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Health inequality attributions and support for healthcare policy

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  • Baute, Sharon

Abstract

This article examines popular explanations of health inequality and introduces a typology distinguishing between behavioural, biological, environmental, and healthcare attributions. Using data from an original survey among 6000 individuals in Germany, the findings reveal that explanations for the social gradient in health vary by income and political ideology. Lower-income groups primarily attribute health inequality to the healthcare system, whereas higher-income groups attribute them to behavioural factors. Similarly, right-wing individuals tend to view income-related health disparities as a consequence of individual behaviour, while left-wing individuals primarily attribute them to environmental health risks. Furthermore, the study shows that such health inequality attributions are associated with citizens’ support for government responsibility for healthcare provision and willingness to pay higher taxes to improve healthcare. These findings suggest that health inequality attributions play an important role in the democratic legitimacy of healthcare policies. Divergent views on the causes of health disparities may undermine solidarity within healthcare systems.

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  • Baute, Sharon, 2025. "Health inequality attributions and support for healthcare policy," Social Science & Medicine, Elsevier, vol. 374(C).
    • Handle: RePEc:eee:socmed:v:374:y:2025:i:c:s0277953625002758
    DOI: 10.1016/j.socscimed.2025.117946
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    1. Smith, K.E. & Macintyre, A.K. & Weakley, S. & Hill, S.E. & Escobar, O. & Fergie, G., 2021. "Public understandings of potential policy responses to health inequalities: Evidence from a UK national survey and citizens’ juries in three UK cities," Social Science & Medicine, Elsevier, vol. 291(C).
    2. Reibling, Nadine & Ariaans, Mareike & Wendt, Claus, 2019. "Worlds of Healthcare: A Healthcare System Typology of OECD Countries," Health Policy, Elsevier, vol. 123(7), pages 611-620.
    3. Blaxter, Mildred, 1997. "Whose fault is it? People's own conceptions of the reasons for health inequalities," Social Science & Medicine, Elsevier, vol. 44(6), pages 747-756, March.
    4. Macintyre, Sally & McKay, Laura & Ellaway, Anne, 2005. "Are rich people or poor people more likely to be ill? Lay perceptions, by social class and neighbourhood, of inequalities in health," Social Science & Medicine, Elsevier, vol. 60(2), pages 313-317, January.
    5. Laudicella, Mauro & Siciliani, Luigi & Cookson, Richard, 2012. "Waiting times and socioeconomic status: Evidence from England," Social Science & Medicine, Elsevier, vol. 74(9), pages 1331-1341.
    6. Moscelli, Giuseppe & Siciliani, Luigi & Gutacker, Nils & Cookson, Richard, 2018. "Socioeconomic inequality of access to healthcare: Does choice explain the gradient?," Journal of Health Economics, Elsevier, vol. 57(C), pages 290-314.
    7. Elizabeth Rigby & Joe Soss & Bridget C. Booske & Angela M. K. Rohan & Stephanie A. Robert, 2009. "Public Responses to Health Disparities: How Group Cues Influence Support for Government Intervention," Social Science Quarterly, Southwestern Social Science Association, vol. 90(5), pages 1321-1340, December.
    8. Dănuț-Vasile Jemna & Mihaela David & Liliane Bonnal & Cornel Oros, 2024. "Socio-economic inequalities in the use of flu vaccination in Europe: a multilevel approach," Health Economics Review, Springer, vol. 14(1), pages 1-20, December.
    9. Hoffmann, Rasmus & Kröger, Hannes & Pakpahan, Eduwin, 2018. "Pathways between socioeconomic status and health: Does health selection or social causation dominate in Europe?," EconStor Open Access Articles and Book Chapters, ZBW - Leibniz Information Centre for Economics, vol. 36, pages 23-36.
    10. Aisha Lofters & Morgan Slater & Maritt Kirst & Ketan Shankardass & Carlos Quiñonez, 2014. "How Do People Attribute Income-Related Inequalities in Health? A Cross-Sectional Study in Ontario, Canada," PLOS ONE, Public Library of Science, vol. 9(1), pages 1-8, January.
    11. Olaf von dem Knesebeck & Nico Vonneilich & Tae Jun Kim, 2018. "Public awareness of poverty as a determinant of health: survey results from 23 countries," International Journal of Public Health, Springer;Swiss School of Public Health (SSPH+), vol. 63(2), pages 165-172, March.
    12. Knotz, Carlo Michael & Gandenberger, Mia Katharina & Fossati, Flavia & Bonoli, Giuliano, 2021. "Public attitudes toward pandemic triage: Evidence from conjoint survey experiments in Switzerland," Social Science & Medicine, Elsevier, vol. 285(C).
    13. Garthwaite, Kayleigh & Bambra, Clare, 2017. "“How the other half live”: Lay perspectives on health inequalities in an age of austerity," Social Science & Medicine, Elsevier, vol. 187(C), pages 268-275.
    14. Carrieri, Vincenzo & Wuebker, Ansgar, 2013. "Assessing inequalities in preventive care use in Europe," Health Policy, Elsevier, vol. 113(3), pages 247-257.
    15. Eddy van Doorslaer & Xander Koolman, 2004. "Explaining the differences in income‐related health inequalities across European countries," Health Economics, John Wiley & Sons, Ltd., vol. 13(7), pages 609-628, July.
    16. Bertin, Giovanni & Carrino, Ludovico & Pantalone, Marta, 2021. "Do standard classifications still represent European welfare typologies? Novel evidence from studies on health and social care," Social Science & Medicine, Elsevier, vol. 281(C).
    17. Carsten Jensen & Michael Bang Petersen, 2017. "The Deservingness Heuristic and the Politics of Health Care," American Journal of Political Science, John Wiley & Sons, vol. 61(1), pages 68-83, January.
    18. Davidson, Rosemary & Kitzinger, Jenny & Hunt, Kate, 2006. "The wealthy get healthy, the poor get poorly? Lay perceptions of health inequalities," Social Science & Medicine, Elsevier, vol. 62(9), pages 2171-2182, May.
    19. Rianne Gelder & Gwenn Menvielle & Giuseppe Costa & Katalin Kovács & Pekka Martikainen & Bjørn Heine Strand & Johan P. Mackenbach, 2017. "Long-term trends of inequalities in mortality in 6 European countries," International Journal of Public Health, Springer;Swiss School of Public Health (SSPH+), vol. 62(1), pages 127-141, January.
    20. Bernard, Kate & McGowan, Victoria J & Bambra, Clare, 2024. "“Power, control, strain”: Lay perceptions of health inequalities across England's ‘North South divide’," Social Science & Medicine, Elsevier, vol. 355(C).
    21. Landi, Stefano & Ivaldi, Enrico & Testi, Angela, 2018. "Socioeconomic status and waiting times for health services: An international literature review and evidence from the Italian National Health System," Health Policy, Elsevier, vol. 122(4), pages 334-351.
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