Revisiting the Effect of Income on Health in Europe: Evidence from the 8th Round of the European Social Survey

  • Michail Papazoglou
  • Ioannis GalariotisEmail author


This study provides new evidence about the effects of income on population health. To do so, our first research question controls for the absolute income hypothesis: Has the recent deterioration of individual income had as a result a lower health status in population across European countries? We assume, as the bulk of the associated studies have found, that the lower the income of an individual, the lower his/her health status. Our second research objective is to examine the validity of the relative income hypothesis. To shed light on this issue, we test two different questions: What is the relationship between an individual’s health status and a country’s wealth and how self-rated health is associated with the degree of income inequality in a society? We expect that the population in wealthier countries report higher health status and individuals who live in countries with higher income inequalities report lower health status. By employing a multilevel binomial model and treating data from the latest European Social Survey Round 8 (2016/2017) from 23 countries in Europe, we have found strong evidence in favor of the above-mentioned hypotheses.


Income inequality Individual income Self-rated health Europe Multilevel modeling Binary logistic regression 



We would like to thank Nevena Kulic (Max Weber Fellow at the European University Institute in Florence) and the two anonymous reviewers for providing useful comments and feedback.

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Human and Animal Rights

This article does not contain any studies with human participants or animals performed by any of the authors.


  1. Abdi, H., & Williams, L. J. (2010). Principal component analysis. Wiley Interdisciplinary Reviews: Computational Statistics, 2(4), 433–459.CrossRefGoogle Scholar
  2. Adler, N., Boyce, T. W., Chesney, M. A., Folkman, S., & Syme, S. L. (1993). Socioeconomic inequalities in health no easy solution. JAMA: The Journal of the American Medical Association, 269(24), 3140–3145.CrossRefGoogle Scholar
  3. Alesina, A., & Giuliano, P. (2009). Preferences for redistribution. IZA discussion paper, (4056), Leibniz: Institute for the Study of Labor.Google Scholar
  4. Babones, S. J. (2008). Income inequality and population health: Correlation and causality. Social Science and Medicine, 66(7), 1614–1626.CrossRefGoogle Scholar
  5. Bakkeli, N. Z. (2016). Income inequality and health in China: A panel data analysis. Social Science and Medicine, 157, 39–47.CrossRefGoogle Scholar
  6. Balaj, M., McNamara, C. L., Eikemo, T. A., & Bambra, C. (2017). The social determinants of inequalities in self-reported health in Europe: Findings from the European social survey (2014) special module on the social determinants of health. European Journal of Public Health, 27(Supplement 1), 107–114.CrossRefGoogle Scholar
  7. Bartlett, J. W., Harel, O., & Carpenter, J. R. (2015). Asymptotically unbiased estimation of exposure odds ratios in complete records logistic regression. American Journal of Epidemiology, 182(8), 730–736. Scholar
  8. Bell, A., Jones, K., & Fairbrother, M. (2018). Understanding and misunderstanding group mean centering: a commentary on Kelley et al.’s dangerous practice. Quality & Quantity, 52(5), 2031–2036.CrossRefGoogle Scholar
  9. Clarke, P. M., Gerdtham, U. G., Johannesson, M., Bingefors, K., & Smith, L. (2002). On the measurement of relative and absolute income-related health inequality. Social Science and Medicine, 55(11), 1923–1928.CrossRefGoogle Scholar
  10. Donnelly, M. J., & Pop-Eleches, G. (2018). Income measures in cross-national surveys: Problems and solutions. Political Science Research and Methods, 6(2), 355–363.CrossRefGoogle Scholar
  11. Dorfman, R. (1979). A formula for the Gini coefficient. The Review of Economics and Statistics, 61(1), 146.CrossRefGoogle Scholar
  12. Ecob, R., & Davey Smith, G. (1999). Income and health: What is the nature of the relationship? Social Science and Medicine, 48(5), 693–705.CrossRefGoogle Scholar
  13. Eikemo, T. A., Bambra, C., Judge, K., & Ringdal, K. (2008). Welfare state regimes and differences in self-perceived health in Europe: A multilevel analysis. Social Science and Medicine, 66(11), 2281–2295.CrossRefGoogle Scholar
