Subjective socioeconomic status and agreement that health is determined by distal and proximal factors

This report examines whether a person's subjective view of their rank relative to others in society-subjective socioeconomic status (SES)-is systematically related to views on distal and proximal determinants of ill-health. This was tested using cross-sectional data from 28,718 respondents from 27 countries who took part in the International Social Survey Programme (ISSP) in 2011. Adjusting for age and gender as well as income and education, mixed logistic regression models showed that subjective SES was negatively associated with the likelihood of agreeing with distal explanations for poor health (being poor or because of work/life environment) and positively associated with the likelihood of agreeing with health-related behaviours as a cause for poor health. Subjective SES was not related to agreement that genes influence health. These analyses introduce a social psychological factor into the lay understanding of health determinants and extend models of subjective status and attributional style to health explanations.

Understanding and addressing populations whose prior experience has led to mistrust in healthcare

BACKGROUND

Policy makers need to maintain public trust in healthcare systems in order to foster citizen engagement in recommended behaviors and treatments. The importance of such commitment has been highlighted by the recent COVID-19 pandemic. Central to public trust is the extent of the accountability of health authorities held responsible for long-term effects of past treatments. This paper addresses the topic of manifestations of trust among patients damaged by radiation treatments for ringworm.

METHODS

For this mixed-methods case study (quan/qual), we sampled 600 files of Israeli patients submitting claims to the National Center for Compensation of Scalp Ringworm Victims in the years 1995-2014, following damage from radiation treatments received between 1946 and 1960 in Israel and/or abroad. Qualitative data were analyzed with descriptive statistics, and correlations were analyzed with chi-square tests. Verbal data were analyzed by the use of systematic content analysis.

RESULTS

Among 527 patients whose files were included in the final analysis, 42% held authorities responsible. Assigning responsibility to authorities was more prevalent among claimants born in Israel than among those born and treated abroad (χ² = 6.613, df = 1, p = 0.01), claimants reporting trauma (χ² = 4.864, df = 1, p = 0.027), and claimants living in central cities compared with those in suburban areas (χ² = 18.859, df = 6, p < 0.01). Men, younger claimants, patients with a psychiatric diagnosis, and patients from minority populations expressed mistrust in health regulators.

CONCLUSIONS

Examining populations' perceived trust in healthcare institutions and tailoring health messages to vulnerable populations can promote public trust in healthcare systems.

Whose responsibility? Part 2 of 2: views of patients, families, and clinicians about responsibilities for addressing the needs of persons with mental health problems in Chennai, India and Montreal, Canada

BACKGROUND

Individuals with mental health problems have many insufficiently met support needs. Across sociocultural contexts, various parties (e.g., governments, families, persons with mental health problems) assume responsibility for meeting these needs. However, key stakeholders' opinions of the relative responsibilities of these parties for meeting support needs remain largely unexplored. This is a critical knowledge gap, as these perceptions may influence policy and caregiving decisions.

METHODS

Patients with first-episode psychosis (n = 250), their family members (n = 228), and clinicians (n = 50) at two early intervention services in Chennai, India and Montreal, Canada were asked how much responsibility they thought the government versus persons with mental health problems; the government versus families; and families versus persons with mental health problems should bear for meeting seven support needs of persons with mental health problems (e.g., housing; help covering costs of substance use treatment; etc.). Two-way analyses of variance were conducted to examine differences in ratings of responsibility between sites (Chennai, Montreal); raters (patients, families, clinicians); and support needs.

RESULTS

Across sites and raters, governments were held most responsible for meeting each support need and all needs together. Montreal raters assigned more responsibility to the government than did Chennai raters. Compared to those in Montreal, Chennai raters assigned more responsibility to families versus persons with mental health problems, except for the costs of substance use treatment. Family raters across sites assigned more responsibility to governments than did patient raters, and more responsibility to families versus persons with mental health problems than did patient and clinician raters. At both sites, governments were assigned less responsibility for addressing housing- and school/work reintegration-related needs compared to other needs. In Chennai, the government was seen as most responsible for stigma reduction and least for covering substance use services.

CONCLUSIONS

All stakeholders thought that governments should have substantial responsibility for meeting the needs of individuals with mental health problems, reinforcing calls for greater government investment in mental healthcare across contexts. The greater perceived responsibility of the government in Montreal and of families in Chennai may both reflect and influence differences in cultural norms and healthcare systems in India and Canada.

