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Abstract (English)

This thesis presents three empirical essays on the wider social determinants of health status. It analyzes the relevance of cultural, social and psychological determinants of health and their implications for health policy in Germany. These factors reflect the dependence of health status and subjective health assessment on the individual’s social environment. The empirical analyses rely on large-scale survey data from the German Socio-Economic Panel (SOEP). It provides, among others, rich information on socioeconomic status, health, leisure, social activities, personality traits and retrospective data on youth and socialization. Furthermore, respondents are followed over an extended period of time. This feature can be used to reduce the bias emanating from unobserved factors. The first study examines whether social participation measured by the consumption of cultural events (theatre, classical concerts etc.) has direct positive effects on self-reported health status. The existing literature generally suggests positive associations. However, credible evidence on causal effects is rather scarce. Using an elaborate propensity-score-matching approach and exploiting the longitudinal structure of the SOEP data, the results suggest that earlier studies may overestimate the relationship between cultural participation and health. Non-random selection into cultural attendance based on unobserved characteristics may heavily bias the observed associations. The second study is concerned with the indirect effects of social participation. It contributes to the current and large health economic literature on the negative effects of providing care to a family member, i.e. informal care. This study particularly investigates whether social capital attenuates the negative effects of providing informal care on mental health. Fixed-effects regression results indicate that social participation can reduce the negative psychological impact of caregiving. This may have important implications for the design and implementation of public caregiver-support programs. Analogous to the relative-income hypothesis, the third study explores whether relative health – that is own health compared to the average health of a reference group – influences perceived health satisfaction. The importance of relative-health effects is twofold. First, if such externalities exist, the private and social benefits of health investments fall apart. Depending on whether these spillovers are positive or negative, relative health raises or decreases the need for public subsidization of health goods and services. Second, reference group characteristics are a potential source of reporting bias in subjective health assessments, which could lead to erroneous conclusions about the cost effectiveness of alternative policy interventions. However, the empirical analysis suggests that social comparisons in health status are only weakly related to satisfaction with health.

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