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Introduction
The existence of social inequalities in health is well established: people with higher education, status and income have lower morbidity and mortality. Although social inequalities in health exist in all societies worldwide (Beckfield et al , 2013), the degree of these inequalities varies spatially, and notable differences exist within Europe (Bartley, 2004; Beckfield and Olafsdottir, 2009). There is a growing literature that examines how these between-country differences in health inequalities are potentially related to variations in the provision of welfare across Europe (for overviews, see Bambra, 2011a; Bambra and Beckfield, 2012; Bergqvist et al , 2013). This literature highlights that the welfare state has an important role in mediating the effects of the social determinants of health and also of socio-economic class on health. Currently, a motivating question for new research on health inequalities is how between-nation, on-average differences in summary health measures such as life expectancy can be reconciled with between-nation differences in the distribution of health and illness. That is, how should researchers theorize the role of the welfare state in the first and second moments of the health distribution?
In this article, we propose a theoretical framework for understanding how the welfare state organizes the distribution of health. We emphasize the role of institutional arrangements in distributing population health. Our objectives are to (i) organize recent social science scholarship on the welfare state and health inequalities into a general framework that conceptualizes the welfare state as a set of stratifying laws and policies, (ii) contribute to the further specification of the 'fundamental cause' approach to disease distribution (Link and Phelan, 1995) and (iii) re-engage research on health inequalities with structural theory in the social sciences (Cockerham, 2013).
Welfare States, Health and Health Inequalities
In its narrow definition as the state's role in education, health, housing, poor relief, social insurance and other social services, the welfare state clearly plays a key role as mediator in the influence of the material and social determinants of health and health inequalities. This is most obvious in terms of the strong relationship between universal health-care systems, higher levels of health-care decommodification (Bambra, 2005), better population health and lower health inequalities (for an overview, see Beckfield and Krieger, 2009).
But in its broadest definition, the welfare state...