UNIVERSITE PARIS-DAUPHINE ECOLE DOCTORALE DE DAUPHINE LABORATOIRE D’ÉCONOMIE DE DAUPHINE Inégalités Sociales des Comportements de Santé: L’herbe est-elle plus verte ailleurs? Social Inequalities in Health-Related Behaviours: Is the grass greener on the other side? THESE Pou lotetio du gade de Doteu e “iees Éooiues présentée et soutenue publiquement le 6 novembre 2014 par Marion DEVAUX sous la direction de Florence JUSOT MEMBRES DU JURY RAPPORTEURS Fabrice ETILE Directeur de Recherche INRA, Paris School of Economics Lise ROCHAIX Pofesseu à lUiesit Pais , Paris School of Economics SUFFRAGANTS Florence JUSOT Pofesseu à lUiesit Paris- Dauphine Thierry LANG Pofesseu à lUiesit Toulouse III, INSERM Franco SASSI Éooiste à lOCDE, Professeur à London School of Economics Jérôme WITTWER Pofesseu à lUiesit Bodeau Segalen, Université Paris-Dauphine LUNIVERSITE PARIS-DAUPHINE nentend donner aucune approbation ni improbation aux opinions émises dans les thèses ; ces opinions doivent être considérées comme propres à leurs auteurs. Table des matières/Table of contents PRÉAMBULE .................................................................................................................................................. I FOREWORD ................................................................................................................................................. III RÉSUMÉ ........................................................................................................................................................ V SUMMARY ................................................................................................................................................. VII RÉSUMÉ CONSÉQUENT EN FRANÇAIS ................................................................................................ IX GENERAL INTRODUCTION .................................................................................................................. - 1 - 1. Background ......................................................................................................................................... - 2 - 2. The determinants of health inequalities .............................................................................................. - 3 - 2.1. Theoretical framework ................................................................................................................. - 4 - 2.2. Focus on social inequalities in health-related behaviours ............................................................ - 5 - 3. How can international comparisons contribute? ................................................................................. - 7 - 3.1. The importance of cross-country comparisons............................................................................. - 7 - 3.2. Cross-country studies on inequalities in health ............................................................................ - 8 - 3.3. Cross-country studies on inequalities in health-related behaviours ............................................. - 9 - 4. What does this thesis bring? ............................................................................................................. - 10 - 4.1. Research questions ..................................................................................................................... - 10 - 4.2. Outline of this thesis ................................................................................................................... - 11 - REFERENCES ..................................................................................................................................... - 14 - CHAPTER 1. ............................................................................................................................................ - 19 - DATA AND METHODS ......................................................................................................................... - 19 - 1. DATA ............................................................................................................................................... - 20 - 1.1. Data sources ............................................................................................................................... - 20 - 1.2. Data comparability and construction of variables ...................................................................... - 22 - 1.3. Data limitations .......................................................................................................................... - 24 - 2. METHODS ....................................................................................................................................... - 31 - 2.1. Multivariate logistic regression .................................................................................................. - 31 - 2.2. Relative and absolute index of inequality .................................................................................. - 32 - 2.3. Concentration Index ................................................................................................................... - 34 - 2.4. Discussion of the measures used: pros and cons ........................................................................ - 36 - REFERENCES ..................................................................................................................................... - 38 - CHAPTER 2. ............................................................................................................................................ - 41 - SOCIAL INEQUALITIES IN OBESITY AND OVERWEIGHT IN ELEVEN OECD COUNTRIES .. - 41 - ABSTRACT .......................................................................................................................................... - 42 - INTRODUCTION ................................................................................................................................ - 43 - METHODS ........................................................................................................................................... - 44 - Data ................................................................................................................................................... - 44 - Inequality measures ........................................................................................................................... - 45 - RESULTS ............................................................................................................................................. - 46 - Inequalities by education level .......................................................................................................... - 46 - Inequalities by socio-economic status ............................................................................................... - 47 - Trends in inequalities across education levels .................................................................................. - 49 - DISCUSSION ....................................................................................................................................... - 49 - REFERENCES ..................................................................................................................................... - 52 - EXPLORING THE RELATIONSHIP BETWEEN EDUCATION AND OBESITY ............................. - 63 - ABSTRACT .......................................................................................................................................... - 64 - Introduction ........................................................................................................................................... - 65 - Existing evidence on the relationship between education and obesity ................................................. - 68 - Policy and institutional environment .................................................................................................... - 70 - General trends in obesity in the four countries ..................................................................................... - 72 - Is the strength of the correlation between education and obesity constant across the entire education spectrum, overall and in different population sub-groups? ................................................................... - 74 - Does the relationship between education and obesity reflect the role of other factors associated with individual education? ............................................................................................................................ - 77 - Do the data provide evidence of the causal nature of the link between education and obesity? .......... - 82 - What theoretical model of the influence of education on social outcomes is supported by the data? .. - 84 - Conclusions ........................................................................................................................................... - 89 - Policy Implications ............................................................................................................................... - 91 - REFERENCES ..................................................................................................................................... - 93 - ANNEXES ............................................................................................................................................ - 98 - CHAPTER 3. ...........................................................................................................................................-