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

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.