Periodic Reporting for period 1 - HI-GEN-SHARE (Health and Gender Health Inequalities: a longitudinal analysis using the Survey of Health Ageing and Retirement in Europe (SHARE))
Reporting period: 2022-09-01 to 2024-08-31
Summary of the context and overall objectives of the project
Health inequalities are a major concern in all European countries and the COVID-19 Pandemic has pointed out how preserving the individuals’ health status is crucial to the overall economy.
Recent statistics of the OECD report that one in three deaths in Europe is caused by chronic diseases such as heart attacks, stroke, chronic respiratory problems and diabetes. Despite mortality rates have declined in most OECD country over time, the population ageing and the rising of socio-economic disparities may hamper future mortality reduction. Many of these chronic conditions are rooted in the overall life course and might be explained by early life conditions. Although health inequalities have been addressed by several fields, from natural to social sciences, the mechanisms through which they originate and persist over the life cycle are still unclear. Several studies have been conducted at country level and with a specific targeted population. However, a comprehensive study on Europeans to understand the origins of health inequalities over life in Europe is lacking.
My project fills this gap by exploiting novel econometric techniques to investigate health inequalities on a panel of European individuals. This will advance our understanding of how socio-economic determinants and health build up and interact over time. The project has therefore two main research directions.
First, it aims to extend the analysis of health inequalities from early to late life exploiting a panel of European countries. I exploit the Survey of Health Ageing and Retirement (SHARE) which provides information of individuals aged 50 and above, along with early childhood conditions and child health status. I take advantage of the retrospective survey conducted in 2009 and 2017 to build the individual health trajectory over the life course. I apply novel econometric techniques to improve the understanding of the origins and evolution of health disparities. The results will shed light on the origins and causes of the heterogenous health trajectories of Europeans. From a policy perspective, the results will contribute to understanding how disparities stem from early ages to late life.
As a second step, I focus on gender health inequalities as a key channel of health disparities. Indeed, social determinants have largely been considered as the main cause of health inequalities, whilst the role of gender has instead been considered only as a biological factor with regards to this disparity. I look at how gender as a driver of health inequalities by exploiting the SHARE data and the European administrative data (EUROSTAT) on the provision of health services. I investigate whether the differences in healthcare usage are also due to gender differences in access to care. I combine the dataset prepared in for the first part of the project with the EUROSTAT data and apply econometric models to analyse this innovative perspective of health inequalities. I also make use of an additional data on gender norms (the European Value Study), to understand whether opinions, beliefs and attitudes based on the gender influence the healthcare usage.
This ambitious project will address health inequalities with a longitudinal approach on a panel of European individuals and will provide cutting-edge quantitative results, along with policy recommendations to reduce health disparities in Europe. The particular focus on the causes of gender health inequalities will advance the understanding on how to tackle this specific matter, which is at the core of the MSCA action.
Recent statistics of the OECD report that one in three deaths in Europe is caused by chronic diseases such as heart attacks, stroke, chronic respiratory problems and diabetes. Despite mortality rates have declined in most OECD country over time, the population ageing and the rising of socio-economic disparities may hamper future mortality reduction. Many of these chronic conditions are rooted in the overall life course and might be explained by early life conditions. Although health inequalities have been addressed by several fields, from natural to social sciences, the mechanisms through which they originate and persist over the life cycle are still unclear. Several studies have been conducted at country level and with a specific targeted population. However, a comprehensive study on Europeans to understand the origins of health inequalities over life in Europe is lacking.
My project fills this gap by exploiting novel econometric techniques to investigate health inequalities on a panel of European individuals. This will advance our understanding of how socio-economic determinants and health build up and interact over time. The project has therefore two main research directions.
First, it aims to extend the analysis of health inequalities from early to late life exploiting a panel of European countries. I exploit the Survey of Health Ageing and Retirement (SHARE) which provides information of individuals aged 50 and above, along with early childhood conditions and child health status. I take advantage of the retrospective survey conducted in 2009 and 2017 to build the individual health trajectory over the life course. I apply novel econometric techniques to improve the understanding of the origins and evolution of health disparities. The results will shed light on the origins and causes of the heterogenous health trajectories of Europeans. From a policy perspective, the results will contribute to understanding how disparities stem from early ages to late life.
