How do perceived changes in inequality affect health?
Dr Aaron Reeves
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Associate Professor of Evidence-Based Social Intervention and Policy Evaluation
Course Director - Evidence-Based Intervention and Policy Evaluation
(+44) 01865 280325
Aaron is a sociologist with interests in public health, culture, and political economy. His research is focused on understanding the causes and consequences of social and economic inequality across countries. He joined DSPI in March 2018. Since 2016 Aaron has been an Associate Professorial Research Fellow in Poverty and Inequality at LSE's International Inequalities Institute. Prior to that he was Senior Research Fellow in the Department of Sociology at Oxford, where he was also a research fellow at Nuffield College. He has also worked briefly at the University of Cambridge. He completed his PhD in Applied Social & Economic Research with the Institute for Social and Economic Research, University of Essex in 2013.
Research
Aaron's research interests are in three main areas: 1) the political economy of health, 2) the political and cultural consequences of the mass media, and 3) the cultural politics of class.
His research on the political economy of health has used natural experiments to understand whether poverty reduction policies affect health and alter health inequalities. Relatedly, he has published on the influence of the Great Recession and austerity policies on health in Europe and North America. His work on the media has begun tracing the economic, social, and political factors shaping attitudes toward the welfare state and people on welfare in the UK, with a specific focus on how the media shapes these narratives. Finally, he has used interview data, small-scale experiments, and large-scale surveys, to explore the cultural politics of class, examining how social inequalities are linked with economic inequalities.
Current projects
Aaron is currently involved in a JRF-funded project examining the relationship between inequalities of various kinds and poverty. It will investigate areas such as the consequences of living in an unequal society for the lives of those in poverty; how people's prospects of social mobility are affected if parental resources are unequally distributed between families; the links between poverty, inequality and geographical and neighbourhood segregation; how inequality affects risks of poverty for different groups, such as by ethnicity, gender, disability and migration status; and the political and attitudinal effects of inequality for support (or otherwise) for effective collective action against poverty.
http://www.lse.ac.uk/International-Inequalities/Research-programmes/Joseph-Rowntree-Foundation
Publications
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Achieving health equity: democracy matters.
2019|Journal article|LancetDemocracy, Europe, Health Equity, Health Policy, Health Services Accessibility, Humans, Life Expectancy, Socioeconomic Factors, Sustainable Development -
Can inequalities in political participation explain health inequalities?
2019|Journal article|Soc Sci MedInequalities in health are pervasive and durable, but they are not uniform. To date, however, the drivers of these between-country patters in health inequalities remain largely unknown. In this analysis, we draw on data from 17 European countries to explore whether inequalities in political participation, that is, inequalities in voting by educational attainment, are correlated with health inequalities. Over and above a range of relevant confounders, such as GDP, income inequality, health spending, social protection spending, poverty rates, and smoking, greater inequalities in political participation remain correlated with higher health inequalities. If 'politicians and officials are under no compulsion to pay much heed to classes and groups of citizens that do not vote' then political inequalities could indirectly affect health through its impact on policy choices that determine who has access to the resources necessary for a healthy life. Inequalities in political participation, then, may well be one of the 'causes of the causes' of ill-health.Health inequality, Mortality, Political economy, Political participation, Voting -
The rise of hunger among low-income households: an analysis of the risks of food insecurity between 2004 and 2016 in a population-based study of UK adults.
