Welfare state regimes and population health: integrating the East Asian welfare states

Abstract

Epidemiological studies have consistently shown that population health varies significantly by welfare state regime. However, these studies have focused exclusively on the welfare states of Europe, North America and Australasia. This focus ignores the existence of welfare states in other parts of the world, specifically in East Asia. This study therefore investigates whether the association between population health (Infant Mortality Rates and Life Expectancy at birth) and welfare state regimes is still valid when the welfare states of East Asia are added into the analysis. It also examines whether population health is worse in the East Asian welfare states. Infant Mortality Rates and Life Expectancy at birth as well as GDP per capita and social and health expenditures as a percentage of GDP were examined in 30 welfare states, categorised into six different regimes (Scandinavian, Anglo-Saxon, Bismarckian, Southern, Eastern European and East Asian). ANOVA analysis showed significant differences by welfare state regime in the magnitude of IMR, LE, SE, HE and GDP per capita. However, when controlling for GDP per capita in the ANCOVA analyses, only Life Expectancy (R² = 0.58, adjusted R² = 0.47, p < 0.05) and Social Expenditure (R² = 0.70, adjusted R² = 0.61, p < 0.05) differed significantly by welfare state regime. 47% of the variation in Life Expectancy was explained by welfare state regime type. Further, the East Asian welfare states did not have the worst health outcomes. The study concludes by highlighting the need to expand comparative health analysis both in terms of the range of countries examined and also in terms of incorporating other societal and public health factors—towards a ‘public health regime’ analysis.