Laboratory

Population Health

Project

Interplay of Care and Health among Adults

Marcus Ebeling, Emma Zai, Md Anwer Hossain

Detailed Description

Care – including health care, formal long-term care, and informal care – plays an increasingly central role in aging societies. Medical and societal advances have substantially improved survival and reshaped health trajectories across adulthood and later life. While health care systems help people maintain and, in many cases, improve their health at older ages, increasing longevity and medical progress also lead to people spending longer periods of their lives with chronic conditions, functional limitations, or care dependency. Thus, the demographic structures of populations, together with institutional and family-based care arrangements, make care a crucial determinant of health among adults.

This project examines the dynamic and multidimensional relationship between care provision and health outcomes. A central focus is investigating how different forms of care both shape and respond to population health.

Health care provision is a key dimension, as it represents the diffusion of medical progress in populations. Health care utilization is both a driver of improvements in survival and well-being and a consequence of population health dynamics. Countries differ in how they organize and finance medical care, including through mandatory social insurance systems (Germany), tax-financed universal services (Sweden), and multi-tiered insurance schemes with varying levels of benefit generosity and substantial out-of-pocket payments (China). These institutional differences structure access, incentives, patient pathways, and the organization of care. The project investigates whether and how such differences translate into variation in health outcomes, longevity, and health inequalities. It further examines how the effects of health care reforms and policy interventions unfold across populations, and how the measurement of the relationship between health care provision and population health can be improved.

Formal long-term care – including home-based professional care and care provided in residential facilities – typically becomes relevant at more advanced stages of the health trajectory, which are often characterized by impairment, frailty, or dependency. Care systems vary widely in their financing structures and eligibility rules, and in the balance between public provision and family responsibility. At the same time, formal care systems not only respond to deteriorating health, but may also contribute to maintaining functioning, well-being, and survival at older ages. The project studies how different long-term care systems are associated with longevity and health trajectories; how the organization of formal care interacts with informal caregiving; and how care uptake varies by gender, socioeconomic status, and family context.

Across these dimensions, the project adopts a comparative and life course perspective. Using longitudinal survey and register data, it analyzes transitions into and out of care, changes in health status, and cumulative inequalities in care access and outcomes. By integrating demographic, institutional, and health perspectives, the project aims to clarify how care systems shape adult health and contribute to differences in longevity and well-being across populations.

Research Keywords:

Aging, Mortality and Longevity, Health Care, Public Health, Medicine, and Epidemiology