The Freedom of Making a Choice: How Social Policies Shape the Possibilities for Healthy Lives and Positive Health Outcomes Across 32 Nations

The interplay between society and individual status in shaping health outcomes is a key sociological concern. Comparative health researchers have found mixed evidence for the health effects of the welfare state in general, with some findings supporting the notion that the population is healthier in more encompassing welfare state, but other findings contradicting that pattern. However, much of this research simply focuses on policies at the macro-level and does not take into account how individual actions are shaped by the broader context. The theory of constrained choice allows us to link together the macro-level of social policy and the micro-level of individual choices. Using data from the 2011 Health Module from the International Social Survey Programme (ISSP), I evaluate how the choices people make across 32 nations translate into physical and mental health outcomes. Importantly, the ISSP includes variables that have been shown to impact health, including use of health services and lifestyle factors. One of the key elements of the constrained choice approach is a consideration of whether certain choices are more or less difficult within certain social policy contexts. Therefore, I use analytical strategy that evaluates whether healthier choices are more likely to take place in contexts with social policies that facilitates such choices. From there, I evaluate how factors at the national and individual level impact health and health inequalities and more importantly whether there are interaction effects between the two levels. The findings indicate that individuals that live in a social policy environment that is more pro-active in promoting health and health behavior are more likely to engage in such behavior, and that individuals who reside in countries with such policies experience better health outcomes. They also indicate that groups that are vulnerable in society may benefit especially from such policies.