The Big Picture: A comparative analysis of the Social Determinants of Health across European welfare states

Background An established notion in public health and health inequalities research is that health is political: the social conditions shaping health, also known as the Social Determinants of Health (SDoH), are fundamentally dependent on political and institutional structures. Despite this awareness, comprehensive and theory-driven analyses of the SDoH from a political perspective remain scarce: much empirical research focusses on isolated determinants (like health behaviours or healthcare access) or on single-country cases without linking living conditions to concrete welfare state policies. As a result, knowledge about how welfare states shape the determinants of health is fragmented, and little is known about how welfare state generosity relates to the broader configuration of social determinants. Taking the framework of the WHO Commission on Social Determinants of Health as a starting point, and through a Political Economy lens, we examine how welfare state generosity is associated with the burden of various SDoH across Europe. The SDoH framework acknowledges how living conditions such as working conditions, psychosocial stress, or educational background influence health, and the Political Economy perspective highlights how these conditions are jointly shaped by welfare state policy choices. In this study, we address the following research question: How is welfare state policy generosity associated with the cross-national distribution of social determinants of health across 29 European countries? Methods To examine the burden of SDoH, we operationalize the WHO Commission on Social Determinants of Health framework using data from the European Social Survey, covering 29 countries. We use individual-level data from 25 variables to build seven country-level indices capturing the burden of key SDoH dimensions: material, behavioral, occupational, educational, psychosocial, social capital, and healthcare access determinants. To examine the welfare state policy generosity, we follow previous operationalizations along three pathways: redistribution, poverty reduction, and status preservation. Indicators for these pathways are derived from the Comparative Welfare Entitlement Project. Combining these measures, we examine cross-national associations between welfare state generosity and the burden of different SDoH dimensions through descriptive and regression-based analyses. Preliminary Results and Conclusions Preliminary analyses suggest that material and psychosocial determinants show the strongest association with welfare state generosity. In contrast, social capital, educational, healthcare access and behavioral dimensions show weaker and more inconsistent associations across countries. Substantial cross-national heterogeneity exists, indicating that the structure and composition of SDoH burden is not uniform across Europe and reflecting diverse political and institutional contexts. Accounting for these differences is essential for both future comparative research and for the design of health policy.