Why Welfare-State Scholars Should Care about Health: Opportunities for Theoretical Development

Social inequalities in health -- like social inequalities in income -- endure, but also vary, through space and time. Building on research that documents the durability and variability of health inequality, recent research has turned toward the welfare state as a major explanatory factor in the search for causes of health inequality. Such research invites new theoretical development that can build on and contribute to welfare-state scholarship. This paper develops an institutional theory of health inequalities. Our institutional theory conceptualizes the welfare state as an institutional arrangement – a set of ‘rules of the game’ – that distributes health. Drawing on the institutional turn in stratification scholarship, we identify four mechanisms that connect the welfare state to health inequalities by producing and modifying the effects of the social determinants of health. These mechanisms are: redistribution, compression, mediation, and imbrication (or overlap). We describe how our framework organizes comparative research on the social determinants of health, and we identify new hypotheses our framework implies.