Economic Vulnerability, Anxiety, and Self-Rated Health among Women and Men in Japan

Self-rated health is closely tied to economic position, yet most research measures position as a level — the income or wealth a household holds — and leaves open the question of whether the household can absorb an economic shock without serious disruption. We distinguish economic vulnerability, the absence of liquid financial buffers, from the level of resources, and ask whether it is associated with poorer self-rated health independently of resource levels, whether the association differs by gender, and whether it operates through psychosocial distress. Using harmonized Japanese panel data on adults observed between 2009 and 2021, we find that what is associated with worse self-rated health is not low income per se but the absence of a buffer: households that are asset-poor despite adequate income fare worse than the income-poor who retain savings, and the doubly poor fare worst. The association is substantially stronger for women — roughly 1.6 times the male estimate for the doubly poor — and is present even in a universal-coverage setting where economic position might be expected to matter least. Economic vulnerability is itself associated with markedly greater anxiety about the future in both sexes; under a decomposition whose assumptions we state explicitly, measured distress accounts for at least as much of the gradient as health behaviours, though much remains unexplained. Causal direction is beyond what an observational panel can establish, but the evidence is consistent with a stress mechanism operating partly through anticipatory anxiety.