Capability inequality

Does disadvantage or plurality matter more for policy? A Swedish cross-sectional study on the population distribution and group differences of capability using Caly-SWE

Bibliographic Data

ID22204920
AuthorsKaspar Walter Meili (0000-0002-9889-4406, Umeå University, corresponding author), Jan Hjelte (0000-0002-5269-1961, Umeå University), Lisbet Lindholm (0000-0002-1633-2179, Umeå University), Lars Lindholm, Anna Månsdotter (0000-0003-2246-2065, Umeå University)
Year2024
Volume10
Pages100961
Publication date2024-01-01
Open AccessYes
TypeARTICLE
VenueSocial Sciences & Humanities Open (JOURNAL)
Journal identifiersISSN: 2590-2911 • E-ISSN: 2590-2911
PublisherElsevier BV (PUBLISHER)
DOI10.1016/j.ssaho.2024.100961
OpenAlexW4399431923
LanguageEN
Citations received1
References cited17

A better understanding of population distributions of capability and inequalities is relevant for public health and social welfare. We surveyed 3639 representatively sampled individuals on background characteristics and on self-reported capability using the capability-adjusted life years Sweden (CALY-SWE) questionnaire, which enables aggregating attribute-level answers into a quality weight score. We analysed the resulting capability distribution by comparing subgroups. Subgroups were formed along axes of inequality that we selected based on theoretical reasoning and relevance. We stratified into groupings of plurality and disadvantage , based on the human dignity principle and the needs and solidarity principle featured in the Swedish platform for healthcare priority-setting. While disadvantage factors come with inherent need-related disadvantages that explain inequality, such as unemployment, no such normatively acceptable reason exist for plurality factors, such as gender. The results averaged per individual showed marked inequalities for the disadvantage groups of individuals with poor self-rated health, long-term sick leave unemployment, and payment difficulties. For plurality groups, the largest inequalities occurred in groups with lower education and groups residing in urban areas, but generally inequalities were lower than disadvantage groups. On the population level, the largest aggregated disability inequalities occurred for self-reported ever NEET (persons who were ever involuntarily not in employment, education or training from age 16 to 29) and payment difficulties groups. Additionally, we assessed the contribution of covariates to these inequalities by counterfactually altering one covariate at a time in a multinomial logistic model of the CALY-SWE attribute-level answers. The most relevant covariates were employment situation, financial difficulties, income, and age group. For policy-making, this indicates the importance of both plurality and disadvantage inequality axes. Prioritization should adopt nuanced contextualizations of inequality when broadening the perspective beyond healthcare to wider public health and social welfare, for example, elderly care and education. • The first large study to describe the Swedish capability distribution using CALY-SWE. • A normative framework of groupings along disadvantage axes or plurality axes was used. • Groups of poor health, unemployment, and financial difficulties showed shortfalls. • Capability inequalities also occurred for women, lower education, and rural areas. • A nuanced view on prioritization in broader social welfare is needed in policy-making

Disadvantage · Inequality · Mathematical analysis · Political science · Population · Sociology · Demography · Income, Poverty, and Inequality · Mathematics

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