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Research into the role of place in shaping inequalities in health has focused largely on examining individual and/or localised drivers, often using a context-composition framing. Whilst this body of work has advanced considerably our understanding of the effects of local environments on health, and re-established an awareness of the importance of place for health, it has done so at the expense of marginalising and minimising the influences of macro political and economic structures on both place and health. In this paper, we argue that: (i) we need to scale up our analysis, moving beyond merely analysing local horizontal drivers to take wider, vertical structural factors into account; and (ii) if we are serious about reducing place-based health inequalities, such analysis needs be overtly linked to appropriate policy levers. Drawing on three case studies (the US mortality disadvantage, Scotland's excess mortality, and regional health divides in England and Germany) we outline the theoretical and empirical value of taking a more political economy approach to understanding geographical inequalities in health. We conclude by outlining the implications for future research and for efforts to influence policy from 'scaling up' geographical research into health inequalities. • Health-place research commonly examines focuses individual and/or localised drivers. • Health geography should 'scale up' analysis of health-place relationships. • Research needs to account for wider, vertical and structural factors. • Political economic approaches add value to insight on geographic health inequalities. • Considers the policy implications of taking a political economy approach. [ABSTRACT FROM AUTHOR]

In this paper we examine the longer term outcomes of young people who experienced out of home care (OHC) as children, in Britain, Germany and Finland, countries characterised by different welfare regimes. While there is some evidence on immediate transitions after leaving care (up to age 21), there is less evidence on experiences around age 30, a phase of early adulthood. Drawing on existing longitudinal data for general population samples we focus on outcomes related to education, employment, family, health and receipt of welfare benefits for those who were ever in care and those who were not. We find evidence for continuing disadvantage regarding education and employment for those who were in care as children, but also indications of subjective wellbeing and commitment to family life – possibly a reflection of “normality” and efforts to “fit in” as parents. Surprisingly, despite variations in welfare system and differences in the scope and quality of available data, trends were similar in each of the countries, suggesting that none provide adequately for the needs of care experienced young adults. The findings point towards the need for a revised conceptualisation of the notion of “independence” which has to take into account the manifold and changing relationships between individuals and the state. Instead of a “cliff edge” approach there should be support for a more gradual shift from “dependence” to “independence” enabling those with care experience to develop their full potential. In interpreting the findings, limitations of the available data have to be acknowledged, pointing to the need for generating harmonised and longitudinal data on vulnerable subpopulations to enable effective monitoring of needs and provision. [ABSTRACT FROM AUTHOR]

Objectives: Fibromyalgia is a chronic condition of unknown aetiology, characterised by widespread pain, sleep disturbances, and fatigue. In this paper we examined the relationship metacognitions and the impact of Fibromyalgia in a German sample, detailing the translation and validation of a self-report metacognitive instrument.Methods: The Metacognitions about Symptoms Control Scale (MaSCS) was translated into German using the back-forward translation process. A total of 348 patients (316 female and 26 male) with Fibromyalgia contributed data to the study to test the structure and psychometric properties of the MaSCS.Results: Confirmatory factor analyses, informed by modification indices, resulted in a 16-item scale consisting of two factors pertaining to positive and negative metacognitions about symptoms control. Further analyses revealed that both factors had good internal consistency. Correlation analyses established convergent validity, indicating that both factors were significantly associated with: (1) established positive and negative metacognitions scales; and (2) with symptoms severity in Fibromyalgia. Regression analyses revealed that positive metacognitions about symptoms control significantly predicted impairment in physical functioning while negative metacognitions about symptoms control significantly predicted the overall Fibromyalgia impact value, when controlling for stress, anxiety, and depression and a general metacognitions.Conclusion: The findings support the potential relevance of metacognitions, and utility of the German version of MaSCS, in examining the role of metacognitions in Fibromyalgia and other chronic health conditions. [ABSTRACT FROM AUTHOR]

This paper investigates the mechanisms behind the health effects of retirement. Using a Regression Discontinuity Design to exploit financial incentives in the German pension system for identification, I find that retirement improves subjective health status and mental health, while also reducing outpatient care utilization. I explore a wide range of health behaviors, time use, and effect heterogeneity as potential mechanisms. Relief from work-related stress and strain, increased sleep duration as well as more frequent physical exercise seem to be key mechanisms through which retirement affects health. [ABSTRACT FROM AUTHOR]

This paper studies the effects of immigration on health. Specifically, we merge information on individual characteristics from the German Socio-Economic Panel (1984-2009) with detailed local labour market characteristics, and we then exploit the longitudinal component of the data to determine how immigration affects the health of both immigrants and natives over time. We find that immigrants to Germany are healthier than natives upon their arrival (the healthy immigrant effect) but that immigrants' health deteriorates over time. We show that the convergence in health is heterogeneous across immigrants and occurs more rapidly among those working in more physically demanding jobs. Because immigrants are significantly more likely to work in strenuous occupations, we investigate whether changes in the spatial concentration of immigrants affect the health of the native population. Our results suggest that immigration reduces the likelihood that residents will report negative health outcomes. We show that these effects are concentrated in blue-collar occupations and are stronger among low-educated natives. Improvements in natives' average working conditions and workloads help explain the positive effects of immigration on the health of the native population. [ABSTRACT FROM AUTHOR]

Abstract: In this paper we investigate the causal effect of years of schooling on health and health-related behavior in West Germany. We apply an instrumental variables approach using as natural experiments several changes in compulsory schooling laws between 1949 and 1969. These law changes generate exogenous variation in years of schooling both across states and over time. We find evidence for a strong and significant causal effect of years of schooling on long-term illness for men but not for women. Moreover, we provide somewhat weaker evidence of a causal effect of education on the likelihood of having weight problems for both sexes. On the other hand, we find little evidence for a causal effect of education on smoking behavior. Overall, our estimates suggest significant non-monetary returns to education with respect to health outcomes but not necessarily with respect to health-related behavior. [Copyright &y& Elsevier]

This paper assesses the impact of the length of maternity leave on children's health outcomes in the long-run. My quasi-experimental design evaluates an expansion in maternity leave coverage from two to six months, which occurred in the Federal Republic of Germany in 1979. The expansion came into effect after a sharp cutoff date and significantly increased the time working mothers stayed at home with their newborns during the first six months after childbirth. Using this cutoff date as a source of exogenous variation, I exploit German hospital registry data, which contains detailed information on the universe of inpatients' diagnoses from 1995-2014. By tracking the health of treated and control children from age 16 up to age 35, this study provides new insights into the trajectory of health differentials over the life-cycle. I find that the legislative change generated positive long-term health effects: My intention-to-treat estimates show that children born after the implementation of the reform experience fewer hospital admissions and are less likely to be diagnosed with mental and behavioral disorders. [ABSTRACT FROM AUTHOR]