TUBEUF Sandy

Objective: We assess the existence of unfair inequalities in health and death using the normative framework of inequality of opportunities, from birth to middle age in Great Britain. Methods: We use data from the 1958 National Child Development Study, which provides a unique opportunity to observe individual health from birth to the age of 54, including the occurrence of mortality. We measure health status combining self-assessed health and mortality. We compare and statistically test the differences between the cumulative distribution functions of health status at each age according to one childhood circumstance beyond people's control: the father's occupation. Results: At all ages, individuals born to a 'professional', 'senior manager or technician' father report a better health status and have a lower mortality rate than individuals born to 'skilled', 'partly skilled' or 'unskilled' manual workers and individuals without a father at birth. The gap in the probability to report good health between individuals born into high social backgrounds compared with low, increases from 12 percentage points at age 23 to 26 at age 54. Health gaps are even more marked in health states at the bottom of the health distribution when mortality is combined with self-assessed health. Conclusions: There is increasing inequality of opportunities in health over the lifespan in Great Britain. The tag of social background intensifies as individuals get older. Finally, there is added analytical value to combining mortality with self-assessed health when measuring health inequalities.

This thesis contributes to the understanding of human capital investment decisions of young adults in France. Young adults are in a decisive period in terms of their development and expression of preferences. Particular attention is paid to preferences, as well as to the resulting inequalities. The first chapter focuses on the roles of anticipatory treatment and multivariate preferences in the health insurance decision. Predictions from a theoretical model are tested on data collected in an experimental laboratory. Results show that higher health preference leads to more intensive treatment demand and that being correlation averse leads to more than full coverage. In the second chapter, using survey data, it is shown that differences in the use of care are primarily associated with need, followed by circumstances, reflecting inequalities of opportunity, and effort, reflecting fair inequalities. The third chapter focuses on the effect of students' psychological fragilities on their control beliefs. The instrumental variable strategy shows that more psychological frailties lead to increased control beliefs, which is consistent with the psychological literature that depressed and anxious individuals blame themselves more.

This thesis is in the field of measuring and explaining health in the context of analyzing health inequalities. A first chapter considers the health indicators commonly used in empirical work and returns to the debate on the use of self-assessed health. It highlights the relevance of methodological refinements in health measurement proposed in the international literature that have not yet been applied to France. A second chapter proposes an original methodology for measuring health. The construction is based on an individual health status data considered less subjective, namely the number of diseases and their degree of severity, and considers variables classically collected in health surveys. A third chapter describes the tools of stochastic dominance and the indices commonly used in the analysis of inequalities in a health framework. The fourth chapter analyses social inequalities in health in France in 2004, then over the period 1998-2004. It highlights social inequalities in health in favour of the highest social groups. However, these inequalities decreased between 1998 and 2004, due to a lower elasticity of health with income and a decrease in the unequal distribution of income within social groups. Moreover, the analysis conducted on different measures of health reveals an inffluence on the magnitude of inequalities of the number of categories of the discrete health variable and of the health distribution chosen to cardinalize it. The fifth chapter focuses on the influence of the social background of origin and the relative longevity of the parents with respect to their birth cohort on the health status in adulthood, using three approaches. The first approach highlights the fact that the distributions of health status of persons born to a father or mother belonging to the upper social categories significantly dominate those of persons with parents from lower social categories. The parametric approach confirms an effect of the occupation of each parent on health status in adulthood. It also shows that health status depends significantly on the longevity of each parent. Finally, the concentration index approach highlights an inequality of health opportunities in favour of individuals whose parents have experienced a high longevity and then an inequality of health in favour of individuals from more privileged backgrounds. The chapter concludes that there are inequalities of opportunity in health in France.