The challenge of growing social health inequalities in the era of participation

In the first two decades of the 21st century, many European welfare states have been transformed into participation societies: the state has rearranged responsibilities for care in such a way that citizens have to take care for themselves and others – the state assigns vulnerable citizens participatory obligations. In this third decade, the negative consequences can no longer be neglected. People with less education and in lower socioeconomic positions have a worse health status than their better-of counterparts. In The Netherlands, people in lower socioeconomic positions live six to seven years shorter than people in higher socioeconomic positions and their shorter lives are spent eighteen to nineteen years longer with all kinds of illnesses. Income inequalities do not tend to narrow.

On a global scale, the poor might have become less poor, but the rich have become much richer. Social security safety nets are increasingly trimmed down, leaving people increasingly on their own coping with adversities like unemployment, disability, illness, school dropout. If people do not have the economic, personal, or social resources on their own, lifestyles get negatively affected, societal and labour participation becomes compromised and the distance to the ones who have resources becomes increasingly unbridgeable, also in health terms. Apart from that we see that many lower educated people are not politically active and not represented in relevant political processes and public debates.

Hence, inequalities in health and wellbeing, in social networks and resources, and in political participation and power are piling up. In HISP, we give ‘life at the bottom’’ a voice. We explore what health and participation mean for vulnerable people and we tap into often ‘hidden’ resources and knowledges of vulnerable people about the dynamics of health inequalities. To disentangle the dynamics and find targets for intervention, we also let numerical data speak. The focus is on whether and how unhealthy residential, work, social, and societal environments accumulate at the “bottom” and contribute to health inequalities in for example infectious diseases and type 2 diabetes. Giving voice is a part of solution in itself, as the Healthy HR project clearly demonstrates. In addition, our projects point at structural causes of health inequality that have been neglected for too long.

Text: Prof.dr. Hans Bosma