Public preferences to trade-off gains in total health for health equality: Discrepancies between an abstract scenario versus the real-world scenario presented by COVID-19

Comerford, David; Tufte-Hewett, Angela; Bridger, Emma K.

doi:10.1177/10434631231193599

Cited by 3 publications

(1 citation statement)

References 40 publications

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“…(2,5,6) Elsewhere, health economists ask respondents to make choices between different health distributions in order to calculate inequality aversion preferences. (7)(8)(9) Others use simpler survey designs to ask about acceptable levels of health or income inequality in society. (10)(11)(12) One feature common to these distinct approaches is that preferences, views or attitudes are typically elicited in a bivariate manner.…”

Section: Main Textmentioning

confidence: 99%

When is health inequality acceptable? Appraisals of inevitability, complexity and causal explanations

Bridger,

Tufte-Hewett,

Comerford

et al. 2023

Preprint

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Background: Health inequalities are typically presented with respect to separate groupings or bases of categorization, such as income-related health inequality or life expectancy by education. We sought to characterize the cognitive consequences of presenting health inequality by bases of categorization. Methods:Across two studies (N = 1,321), UK and US participants made a number of judgments about life expectancy differences (including how acceptable they are and whether they should be addressed) attributed to distinct bases of categorization: income, education, social class, neighbourhood, lifestyle choices and genetics. Results:Health inequality was perceived as least acceptable when attributed to the four socioeconomic bases, and most acceptable for lifestyle choices and genetics. Six appraisal dimensions – complexity, malleability, inevitability, extent driven by biological, psychological and sociocultural causes - varied with basis of categorization and predicted views on health inequality. These dimensions could explain the majority (47-57%) of the drop in acceptability for health inequality attributed to neighbourhood, social class and education differences relative to a condition with no categorization. Conclusions:These findings illustrate for the first time some of the causal explanations and affiliated inferences that underpin views on health inequality, and the corresponding consequences for communicating about health and health inequalities.

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Section: Main Textmentioning

confidence: 99%

When is health inequality acceptable? Appraisals of inevitability, complexity and causal explanations

Bridger,

Tufte-Hewett,

Comerford

et al. 2023

Preprint

View full text Add to dashboard Cite

show abstract

Why are socioeconomic health inequalities unacceptable? Studying the influence of explanatory framings on cognitive appraisals

Bridger,

Tufte‐Hewett,

Comerford

et al. 2024

Anal Soc Iss & Public Policy

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Studies of aversion to health inequality have found that this is often greater when health outcomes are presented as varying with socioeconomic conditions. We sought to understand better why this is by studying the cognitive appraisals made about health inequality when presented with distinct explanatory framings. Across two pre‐registered studies (N = 1321), UK and US participants judged the acceptability of life expectancy differences attributed to distinct framings: income, education, social class, neighborhood, lifestyle choices, and genetics. Health inequality was least acceptable when attributed to the four socioeconomic framings, and most acceptable for lifestyle choices and genetics. Six appraisal dimensions—complexity, malleability, inevitability, and extent driven by biological, psychological, and sociocultural causes—varied with framing and predicted views on health inequality. These dimensions could explain most of the drop in acceptability for health inequality attributed to socioeconomic factors relative to a condition with no framing. This work illustrates for the first time the cognitive appraisals and causal intuitions that link different explanatory framings to views on health inequality. These framings are viewed as least acceptable because they reduce the perceived involvement of biological causes while increasing the perception that sociocultural and psychological factors contribute to health inequality.Public significance statement: Academics use different socioeconomic variables to describe health inequalities. We show that different explanatory framings change appraisals about the causes, malleability, and inevitability of health inequalities. Socioeconomic explanations (income, education, social class, and neighborhood) reduce acceptability because they reduce the perception that health is biologically caused and increase the perceived role of socio‐cultural factors. Public support for intervention on health inequalities will be best served by framings that emphasize these differences

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Perceived health inequalities: are the UK and US public aware of occupation-related health inequality, and do they wish to see it reduced?

Bridger,

Tufte-Hewett,

Comerford

2023

BMC Public Health

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Background One underexamined factor in the study of lay views of socioeconomic health inequalities is occupation-related health. Examining health by occupational social class has a long history in the UK but has been comparatively overlooked in US public health literatures, where the relationship between health and work has attended more to hazard exposure. Methods Representative samples of the UK and US indicated the perceived and ideal lifespan of people working in “higher managerial/professional” and “routine” occupations. We examine perceptions of inequality and desires for equality across occupation groups as a function of country and key socio-demographic variables. Results 67.8% of UK and 53.7% of US participants identified that professionals live longer than routine workers. Multivariate models indicated that US participants were markedly less likely to be aware of occupation-related inequalities after controlling for age, gender, and education. Awareness was negatively related to age (in the US) and recent voting behaviours (both samples). Desiring equal life expectancy was less likely in the US sample, and less likely across both samples among older participants and those with lower levels of education. Conclusion Employing a novel approach to measuring perceived and ideal life expectancy inequality, this is the first study to examine perceptions of lifespan inequality by occupational groups. It reports widespread understanding of the occupation-related gradient in lifespan and a desire that these inequalities be eliminated in the UK, but considerably less awareness and desire for equality in the US. Greater tolerance for social status inequalities in the US than other similar countries appear to also extend to differences in life expectancy.

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Public preferences to trade-off gains in total health for health equality: Discrepancies between an abstract scenario versus the real-world scenario presented by COVID-19

Cited by 3 publications

References 40 publications

When is health inequality acceptable? Appraisals of inevitability, complexity and causal explanations

When is health inequality acceptable? Appraisals of inevitability, complexity and causal explanations

Why are socioeconomic health inequalities unacceptable? Studying the influence of explanatory framings on cognitive appraisals

Perceived health inequalities: are the UK and US public aware of occupation-related health inequality, and do they wish to see it reduced?

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