As a second step, I focus on gender health inequalities as a key channel of health disparities. Indeed, social determinants have largely been considered as the main cause of health inequalities, whilst the role of gender has instead been considered only as a biological factor with regards to this disparity. I look at how gender as a driver of health inequalities by exploiting the SHARE data and the European administrative data (EUROSTAT) on the provision of health services. I investigate whether the differences in healthcare usage are also due to gender differences in access to care. I combine the dataset prepared in for the first part of the project with the EUROSTAT data and apply econometric models to analyse this innovative perspective of health inequalities. I also make use of an additional data on gender norms (the European Value Study), to understand whether opinions, beliefs and attitudes based on the gender influence the healthcare usage.
This ambitious project will address health inequalities with a longitudinal approach on a panel of European individuals and will provide cutting-edge quantitative results, along with policy recommendations to reduce health disparities in Europe. The particular focus on the causes of gender health inequalities will advance the understanding on how to tackle this specific matter, which is at the core of the MSCA action.
Work performed from the beginning of the project to the end of the period covered by the report and main results achieved so far
In the first part of the project, I started implementing the data preparation of the SHARE data to build the panel dataset and the retrospective data, I also include the EUROSTAT data and the NUTS level information in the dataset, to map the availability of healthcare supply. At the same time, I explore the existing literature and the econometric methods to be developed in the project. This part took place between September 2022 to January 2023.
I exploit several sections of the SHARE survey in order to build the dataset for the empirical analysis. SHARE is the largest pan-European social science panel study providing internationally comparable longitudinal micro data. The data are available at different level of investigation: current waves where individuals are interviewed about their current situation and the retrospective life. The information were merged with EUROSTAT data from which information about the healthcare supply is collected at NUTS2 level.
Data preparation was organized in several step: merging of the current waves of share, merging of the retrospective analysis including the working career history and the childhood health and housing information, merging of the information of SHARE at NUTS2 level, finally merging of the EUROSTAT data information on healthcare supply at NUTS2 level. The EUROSTAT data have been merged together with the SHARE data at NUTS2 level. As a following steps, I proceed with data cleaning, variable selection and measure construction. As a result, the datasets are prepared and stored in PSE server for proper use for research. They cannot be publicly shared due to the SHARE user agreement condition, but the raw data are publicly accessible from the SHARE website (upon signature of the agreement). The codes to prepare the data are ready and will be available when the papers are published.
Furthermore, I include an additional source of data coming from the European Values Study, which incorporates information about gender norms and have been used for the second part of the project. This information is very detailed and asked multiple questions on the role of women in the society. For example, it asks whether women are suited for a working careers, or if men can be good fathers, if both men and women should work, and more. It aimed at capturing how the role of women is perceived in the family and work context. This data preparation was then used for the second part of the project when working on gender health inequalities.
I proceed by working on health inequalities and setting up an econometric analysis. The work focused on health inequalities across the life course using the SHARE data and combining current and retrospective information.
This part includes a descriptive and econometric analysis of the determinants of health inequalities using a panel data perspective. The innovation of this project is the methodology that has been implemented using the cutting-edge econometric literature on event study. The analysis has aimed at identifying the main causes of health inequalities from childhood and how these affects later life outcome. The econometric method was a difference in difference method with treatment at different timing, since individuals could have had health shocks at different points in time during childhood. The results of the analysis have found that infection diseases are among the most impactful events during childhood that can affects health and late life outcomes. The working paper is under preparation and will be publicly available by the end of November 2024.
In the second part of the project, from September 2023 to June 2024 I work on the gender health inequalities project and set up descriptive and econometric analysis to understand the role of social norms on the gender health gap. I have prepared the paper for gender health inequalities in Europe to inform policy makers and scholars in the field. This section aimed at addressing how gender health disparities originates and the role of healthcare utilization. Originally, this section wanted to exploit the vignettes (method used in sociology, psychology and experiment economics), which are present in the SHARE dataset in wave 3. However, a more innovative information has been used by exploiting the European Value Study survey, such as the gender norms measures. As anticipated, this survey contains information about norms towards women and men in the society in Europe. The analysis has focused on the role of gender norms in different domains and their effect on the men and women health. This part of the project was targeted on the gender dimension and it was among the first study in the field of health economics that looked at the role of gender norms on health outcomes and healthcare.
The evidence of the analysis show that women are affected by traditional gender norms which see them as the one in charge for family and caring activities. The evidence suggest that this type of norms increased women’s depression and poor health status. This result is consistent across different specification of the gender norms as well as heterogeneous group analyses (for example at different education level or age). The results are available in the working paper entitled “How Gender Norms Shape the Health of Women and Men?”, published under the Paris School of Economics working paper series.