2019|Journal article|J Epidemiol Community HealthBACKGROUND: Rising food bank use in the past decade in the UK raises questions about whether food insecurity has increased. Using the 2016 Food and You survey, we describe the magnitude and severity of the problem, examine characteristics associated with severity of food insecurity, and examine how vulnerability has changed among low-income households by comparing 2016 data to the 2004 Low Income Diet and Nutrition Survey. METHODS: The Food and You survey is a representative survey of adults living in England, Wales, and Northern Ireland (n=3118). Generalised ordered logistic regression models were used to examine how socioeconomic characteristics related to severity of food insecurity. Coarsened exact matching was used to match respondents to respondents in the 2004 survey. Logistic regression models were used to examine if food insecurity rose between survey years. RESULTS: 20.7% (95% CI 18.7% to 22.8%) of adults experienced food insecurity in 2016, and 2.72% (95% CI 2.07% to 3.58%) were severely food insecure. Younger age, non-white ethnicity, low education, disability, unemployment, and low income were all associated with food insecurity, but only the latter three characteristics were associated with severe food insecurity. Controlling for socioeconomic variables, the probability of low-income adults being food insecure rose from 27.7% (95% CI 24.8% to 30.6 %) in 2004 to 45.8% (95% CI 41.6% to 49.9%) in 2016. The rise was most pronounced for people with disabilities. CONCLUSIONS: Food insecurity affects economically deprived groups in the UK, but unemployment, disability and low income are characteristics specifically associated with severe food insecurity. Vulnerability to food insecurity has worsened among low-income adults since 2004, particularly among those with disabilities.disability, nutrition, poverty, socio-economic -
How class identities shape highbrow consumption: A cross-national analysis of 30 European countries and regions
2019|Journal article|Poetics© 2019 Elsevier B.V. Highbrow culture may not always be central to cultural capital and, in such circumstances, the distinctiveness of middle-class consumption of highbrow culture may diminish, becoming more similar to working-class patterns of highbrow consumption. Using data from 30 European countries, I explore this issue through examining three questions: 1) is class identity associated with highbrow consumption; 2) does this association vary across countries; and 3) is the relationship between class identity and highbrow consumption altered when the majority of people in a given society identify as either ‘working-class’ or ‘middle-class’? After accounting for other socio-demographic controls, people who identify as middle-class are more active highbrow consumers than those who identify as working class. Yet, the distinctiveness of middle-class consumption of highbrow culture varies across countries and is negatively correlated with how many people identify as working-class in a society. As more people identify as working-class (rejecting middle-class identities) highbrow culture less clearly distinguishes middle-class and working-class identifiers. In the absence of any class-structured divisions in highbrow culture, whether and how cultural practices function as a form of cultural capital is likely quite different, reinforcing the claim that the centrality of highbrow culture to cultural capital varies geographically. -
The Rhetoric of Recessions: How British Newspapers Talk about the Poor When Unemployment Rises, 1896–2000
2019|Journal article|Sociology© The Author(s) 2019. Recessions appear to coincide with an increasingly stigmatising presentation of poverty in parts of the media. Previous research on the connection between high unemployment and media discourse has often relied on case studies of periods when stigmatising rhetoric about the poor was increasing. We build on earlier work on how economic context affects media representations of poverty by creating a unique dataset that measures how often stigmatising descriptions of the poor are used in five centrist and right-wing British newspapers between 1896 and 2000. Our results suggest stigmatising rhetoric about the poor increases when unemployment rises, except at the peak of very deep recessions (e.g. the 1930s and 1980s). This pattern is consistent with the idea that newspapers deploy deeply embedded Malthusian explanations for poverty when those ideas resonate with the economic context, and so this stigmatising rhetoric of recessions is likely to recur during future economic crises. -
Does government expenditure reduce inequalities in infant mortality rates in low- and middle-income countries?: A time-series, ecological analysis of 48 countries from 1993 to 2013.
2019|Journal article|Health Econ Policy LawInequalities in infant mortality rates (IMRs) are rising in some low- and middle-income countries (LMICs) and decreasing in others, but the explanation for these divergent trends is unclear. We investigate whether government expenditures and redistribution are associated with reductions in inequalities in IMRs. We estimated country-level fixed-effects panel regressions for 48 LMICs (142 country observations). Slope and Relative Indices of Inequality in IMRs (SII and RII) were calculated from Demographic and Health Surveys between 1993 and 2013. RII and SII were regressed on government expenditure (total, health and non-health) and redistribution, controlling for gross domestic product (GDP), private health expenditures, a democracy indicator, country fixed effects and time. Mean SII and RII was 39.12 and 0.69, respectively. In multivariate models, a 1 percentage point increase in total government expenditure (% of GDP) was associated with a decrease in SII of -2.468 [95% confidence intervals (CIs): -4.190, -0.746] and RII of -0.026 (95% CIs: -0.048, -0.004). Lower inequalities were associated with higher non-health government expenditure, but not higher government health expenditure. Associations with inequalities were non-significant for GDP, government redistribution, and private health expenditure. Understanding how non-health government expenditure reduces inequalities in IMR, and why health expenditures may not, will accelerate progress towards the Sustainable Development Goals.Developing Countries, Financing, Government, Humans, Infant, Infant Mortality, Regression Analysis, Socioeconomic Factors, Surveys and Questionnaires -
Constructing a housing precariousness measure for Europe
2019|Journal article|Journal of European Social Policy© The Author(s) 2018. There are concerns that the recovery from the Great Recession in Europe has left growing numbers of people facing precarious housing situations. Yet, to our knowledge, there is no comparative measure of housing precariousness in contrast to an extensive body of work on labour market precariousness. Here, we draw on a comparative survey of 31 European countries from the 2012 wave of European Union Survey of Income and Living Conditions to develop a novel housing precariousness measure. We integrate four dimensions of housing precariousness: security, affordability, quality and access to services, into a scale ranging from 0 (not at all precarious) to 4 (most precarious). Over half of the European population report at least one element of housing precariousness; 14.7 percent report two dimensions and 2.8 percent three or more (equivalent to ~15 million people). Eastern European and small island nations have relatively greater precariousness scores. Worse precariousness tends to be more severe among the young, unemployed, single and those with low educational attainment or who live in rented homes and is associated with poor self-reported health. Future research is needed to strengthen surveillance of housing precariousness as well as to understand what policies and programmes can help alleviate it. -
Can cultural consumption increase future earnings? Exploring the economic returns to cultural capital.