Association of public explanations of why children struggle and support for policy solutions using a national sample

Purpose

Despite evidence showing the importance of structural determinants for child well-being and the existence of policies that can promote child well-being, many communities are not adopting these policies. Limited awareness of structural determinants may explain this gap. This study establishes the public's recognition of structural determinants and their associations with support for policies that promote child well-being.

Methods

Secondary analyses of survey data collected in 2019 from a random sample of 2496 adults in the United States. This survey asked why some children "struggle" (e.g., do poorly in school, use drugs, or get involved in crime). Respondents could select individual (e.g., lack of effort) and structural (e.g., low wages) explanations. Respondents were also asked about their support for policies that are supportive of children and families.

Results

Stronger beliefs of structural explanations were associated with greater support for policies that strengthen family economics, family-friendly work, and afford access to high-quality early childcare and education. Beliefs in individual explanations were inversely associated with support for these policies.

Conclusions

These findings suggest increasing recognition of the structural determinants that hinder child development may help increase support for policies that are effective in improving children's outcomes.

How do people make sense of wealth and poverty?

Economic outcomes reflect an intricate mixture of people's internal dispositions and external circumstances that are beyond their control. How, then, do people make sense of wealth and poverty? I suggest that attributions of economic outcomes are susceptible to various influences that can be grouped into two broad categories-who people are (i.e. personal influences) and what people see in the world (i.e. societal influences). Personal influences include people's ideological leanings and worldviews, socioeconomic standing, and experiences of economic success or failure. Societal influences include macroeconomic circumstances, cultural narratives, structural prejudices, and salient consumption behaviors by the rich and the poor. I discuss how these influences shape (and distort) attributions of economic outcomes and lay beliefs about wealth and poverty.

How do fatalistic beliefs affect the attitudes and pedestrian behaviours of road users in different countries? A cross-cultural study

This paper reports on an exploratory investigation of the influence of five different fatalistic belief constructs (divine control, luck, helplessness, internality, and general fatalism) on three classes of self-reported pedestrian behaviours (memory and attention errors, rule violations, and aggressive behaviours) and on respondents' general attitudes to road safety, and how relationships between constructs differ across countries. A survey of over 3400 respondents across Bangladesh, China, Kenya, Thailand, the UK, and Vietnam revealed a similar pattern for most of the relationships assessed, in most countries; those who reported higher fatalistic beliefs or more external attributions of causality also reported performing riskier pedestrian behaviours and holding more dangerous attitudes to road safety. The strengths of relationships between constructs did, however, differ by country, behaviour type, and aspect of fatalism. One particularly notable country difference was that in Bangladesh and, to a lesser extent, in Kenya, a stronger belief in divine influence over one's life was associated with safer attitudes and behaviours, whereas where significant relationships existed in the other countries the opposite was true. In some cases, the effect of fatalistic beliefs on self-reported behaviours was mediated through attitudes, in other cases the effect was direct. Results are discussed in terms of the need to consider the effect of locus of control and attributions of causality on attitudes and behaviours, and the need to understand the differences between countries therein.

Intergenerational objective and subjective mobility and attitudes towards income differences: evidence from transition societies

This article explores the association between intergenerational social mobility and attitudes towards income differences in post-socialist societies. I hypothesise that based on the psychological mechanism of self-serving bias in causal attribution, those who experience upward social mobility are more likely to support greater income differences, and that subjective intergenerational mobility has stronger association with attitudes towards income differences than objective mobility because individuals filter their objective environment in order to derive their subjective perceptions of the world and their own experiences. The described hypotheses are tested with two cross-national data sets – European Values Studies and Life in Transition Survey. The derived findings are robust to alternative statistical specifications and indicate that individuals who perceive themselves as subjectively mobile have significantly different attitudes towards income differences in comparison to non-mobile groups, but that this effect does not manifest among objectively mobile individuals.

