Do Europeans Perceive Their Health Differently? A Cross-National Analysis

Martina Bodo
Ognjen Obucina, Institut National d'Études Démographiques (INED)
Angela Paparusso, Institute for Research on Population and Social Policies - National Research Council (CNR-IRPPS)
Elena Ambrosetti, Sapienza University of Rome

Self-rated health (SRH) is a widely used indicator of population health, capturing individuals’ subjective evaluations of their own health. Although strongly correlated with objective outcomes such as mortality, cross-national research shows that SRH responses vary markedly between countries with similar life expectancy. Despite being derived from a single-item question, SRH is a complex construct shaped by multiple factors. This study adopts a pan-European perspective to examine how populations differ in evaluating their health and which factors account for distinct SRH distributions across countries. It also incorporates response styles—often omitted from SRH studies—whose influence on self-assessment has been empirically demonstrated. Using pooled data from Rounds 7 and 11 of the European Social Survey, the analysis includes 69,568 respondents from 26 countries. Hierarchical cluster analysis identified three groups: Cluster 1 (e.g., Greece, Cyprus, Denmark) shows the most positive evaluations; Cluster 2 (e.g., Belgium, Netherlands, Sweden) a moderately positive profile; and Cluster 3 (e.g., Germany, Spain, Portugal) a more critical one. Multinomial logistic regressions estimated by cluster reveal consistent socioeconomic and behavioural gradients: higher education, income, and physical activity increase the likelihood of reporting good health, whereas chronic disease, depressive symptoms, and smoking reduce it. The strength of these associations differs across clusters, suggesting that Europeans interpret and use the SRH scale differently. Finally, response styles matter: extreme responding increases the use of both scale ends, and acquiescence favours positive ratings, particularly in clusters 2 and 3. These findings enhance understanding of SRH’s interpretability and validity as a cross-national indicator.

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 Presented in Session 35. International and Cross-Country Health Comparisons