the most in Belgium, the Netherlands, Italy, Germany, Poland and Denmark.

In most countries, inequalities of opportunity in health are mainly driven by social background affecting adult health directly, and so would require policies compensating for poorer initial conditions. On the other hand, our results suggest a strong social and family determinism of lifestyles in Belgium, the Netherlands, Italy, Germany, Poland and Denmark, which emphasises the importance of inequalities of opportunity in health within those countries and calls for targeted prevention policies.




We gratefully acknowledge the financial support of the Health Chair, a joint initiative by PSL, Université Paris-Dauphine, ENSAE and MGEN under the aegis of the Fondation du Risque (FDR). Damien Bricard also benefited from a PhD studentship from the Régime Social des Indépendants (RSI).

We thank Bénédicte Apouey, Andrew Clark, Martin Karlsson, Erik Schokkaert and the participants to the 2013 PhD Seminar on Health Economics and Policy (Grindelwald, Switzerland) and to the 12th Journées Louis-André Gérard-Varet Conference in Public Economics for their helpful comments. We would like to thank the editors of this special issue for valuable remarks.

This chapter uses data from wave 1 and 2 release 2.5.0, as of 24 May 2011 and SHARELIFE release 1, as of 24 November 2010. The SHARE data collection has been primarily funded by the European Commission through the 5th Framework Programme (project QLK6-CT-2001-00360 in the thematic programme Quality of Life), through the 6th Framework Programme (projects SHARE-I3, RII-CT-2006-062193, COMPARE, CIT5-CT-2005-028857 and SHARELIFE, CIT4-CT-2006-028812) and through the 7th Framework Programme (SHARE-PREP, No. 211909, SHARE-LEAP, No. 227822 and SHARE M4, No. 261982). Additional funding from the U.S. National Institute on Aging (U01 AG09740-13S2, P01 AG005842, P01 AG08291, P30 AG12815, R21 AG025169, Y1-AG-4553-01, IAG BSR06-11 and OGHA 04-064) and the German Ministry of Education and Research as well as from various national sources is gratefully acknowledged (see for a full list of funding institutions).


Bricard, D., Jusot, F., Trannoy, A. and Tubeuf, S. (2013), "Inequality of Opportunities in Health and the Principle of Natural Reward: Evidence from European Countries", Health and Inequality (Research on Economic Inequality, Vol. 21), Emerald Group Publishing Limited, Bingley, pp. 335-370.



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