I exploit several sections of the SHARE survey in order to build the dataset for the empirical analysis. SHARE is the largest pan-European social science panel study providing internationally comparable longitudinal micro data. The data are available at different level of investigation: current waves where individuals are interviewed about their current situation and the retrospective life. The information were merged with EUROSTAT data from which information about the healthcare supply is collected at NUTS2 level.
Data preparation was organized in several step: merging of the current waves of share, merging of the retrospective analysis including the working career history and the childhood health and housing information, merging of the information of SHARE at NUTS2 level, finally merging of the EUROSTAT data information on healthcare supply at NUTS2 level. The EUROSTAT data have been merged together with the SHARE data at NUTS2 level. As a following steps, I proceed with data cleaning, variable selection and measure construction. As a result, the datasets are prepared and stored in PSE server for proper use for research. They cannot be publicly shared due to the SHARE user agreement condition, but the raw data are publicly accessible from the SHARE website (upon signature of the agreement). The codes to prepare the data are ready and will be available when the papers are published.
Furthermore, I include an additional source of data coming from the European Values Study, which incorporates information about gender norms and have been used for the second part of the project. This information is very detailed and asked multiple questions on the role of women in the society. For example, it asks whether women are suited for a working careers, or if men can be good fathers, if both men and women should work, and more. It aimed at capturing how the role of women is perceived in the family and work context. This data preparation was then used for the second part of the project when working on gender health inequalities.
I proceed by working on health inequalities and setting up an econometric analysis. The work focused on health inequalities across the life course using the SHARE data and combining current and retrospective information.
This part includes a descriptive and econometric analysis of the determinants of health inequalities using a panel data perspective. The innovation of this project is the methodology that has been implemented using the cutting-edge econometric literature on event study. The analysis has aimed at identifying the main causes of health inequalities from childhood and how these affects later life outcome. The econometric method was a difference in difference method with treatment at different timing, since individuals could have had health shocks at different points in time during childhood. The results of the analysis have found that infection diseases are among the most impactful events during childhood that can affects health and late life outcomes. The working paper is under preparation and will be publicly available by the end of November 2024.
In the second part of the project, from September 2023 to June 2024 I work on the gender health inequalities project and set up descriptive and econometric analysis to understand the role of social norms on the gender health gap. I have prepared the paper for gender health inequalities in Europe to inform policy makers and scholars in the field. This section aimed at addressing how gender health disparities originates and the role of healthcare utilization. Originally, this section wanted to exploit the vignettes (method used in sociology, psychology and experiment economics), which are present in the SHARE dataset in wave 3. However, a more innovative information has been used by exploiting the European Value Study survey, such as the gender norms measures. As anticipated, this survey contains information about norms towards women and men in the society in Europe. The analysis has focused on the role of gender norms in different domains and their effect on the men and women health. This part of the project was targeted on the gender dimension and it was among the first study in the field of health economics that looked at the role of gender norms on health outcomes and healthcare.
The evidence of the analysis show that women are affected by traditional gender norms which see them as the one in charge for family and caring activities. The evidence suggest that this type of norms increased women’s depression and poor health status. This result is consistent across different specification of the gender norms as well as heterogeneous group analyses (for example at different education level or age). The results are available in the working paper entitled “How Gender Norms Shape the Health of Women and Men?”, published under the Paris School of Economics working paper series.
Progress beyond the state of the art and expected potential impact (including the socio-economic impact and the wider societal implications of the project so far)
The results of the project are twofold: first, the analysis on health inequalities from childhood to late life is among the first to address this issue on a multi-country analysis. The results suggest that having an infection at early ages is particularly detrimental for later life outcomes such as work and health later in life. This evidence is important from a policy perspective and guide policy makers in supporting early life intervention in Europe, in particular from the healthcare perspective.
The second important results are the evidence on gender health inequalities. The analysis support that traditional gender norms, where women are seen as those that have to stay home and take care of the family, are particularly detrimental for women's mental health and poor health status reported. This evidence suggests that policymaker should promote gender neutral norms trough regulation, as well as support women at home with mental healthcare programs to ensure appropriate access. This evidence advance the state of the art literature and have not been shown previously in European countries.
The second important results are the evidence on gender health inequalities. The analysis support that traditional gender norms, where women are seen as those that have to stay home and take care of the family, are particularly detrimental for women's mental health and poor health status reported. This evidence suggests that policymaker should promote gender neutral norms trough regulation, as well as support women at home with mental healthcare programs to ensure appropriate access. This evidence advance the state of the art literature and have not been shown previously in European countries.