Measuring Capability Inequality in Finland: A Cross-Sectional Study of Individual Deficits and Societal Losses

• In Event: Inequality, Poverty, and Mobility Section Roundtables
  In Refereed Roundtable (60 minute): 4. Global Inequality, Poverty, and Mobility

Abstract

Capability-based approaches have been proposed as complements to existing quality-of-life indicators, shifting the focus from health outcomes to people’s real opportunities to lead valued lives. However, empirical evidence on population-level capability inequalities remains scarce. We apply CALY-SWE-measure, developed in Sweden, to investigate capability inequalities and individual deficits and societal losses of capabilities. We also compare CALY(capability-adjusted-life-years) estimates with health-utility-based QALY (quality-adjusted life years) estimates to assess the added value of capability-oriented evaluation for policy.
We used data from a 2024 cross-sectional survey of a representative sample of Finnish adults. Capabilities were assessed with a Finnish translation of the CALY-SWE measure, health utility with EQ-5D, and various sociodemographic variables were used as determinants. We compared capability deficits in different sociodemographic groups as difference to the total sample mean and tested statistical significance of group differences with one-way ANOVA. Additionally, marginal effects on capability and health utility were assessed with a two-part model consisting of logistic regression and gamma regression. Annual CALY and QALY losses were estimated with the weighted prevalence of each sociodemographic group in our data.
Capability inequalities were observed across sociodemographic groups, with the largest gaps among respondents reporting poor health, income difficulties, mental disorders, unemployment, and low education. Poor health, income difficulties, and mental disorders accounted for the greatest overall societal burden in terms of lost capabilities based on group prevalences in Finnish population.
Our findings reveal systematic capability inequalities in Finland, narrowing opportunities for a good life and potentially hindering societal development. Comparisons with QALY estimates showed that capability-based and health utility–based measures identify overlapping but not identical patterns of inequality. Promoting equality of opportunity requires more targeted efforts and suitable metrics. CALY, or other capability-based measures, could play a crucial role in guiding Finnish social and health policies.

Authors

• Tiina Annika Karoliina Ahonen, University of Eastern Finland

• Hanna Rekola, University of Eastern Finland

• Annika Frahsa, Institute of Social and Preventive Medicine, University of Bern, Switzerland

• Kaspar Walter Meili, Department of Epidemiology and Global Health, Umeå University, Sweden

• Tomi Mäki-Opas, Tomi Mäki-Opas, Department of Social Sciences, University of Eastern Finland, Finland and Social, Wellbeing, and Rescue Service Research Centre, Wellbeing Services County of North Savo, Finland