  14. European Social Survey. (2016). Welfare attitudes: Question design final module in template. London: ESS ERIC Headquarters c/o City University London. Retrieved May 26, 2019.
  15. European Social Survey. (2018). Preparing the data. Retrieved May 19, 2019.
  16. Eurostat. (2016). International Standard Classification of Education (ISCED): Statistics explained. Retrieved May 26, 2019.
  17. Fox, J. (2003). Effect displays for generalized linear models. Journal of Statistical Software, 8(15), 1–27.CrossRefGoogle Scholar
  18. Gravelle, H. (1998). How much of the relation between population mortality and unequal distribution of income is a statistical artefact? BMJ, 316(7128), 382.CrossRefGoogle Scholar
  19. Gravelle, H., Wildman, J., & Sutton, M. (2002). Income, income inequality and health: What can we learn from aggregate data? Social Science and Medicine, 54(4), 577–589. Scholar
  20. Groves, R. M., Fowler, F. J., Couper, M. P., Lepkowski, J. M., Singer, E., & Tourangeau, R. (2004). Survey methodology: Wiley series in survey methodology. New York, USA.Google Scholar
  21. Hoffmeyer-Zlotnik, J., & Warner, U. (2006). Methodological discussion of the income measure in the European social survey round 1. Metodološki zvezki, 3(2), 289–334.Google Scholar
  22. Holstein, B. E., Currie, C., Boyce, W., Damsgaard, M. T., Gobina, I., Kökönyei, G., et al. (2009). Socio-economic inequality in multiple health complaints among adolescents: International comparative study in 37 countries. International Journal of Public Health, 54(SUPPL. 2), 260–270.CrossRefGoogle Scholar
  23. Jen, M. H., Jones, K., & Johnston, R. (2009). Global variations in health: Evaluating Wilkinson’s income inequality hypothesis using the World Values Survey. Social Science and Medicine, 68(4), 643–653.CrossRefGoogle Scholar
  24. Kennedy, B. P., Kawachi, I., Glass, R., & Prothrow-stith, D. (1998). Income distribution, socioeconomic status, and self rated health in the United States: Multilevel analysis. BMJ, 317(October), 917–921.CrossRefGoogle Scholar
  25. Lessler, J. T., & Kalsbeek, W. D. (1992). Nonsampling error in surveys. Wiley series in probability and statistics. Hoboken: Wiley.Google Scholar
  26. McNabb, D. E. (2013). Nonsampling error in social surveys. Thousand Oaks: Sage publications.Google Scholar
  27. Molenberghs, G., Fitzmaurice, G., Kenward, M., Tsiatis, A., & Verbeke, G. (Eds.). (2004). Handbook of missing data methodology. New York: CRC Press.Google Scholar
  28. Moore, S., Teixeira, A. C., & Shiell, A. (2006). The health of nations in a global context: Trade, global stratification, and infant mortality rates. Social Science and Medicine, 63(1), 165–178.CrossRefGoogle Scholar
  29. OECD. (2018). Income distribution database (IDD): Gini, poverty, income, methods and concepts. Retrieved July 30, 2018.
  30. Pickett, K. E., & Wilkinson, R. G. (2015). Income inequality and health: A causal review. Social Science and Medicine, 128, 316–326.CrossRefGoogle Scholar
  31. Subramanian, S. V., & Kawachi, I. (2006). Whose health is affected by income inequality? A multilevel interaction analysis of contemporaneous and lagged effects of state income inequality on individual self-rated health in the United States. Health and Place, 12(2), 141–156. Scholar
  32. Svallfors, S. (2012). Welfare attitudes in Europe: Top line results from round 4 of the European social survey. Bergen: European Social Survey.Google Scholar
  33. Wilkinson, R. G. (1996). Unhealthy societies: The afflictions of inequality. New York: Routledge.Google Scholar
  34. Wilkinson, R. G. (1998). Mortality and distribution of income. Low relative income affects mortality. The British Medical Journal (Clinical Research Ed.), 136(7144), 1611.Google Scholar
  35. Wilkinson, R. G., & Pickett, K. E. (2006). Income inequality and population health: A review and explanation of the evidence. Social Science and Medicine, 62(7), 1768–1784.CrossRefGoogle Scholar
  36. WorldBank. (2018). GDP per capita, PPP | data. Retrieved July 30, 2018.

Copyright information

© Springer Nature B.V. 2019

Authors and Affiliations

  1. 1.Unisystems S.A.MilanItaly
  2. 2.School of Transnational GovernanceEuropean University InstituteSan Domenico di FiesoleItaly

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