2019|Journal article|Br J SociolCultural consumption is often viewed as a form of embodied cultural capital which can be converted into economic rewards (e.g., earnings) because such practices increase the likelihood of moving into more advantaged social positions. However, quantitative evidence supporting this theory remains uncertain because it is often unable to rule out alternative explanations. Cultural consumption appears to influence hiring decisions in some elite firms, in both the US and the UK, but it is unclear whether these processes are applicable to other professional occupations and other labour market processes, such as promotions. We examine these processes using data from Understanding Society, an individual-level panel survey conducted in the UK, allowing us to explore whether cultural consumption predicts future earnings, upward social mobility and promotions. People who consume a larger number of cultural activities are more likely to earn higher wages in the future, to be upwardly socially mobile, and to be promoted. Cultural consumption, then, can function as cultural capital in some labour market settings, potentially contributing to the reproduction of income inequality between generations.Earnings, cultural capital, cultural consumption, hiring, labour market, Adult, Art, Cognition, Female, Humans, Income, Male, Middle Aged, Occupations, Regression Analysis, Social Class, Socioeconomic Factors, Surveys and Questionnaires, United Kingdom -
Employment relations and dismissal regulations: Does employment legislation protect the health of workers?
2019|Journal article|Social Policy and Administration© 2019 The Authors. Social Policy & Administration published by John Wiley & Sons Ltd. Sociologists have long acknowledged that being in a precarious labour market position, whether employed or unemployed, can harm peoples' health. However, scholars have yet to fully investigate the possible contextual, institutional determinants of this relationship. Two institutions that were overlooked in previous empirical studies are the regulations that set minimum compensation for dismissal, severance payments, and entitlements to a period of notice before dismissal, notice periods. These institutions may be important for workers' health as they influence the degree of insecurity that workers are exposed to. Here, we test this hypothesis by examining whether longer notice periods and greater severance payments protect the health of labour market participants, both employed and unemployed. We constructed two cohorts of panel data before and during the European recession using data from 22 countries in the European Union Statistics on Income and Living Conditions (person years = 338,000). We find more generous severance payments significantly reduce the probability that labour market participants, especially the unemployed, will experience declines in self-reported health, with a slightly weaker relationship for longer notice periods. -
The cost of austerity policies for public health
2018|Other|Physics and Chemistry of Glasses: European Journal of Glass Science and Technology Part B -
The Cost of Austerity Policies for Public Health
2018|Journal article|CURRENT HISTORY -
The enduring influence of institutions on universal health coverage: An empirical investigation of 62 former colonies
2018|Journal article|World Development© 2018 Elsevier Ltd In this paper, we argue that particular institutional arrangements partly explain the large and persistent differences in health systems and health outcomes observed in former colonies. Drawing on data from the World Health Organization for 62 countries, covering the period 2000–2014, we explore whether economic (risk of expropriation) and health (complete cause of death registries) institutions explain mortality rates and access to healthcare. To identify this relationship, we use settler mortality and the distance of the capital from the nearest major port – factors associated with institutional arrangements – to explain cross-national variation in health outcomes and the universality of health systems. We find that inclusive institutions arrangements – that protect and acknowledge the rights of citizens – are associated with better health outcomes (e.g. lower infant mortality and lower maternal mortality) as well as with better health systems (e.g. more skilled birth attendance and greater immunization). Inclusive institutions not only foster economic growth but improve health and well-being too. -
Effects of tobacco control policy on cardiovascular morbidity and mortality in Russia.
