What we learn from British, Finnish, and Japanese civil servants study and the role of social democracy in reducing socioeconomic inequalities in health: A response to Bosma

摘要

We very much appreciate the detailed comments by Bosma (2009) on our international comparative paper entitled "Socio-economic inequalities in physical and mental functioning of British, Finnish, and Japanese civil servants: role of job demand, control and work hours" (Sekine, Chandola, Martikainen, Marmot, & Kagamimori, 2009). Here we would like to further explain the background and interpretations of the international comparisons and discuss the potential role of politics, including social democracy, in social determinants of health.During the post-war period, Japan has enjoyed consistent improvement in population health and longevity, which may be attributable to the equalization of economic and educational levels among the Japanese people (Marmot & Davey Smith, 1989). Such egalitarian policies originated from a series of reforms under the Allied Occupation, which included the dissolution of great financial conglomerates and antitrust policies, agricultural land reforms, labor democratization, tax reforms, and educational reforms for equal opportunity (Tachibanaki, 1998). In addition, universal healthcare services (e.g., National Insurance System) and the social security system have contributed to population health.