Welfare States, Trade and Health Inequalities

The persistence of socioeconomic inequalities in health is now well established and a subject of intense scholarly inquiry. A growing literature of comparative social epidemiological studies demonstrates that health outcomes vary significantly across different welfare state arrangements. Contrary to expectations however, evidence demonstrates that health inequalities are not always the smallest in social democratic countries with their more generous and universal welfare state policies. A range of potential explanations has been put forth to explain this paradox. This paper seeks to add to this rapidly developing research agenda by bringing trade policy into the fold. Different welfare state regimes have been shown to display different levels of trade openness, as well as qualitatively different types of trade. Social democratic countries in particular are noted to have the greatest level of inter-industry trade which is characterized by higher levels of labor market adjustments such as job loss among lower-wage workers. This paper draws on theoretical and empirical insights from political sciences as well as social epidemiology to generate hypotheses about the effects of trade openness on health inequalities in the different welfare state regimes. It will discuss whether the persistence of health inequalities can partly be seen as a failure of welfare states to compensate for the impacts of greater market integration. The relevance of this work for future health inequalities research will be considered.