Health inequality attributions and support for healthcare policy

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.