Socioeconomic inequalities and health: latent variables approach

Purpose Self-rated health (SRH) is a core indicator of social, psychological and physical well-being. Few studies jointly examine socioeconomic status (SES), physical health (PH), mental health (MH), chronic disease (CD) and health behaviours. We assess how these factors shape SRH. Design/methodology/approach We analyse the 2022 Turkish Health Survey (N = 22,742; nationally representative, multistage stratified) using PLS-SEM (SmartPLS 3; bootstrap). We estimate direct and mediated SES→SRH paths via MH, PH and CD and monetize effects through an absenteeism-cost simulation. Findings The PLS-SEM explains 45% of the variance in self-rated health. Socioeconomic status is the dominant driver (ß = 0.43, p < 0.01); moving from the lowest to the highest SES quintile increases predicted SRH by ≈ approximately 28 points (0–100 scale). Physical health exerts a comparably strong positive association (ß = 0.44), whereas chronic disease suppresses SRH (ß = −0.29). Mental-health mediation accounts for 0.17 SD of the SES association. Practical implications Reallocating ∼2% of primary-care budgets to routine MH screening, establishing subsidized Community Wellness Hubs in the 20 least healthy provinces and removing co-pays for hypertension/diabetes drugs in the poorest quintile could narrow the SES–SRH gap by 10–12% and recover ≈US$500 in annual productivity per worker. Originality/value Our study reveals important routes associated with SRH, especially for vulnerable groups like women and the elderly. The results provide public health professionals and legislators striving to improve health equity and support sustainable economic growth in an important direction. To our knowledge, this is the first nationally representative application in Türkiye that models the complete SES → MH → PH → CD → SRH pathway and translates the coefficients into absenteeism-cost terms.