Unequal Health, Unequal Needs: Understanding the complexities of socioeconomic insecurity and health

Abstract

This dissertation investigated socioeconomic differences in health, the role of health in daily life, health needs, and policy support. In addition to a socioeconomic health gap, we found a gap between policy and needs. To reduce health inequalities, the needs of vulnerable populations must be prioritized. Chapter 2 found that the risk of poor mental health was particularly high among women with low incomes, but during COVID-19, mental health deteriorated the most among people aged 65 and older. In chapter 3, small socioeconomic differences in the perceived importance of health were observed. However, chapter 4 revealed that stress played a far greater role in explaining socioeconomic health inequalities than the value people attached to health. The experiences of people experiencing socioeconomic insecurity, presented in chapter 5, describe that people facing socioeconomic insecurity often prioritized mental relaxation in caring for their health. However, due to a lack of control over life, health routines faded, creating vicious cycles of deteriorating health. The primary need that socioeconomically insecure individuals identified in chapter 5 was greater socioeconomic security, particularly housing security. However, even if this need were met, a desire to be heard and seen persisted. Accessible conversations could help people experiencing socioeconomic insecurity progress from surviving to thriving. Policies to reduce health inequalities are typically designed by highly educated individuals. Chapter 6 investigated socioeconomic differences in policy support. The results indicate that people with high incomes and educational levels often favor policies focusing on information and skills to improve the health of people in socioeconomically insecure positions. However, these policies receive little support from socioeconomically insecure groups, signaling a mismatch between policy and needs. Policy measures that improve socioeconomic circumstances were most frequently preferred by socioeconomically insecure groups and enjoyed broad support. By highlighting the disproportionate daily stressors, limited opportunities, and differing policy preferences of people in socioeconomic insecurity, this dissertation revealed that current health policies may overlook the unique needs of these populations. To effectively address these gaps, policies should be designed using an inclusive approach that centers on the self-perceived needs of individuals from lower socioeconomic backgrounds.