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Health selection and health inequalities -PhD thesis-


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Social inequalities in health remain a major social issue globally. One possible explanation of health inequality is health selection: in other words people with poor health move down the social hierarchy. This study started with the conceptual distinction between two types of health selection studies. Type I health selection study (the presence of health selection) examines the impact of poor health on the subsequent social mobility. On the contrary, type II study (the contribution of health selection to social inequalities in health) examines whether health selection changes social inequalities in health.
The first 13 waves (1991-2003) of the British Household Panel Survey with 63599 observations from 8819 individuals were used. In accordance with the typology, two different approaches were applied to empirical and theoretical investigation. For type I study, a multilevel multinomial model to fit all possible transition from multiple origins was used to assess social mobility with regard to health status. For type II study, both empirical and hypothetical analyses are applied in order to address the relationship between social mobility, health selection, and social inequalities in health on the population-level framework.
Findings from the type I study presented that health selection was negligible in mobility within employment indicated by class and income measures, although it was highly significant in the transition between employment and non-employment. In type II study, changes in social inequalities in health were associated with a set of elements extracted from a social mobility process. Varying levels of health selection and scales of social mobility result in different extents of change in social inequalities in health.


Health and Social Mobility



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