Under what conditions do people accept health inequality? A cross-national regression analysis of OECD countries

Background

Health inequality remains a persistent challenge for welfare states. Over the past two decades (1999–2019), neoliberal policies and rising inequality have significantly influenced these attitudes.

Objective

The study investigates the evolution of public attitudes towards health inequality in OECD countries and evaluates the interaction between institutional structures and societal norms over time.

Methods

This study employs a longitudinal quantitative design utilizing data from the International Social Survey Programme (ISSP) Social Inequality module (1999, 2009, 2019) across 12 OECD countries. Descriptive analysis and multiple linear regression models were conducted to test grievance and policy feedback theories.

Results

In 1999, countries with lower public healthcare spending and higher inequality exhibited strong opposition to health inequality. However, by 2019, attitudes shifted, with opposition decreasing in highly unequal societies and increasing in countries with robust public healthcare spending. Regression analyses revealed significant changes over time, suggesting a transition from grievance-based responses to inequality toward acceptance influenced by policy feedback effects.

Conclusions

The findings underscore the need for policymakers to consider long-term policy impacts on public perceptions. Institutional frameworks fostering equitable healthcare access can counter the normalization of inequality, thereby promoting societal resistance to health disparities.