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

Abstract

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