Political and welfare state determinants of infant and child health indicators: an analysis of wealthy countries.

Economic indicators such as income inequality are gaining attention as putative determinants of population health. On the other hand, we are just beginning to explore the health impact on population health of political and welfare state variables such as political orientation of government or type of medical care coverage. To determine the socially structured impact of political and welfare state variables on low birth weight rate, infant mortality rate, and under-five mortality rate, we conducted an ecological study with unbalanced time-series data from 19 wealthy OECD countries for the years from 1960 to 1994. Among the political/welfare state variables, total public medical coverage was the most significant predictor of the mortality outcomes. The low birth weight rate was more sensitive to political predictors such as percentage of vote obtained by social democratic or labor parties. Overall, political and welfare state variables (including indicators of health policies) are associated with infant and child health indicators. While a strong medical care system seems crucial to some population health outcomes (e.g., the infant mortality rate), other population health outcomes might be impacted by social policies enacted by parties supporting strong welfare states (the low birth weight rate). Our investigation suggests that strong political will that advocates for more egalitarian welfare policies, including public medical services, is important in maintaining and improving the nation's health.