2018|Journal article|European journal of public healthBackground:According to the Global Adult Tobacco Survey carried out in Russia in 2009, the country had one of the highest smoking prevalence rates in Europe. In response to this health and economic burden, Russia implemented a comprehensive Tobacco Control Law (TCL) in 2013, which has been associated with a 21.5% relative decline in adult smoking prevalence in 2016 compared with 2009. This study tests the impact of the TCL on cardiovascular disease (CVD) related health outcomes, including morbidity and mortality. Method:The study evaluated the TCL as an intervention in a natural experiment during the period 2003-2015. A synthetic control was created as a comparator, using data from countries that did not have a comparable comprehensive tobacco control intervention. Changes in trends in CVD outcomes - hospital discharge rates (HDRs) and standardized death rates (SDRs) - were then compared to test for an impact associated with the TCL. Results:Pre-intervention trends in CVD-related HDRs were similar between Russia and the synthetic control, but became divergent after the TCL with greater benefit observed in Russia. This implies a beneficial impact of the TCL on CVD related morbidity in the Russian population. Whilst SDRs continued to reduce in both Russia and the control, the impact of TCL is less clear. Conclusion:This study provides further evidence to support comprehensive tobacco control in line with the WHO Framework Convention for Tobacco Control (WHO FCTC). Alongside a reduction in tobacco consumption, smoking-related CVD morbidity appears to benefit quite soon after implementation, whilst smoking-related deaths might need a longer post-intervention period to be detectable.Humans, Tobacco, Cardiovascular Diseases, Morbidity, Prevalence, Mortality, Smoking, Smoking Cessation, Public Health, Public Policy, Health Policy, Tobacco Industry, Adult, Taxes, Russia, Female, Male, Tobacco Products, Smoking Prevention -
The perspectives of politicians on tobacco control in Turkey.
2018|Journal article|European journal of public healthBackground:Tobacco use is a leading but preventable cause of non-communicable diseases and premature death. The legislature has a key role in setting tobacco control policies. Smoking trends are decreasing thanks to the introduction of effective tobacco control policies in Turkey and these policies may have been shaped by how politicians' interpreted social problems that were prominent during the development and implementation of tobacco regulations. Aim:This paper explores the long-term national relationship between tobacco consumption, tobacco control policies and the associated political discourse in Turkey, considering the varying influences through national leadership on this important public health agenda. This relationship is studied by comparing a time series analysis of tobacco consumption trends with a policy analysis of the minutes of deliberations at the Grand National Assembly of Turkey (GNAT). Methods:This study uses Bayesian time series analysis in order investigate whether the tobacco control policies and related activities influenced the annual per adult cigarette consumption in Turkey. We used a novel method to identify change points in tobacco trends and whether they correspond with key policy changes intended to alter usage after adjusting for the effect of other non-policy related covariates, such as the purchasing power. The policy analysis included an examination of the minutes of deliberations at the GNAT-which is the Turkish parliament and unicameral Turkish legislature-1 year before and 1 year after the break years associated with an increase or decrease in tobacco consumption. Results and recommendations:Tobacco consumption increased with the encouragement of tobacco production and the entrance of multinational companies in the country in 1976 and 1993, respectively. The National Tobacco Law of 1996 and comprehensive amendments in 2008, including smoke-free public places and tax increases, appear to have helped reduce tobacco consumption in Turkey. The focus of Parliamentary discussions throughout this period changed, becoming less supportive of tobacco over time. However, throughout the period there remained discussions focussing on concerns around the implications for the economy and the privatization agenda, national agriculture and the welfare of farmers. Effective control appears to require certain political ingredients to be implemented: politicians who are well informed on tobacco control measures and understand the range of issues surrounding the policies (not only those directly health-related); and supportive public health information in the community. Evidence-based public health policy should be introduced to the politicians.Humans, Tobacco, Smoking, Public Health, Politics, Public Policy, Tobacco Industry, Turkey, Tobacco Products
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Supervision
Aaron would welcome applications for D.Phils from students who are committed to policy-relevant research and are interested in using quantitative methods – and quasi-experimental research designs in particular – to shed light on pressing social problems, such as welfare reform, the role of the media in society, and how social inequalities are (re)produced.
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