Is trade policy a missing piece to a public health puzzle?
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Original versionGlobal Social Policy. 2018, 18 81-87. 10.1177/1468018117748699
Health outcomes vary across different welfare state arrangements (Bergqvist et al., 2013). Strikingly, while overall health is typically better in social democratic countries (Denmark, Finland, Norway, Sweden), these countries do not always have the smallest health inequalities. A range of potential explanations has been put forth to explain this ‘Nordic Paradox’ (Bambra, 2011a). A commonly invoked one is that the welfare state itself plays a major role in determining health inequalities as welfare states both distribute major determinants of health (such as income, education, and employment) and mediate their health impact (Beckfield et al., 2015). Global processes have also been acknowledged as important influences on these broader, social determinants of health (Blouin et al., 2009; McNamara, 2017), but little is known about how global processes interact with welfare state policies to influence health inequalities (see also Huijts and McNamara, 2018). It has been found that social policies can both moderate the health impact of trade liberalization and influence the type of health-related pathways resulting from it (McNamara, 2015), but we lack studies on whether global processes might influence how social policies shape health. This is the focus of this article which specifically asks whether the persistence of health inequalities in Nordic states can be partly seen as a failure of welfare states to compensate for the impacts of greater global market integration. Two trade-related mechanisms that may in part explain the Nordic paradox are explored with the aim of laying the ground work for a more in-depth investigation and bringing a global perspective into the fold of health inequality research.