Social Science & Medicine
Volume 63, Issue 3 , August 2006, Pages 829-842

Political and welfare state determinants of infant and child health
indicators: An analysis of wealthy countries

   Haejoo Chung a, ,  and Carles Muntaner b,

aDepartment of Health Policy and Management, Johns Hopkins School of Public
Health, USA
bPsychiatric and Addictions Nursing Research Chair, Center for Addiction
and Mental Health, Faulty of Nursing, and Department of Public Health
Sciences, University of Toronto, Canada

Abstract
Economic indicators such as income inequality are gaining attention as
putative determinants of population health. On the other hand, we are just
beginning to explore the health impact on population health of political
and welfare state variables such as political orientation of government or
type of medical care coverage. To determine the socially structured impact
of political and welfare state variables on low birth weight rate, infant
mortality rate, and under-five mortality rate, we conducted an ecological
study with unbalanced time-series data from 19 wealthy OECD countries for
the years from 1960 to 1994. Among the political/welfare state variables,
total public medical coverage was the most significant predictor of the
mortality outcomes. The low birth weight rate was more sensitive to
political predictors such as percentage of vote obtained by social
democratic or labor parties. Overall, political and welfare state variables
(including indicators of health policies) are associated with infant and
child health indicators. While a strong medical care system seems crucial
to some population health outcomes (e.g., the infant mortality rate), other
population health outcomes might be impacted by social policies enacted by
parties supporting strong welfare states (the low birth weight rate). Our
investigation suggests that strong political will that advocates for more
egalitarian welfare policies, including public medical services, is
important in maintaining and improving the nation's health.

Keywords: Welfare state; Politics of health care; Public medical care;
Infant mortality; Under-five mortality; Low birth weight; Comparative

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