TY - GEN
T1 - Mortality inequalities in crises and living arrangements in Europe
AU - Vigezzi, Serena
PY - 2024/8/21
Y1 - 2024/8/21
N2 - Living arrangements have long been proven to be strongly tied
with age at death, with single individuals typically dying earlier
than their married counterparts. In recent decades, this mortality
gap has deepened in low-mortality countries, including in Europe.
This trend is compounded by a growing proportion of people living on their own, creating an alarming situation, as more and
more individuals can be expected to experience an intensifying
disadvantage. At the same time, public policy largely overlooks
inequalities based on living arrangements, with the risk of leaving
the door open for the constitution of a large and vulnerable group,
that will lack informal systems of care and support.The main aim of this thesis is to highlight the societal consequences of mortality inequalities by living arrangement in Danish
society. It does so by focusing on two circumstances that place
increasing stress on the health and welfare systems, which are
supposed to address these inequalities. On the one hand, population ageing endangers the financial sustainability of retirement
systems across Europe, but reforms to tackle this issue often fail
to consider their impact in a context of increasing inequalities. On
the other hand, the recent COVID-19 pandemic has intensified
pre-existing inequalities in mortality by disproportionately affecting the most disadvantaged subpopulations. As public health
emergencies are likely to become more frequent and intense, we
must understand their impact on existing inequalities. While the
interaction between socioeconomic inequalities and patterns of
both retirement and COVID-19 mortality is clear, fewer studies
have considered living arrangements. It remains therefore difficult
to attest to the role played by household composition in these respects.In this thesis I present three papers. The first two focus on inequalities by living arrangement, while the third investigates overall mortality inequalities in periods where detailed data on living arrangements are not available. The first paper quantifies inequalities in middle-age mortality by living arrangements in Denmark, in light of reforms to the retirement system. It highlights the
widening of this gradient and shows how it interacts with policy
to affect the retirement chances especially of single individuals.
The second paper carries this line of investigation further to show
the consequences of the pandemic on inequalities by living arrangement in Denmark. It reveals that the pandemic deepened
only some of the pre-existing inequalities, for example sparing
single individuals, but not nursing home residents. Moreover, it
shows that these patterns were not driven by COVID-19 mortality. Finally, the third paper focuses on the impact of severe mortality crises on overall mortality inequality. The trends diverge depending on the measure used, suggesting that defining inequality
is a crucial part of its study. This paper also uncovers the unexpected role of older ages in driving mortality differences, even in
past centuries.The question of mortality inequalities is pressing. They are wide
and growing across Europe, challenging the efficacy of welfare
and health systems and the social pact between citizens and states.
By showing the strength of the relationship between mortality and
living arrangements, as well as its relevance in two concrete instances, I highlight the necessity of studying mortality inequalities
beyond socioeconomic characteristics and taking them into account in public policy. I also uncover the role of mortality crises
in terms of survival inequalities, underscoring the need to protect
the most vulnerable subgroups, while accounting for the possibility of unexpected patterns to arise.
AB - Living arrangements have long been proven to be strongly tied
with age at death, with single individuals typically dying earlier
than their married counterparts. In recent decades, this mortality
gap has deepened in low-mortality countries, including in Europe.
This trend is compounded by a growing proportion of people living on their own, creating an alarming situation, as more and
more individuals can be expected to experience an intensifying
disadvantage. At the same time, public policy largely overlooks
inequalities based on living arrangements, with the risk of leaving
the door open for the constitution of a large and vulnerable group,
that will lack informal systems of care and support.The main aim of this thesis is to highlight the societal consequences of mortality inequalities by living arrangement in Danish
society. It does so by focusing on two circumstances that place
increasing stress on the health and welfare systems, which are
supposed to address these inequalities. On the one hand, population ageing endangers the financial sustainability of retirement
systems across Europe, but reforms to tackle this issue often fail
to consider their impact in a context of increasing inequalities. On
the other hand, the recent COVID-19 pandemic has intensified
pre-existing inequalities in mortality by disproportionately affecting the most disadvantaged subpopulations. As public health
emergencies are likely to become more frequent and intense, we
must understand their impact on existing inequalities. While the
interaction between socioeconomic inequalities and patterns of
both retirement and COVID-19 mortality is clear, fewer studies
have considered living arrangements. It remains therefore difficult
to attest to the role played by household composition in these respects.In this thesis I present three papers. The first two focus on inequalities by living arrangement, while the third investigates overall mortality inequalities in periods where detailed data on living arrangements are not available. The first paper quantifies inequalities in middle-age mortality by living arrangements in Denmark, in light of reforms to the retirement system. It highlights the
widening of this gradient and shows how it interacts with policy
to affect the retirement chances especially of single individuals.
The second paper carries this line of investigation further to show
the consequences of the pandemic on inequalities by living arrangement in Denmark. It reveals that the pandemic deepened
only some of the pre-existing inequalities, for example sparing
single individuals, but not nursing home residents. Moreover, it
shows that these patterns were not driven by COVID-19 mortality. Finally, the third paper focuses on the impact of severe mortality crises on overall mortality inequality. The trends diverge depending on the measure used, suggesting that defining inequality
is a crucial part of its study. This paper also uncovers the unexpected role of older ages in driving mortality differences, even in
past centuries.The question of mortality inequalities is pressing. They are wide
and growing across Europe, challenging the efficacy of welfare
and health systems and the social pact between citizens and states.
By showing the strength of the relationship between mortality and
living arrangements, as well as its relevance in two concrete instances, I highlight the necessity of studying mortality inequalities
beyond socioeconomic characteristics and taking them into account in public policy. I also uncover the role of mortality crises
in terms of survival inequalities, underscoring the need to protect
the most vulnerable subgroups, while accounting for the possibility of unexpected patterns to arise.
U2 - 10.21996/axwv-ec50
DO - 10.21996/axwv-ec50
M3 - Ph.D. thesis
PB - Syddansk Universitet. Det Samfundsvidenskabelige Fakultet
ER -