‘Marry a doctor, live healthier’ - A quantitative study of family health influence in Europe under different macro policy contexts

This thesis examined the importance of family interactions for health outcomes in European countries. The primary aim of the thesis was to improve our understanding of socio-economic determinants of health and health inequalities under varying macro- policy contexts. We identified a gap in our understanding of the effect of spousal or common-law partner interactions, particularly their caring responsibilities and health- behavioural influence within partnerships on health inequalities. Using European Social Survey and a set of linear regression analyses, we analyse two primary hypotheses. The first hypothesis aims to reconfirm existing evidence of family health spill-overs by Polyakova et al (2019), which established that families with superior informal access to health-related expertise, such as those with a medically-educated family member, exhibit better overall health outcomes. In light of this evidence, we design our second hypothesis by considering the presence of a medically-educated spouse as a proxy for superior caring abilities and access to health-related expertise within families. Given this design, we wish to see whether the reliance on family members for help and advice or ‘health privilege’ of some individuals persists equally given different healthcare financing design and under different welfare regime types with varying emphasis on family values and caring responsibilities. We find that individuals married to doctors not only experience better overall health but having married a doctor helps them mediate negative associations between their health and increasing proportions of private, out-of- pocket healthcare financing. We hypothesise that this is because decreased affordability of formal healthcare system forces individuals to rely on their families for provision of health-related services, and individuals with medically-educated spouses have the ‘privilege’ of access to superior informal care and advice. Furthermore, we find that this ‘health privilege’ of doctor spouses is most pronounced in welfare regimes that directly promote family values and support families in their caring responsibilities, such as the Conservative Welfare Regime. Once again, we take advantage of the hypothesized superior caring abilities and expertise that a doctor brings home to rationalise these results. We explain that in countries that support informal provision of care more than its formal alternatives and therefore where individuals rely more on their families for provision of help and advice, the difference between having a family member who is qualified to provide such care and not is starker than in countries with more developed and affordable formal healthcare and caring infrastructure. The findings presented in this thesis contribute to our improved understanding of health systems and the domains through which family interactions exert its health effects and overall health inequalities given the macro policy context under which families live. Based on our findings, we recommend that policy-makers interested in reducing health and gender inequalities should be sensitive to the effect of their policy recommendations on caring responsibilities within families. Because not all families can provide informal care and advice to an equal standard, formal health expertise, care and advice alternatives should be created for those without the privilege of living with a medically-educated or health- conscious spouse.

Keywords: Health Influence
Health Inequalities
Political Epidemiology
Spousal Health Concordance
Welfare Regimes
Health Policy
European Social Survey
Family Health
Quantitative Analysis
Healthcare Payment Privatisation
Advisor: Gugushvili, A