Healthcare Policy and the Reduction of Social Inequality in Health – the Importance of Intersectional Dimensions of Health Inequality

Although social inequalities in health have been observed worldwide, the strength of social inequalities in health appears to vary markedly across countries. Recent research suggests that this could be due to difference in healthcare systems across countries. However, some studies indicate that healthcare systems do not always have the expected effect on social inequalities in health. In this study, we argue that this is because it is not well understood yet how healthcare systems influence social inequalities in health. In this study, we build on sociological theories on institutions to provide more insight in the mechanisms through which healthcare systems have an effect on social inequalities in health. Moreover, whereas most research has ignored the intersectionality of separate dimensions of social inequality in health, we argue that different dimensions of social inequality may interact in affecting health. Using individual level data from the European Social Survey (2002-2012), and institutional data on several specific healthcare policies on 25 European countries we examine how the educational gradient in health interacts with ethnic inequalities in health, and how healthcare systems influence both dimensions of social inequality in health. We expect that healthcare policies that are aimed at reducing socioeconomic inequalities in health may indeed diminish educational inequalities in health, but that ethnic inequalities in health may increase rather than decrease with these policies. However, policies that are specifically aimed at reducing ethnic inequalities in health may be more appropriate to tackle this particular dimension of social inequality in health.