Macroeconomic conditions, welfare state policy, and the evaluation of disability

Abstract

Rates of self-reported disability vary widely across the U.S. and Europe and are not always strongly correlated with other measures of population health. This dissertation analyzes how two elements of social context--labor market conditions and welfare state policy--influence evaluations of disability status.

Using data on local labor market conditions in the United States, in Chapter two I find that increasing local area unemployment is associated with increased rates of self-reported disability, including among currently employed and highly educated workers who are less likely to be influenced by the availability of disability benefits. I argue that worsening macroeconomic conditions may produce disability through a direct effect on health or through increasing the salience of existing health conditions.

In the third chapter, I explore how welfare state policy influences self-reported disability cross-nationally. Using data from 15 Western European countries, I find that residents of generous welfare states-particularly the Netherlands and Nordic countries-are significantly more likely to report a disability net of self-reported health, sociodemographic and labor force characteristics. I argue that welfare state context directly shapes what it means to be disabled, which in turn may have consequences for social stratification and empiric evaluations of welfare state performance.

Chapter four investigates how the monetization of illness in disability benefit policy influences the evaluation of health symptoms. I conducted an original survey experiment in which a nationally representative sample of adults in the United States was asked to evaluate a series of vignettes describing the health conditions of adults and children. The treatment group was told that individuals in the U.S. who are found to have a work-limiting disability may be eligible for hundreds or thousands of dollars a month in government assistance. I find respondents who were primed with information about the existence of disability benefits are significantly less likely to evaluate a health condition as being disabling. In addition, individuals in the treatment condition were significantly more likely to blame the individual for his or her health condition. These findings have important implications for policymakers and medical practitioners as applications for disability assistance have increased dramatically in recent years.