'Falling from grace' and 'rising from rags': Intergenerational educational mobility and depressive symptoms

With this study, we make a number of contributions to the ongoing debate on the implications of intergenerational mobility for individuals' health. First, instead of focusing on absolute intergenerational mobility in educational attainment, we analyse varying implications of relative intergenerational mobility for depressive symptoms by considering the distribution of educational credentials separately in the parental and offspring generations. Second, unlike conventional approaches, which predominantly emphasise that upward and downward mobility has a negative effect, we argue that upward mobility might improve individuals' mental well-being and that this effect may vary by gender. Third, we use statistical approach which was designed specifically to study the consequences of intergenerational mobility and does not conflate mobility effects with effects of the positions of origin and destination. Using the 2012-2014 waves of the European Social Survey and data for 52,773 individuals nested in 28 societies, we fit the diagonal reference models with both individuals' short- and long-range experiences of intergenerational educational mobility. The results indicate that upward and downward mobility is associated with, respectively, lower and higher levels of depressive symptoms, as measured with the Center for Epidemiological Studies Depression Scale, and that these effects are only observed among men.

Motivational Accounts of the Vicious Cycle of Social Status: An Integrative Framework Using the United States as a Case Study

Social mobility is limited in most industrialized countries, and especially in the United States: Children born to relatively poor parents are less likely to prosper than other children. This observation has multiple explanations; in the current article, we focus on emerging motivational perspectives, synthesizing them into a novel integrative framework grounded in a classic theory of motivation: expectancy-value theory. Together, these findings indicate that individuals with lower socioeconomic status (SES) may be less motivated to achieve status relative to individuals with higher SES—not because of their own personal failings, but as a result of their material, social and cultural contexts. We then consider the significant theoretical advantages of this integrative framework, most notably that it enables us to consider how the disparate perspectives linking motivation to SES are linked and may at times compound or offset each other. In turn, this enables us to make sophisticated predictions concerning the conditions that will enable individuals with low SES to escape the vicious cycle of low motivation. Moreover, our account helps bridge the gap between explanations that locate the cause for low social mobility within individuals and those that locate it in the broader system. We end by addressing implications for the psychological understanding of low status and implications for social policy.

Who should be responsible for supporting individuals with mental health problems? A critical literature review

BACKGROUND

Individuals with mental health problems have many support needs that are often inadequately met; however, perceptions of who should be responsible for meeting these needs have been largely unexplored. Varying perceptions may influence whether, how, and to what extent relevant stakeholders support individuals with mental health problems.

AIMS

To critically evaluate the literature to determine who different stakeholders believe should be responsible for supporting individuals with mental health problems, what factors shape these perceptions, and how they relate to one another.

METHOD

A critical literature review was undertaken. Following an extensive literature search, the conceptual contributions of relevant works were critically evaluated. A concept map was created to build a conceptual framework of the topic.

RESULTS

Views of individual versus societal responsibility for need provision and health; the morality of caring; and attributions of responsibility for mental illness offered valuable understandings of the review questions. Creating a concept map revealed that various interrelated factors may influence perceptions of responsibility.

CONCLUSIONS

Varying perceptions of who should be responsible for supporting individuals with mental health problems may contribute to unmet support needs among this group. Our critical review helps build a much-needed conceptual framework of factors influencing perceptions of responsibility. Such a framework is essential as these views iteratively shape and reflect the complex divisions of mental healthcare roles and responsibilities. Understanding these perceptions can help define relevant stakeholders' roles more clearly, which can improve mental health services and strengthen stakeholder accountability.

Culture and the Sense of Justice

This article examines the intersection of culture and the sense of justice, summarizing a cumulative framework for analyzing human justice judgments that has emerged from several decades of social science research. It outlines a comprehensive guide to the terms and factors where culture may manifest itself and proposes a protocol for discerning the operation of culture. Methodological issues related to the conceptualization and operationalization of justice processes are addressed throughout. The first section develops a framework for justice analysis, distinguishing between ingredients thought to be universal and ingredients in which culture may operate. The second section discusses deductive theories in justice analysis and provides an illustration, in which one of the theories yields implications for individualism and collectivism, thus showing how justice processes can generate phenomena that come to be viewed as culturally based. The concluding section briefly discusses agendas and research designs for empirical analysis of justice and culture.

Influence of social class perceptions on attributions among mental health practitioners

OBJECTIVE

A vignette-based study assessed the influence of social class attributions toward a hypothetical client's difficulty.

METHOD

188 licensed mental health professionals who were recruited through professional listservs completed an online survey after reviewing one of two versions of a vignette describing a hypothetical client that varied based on social class cues.

RESULTS

As expected, this sample of licensed mental health practitioners detected social class differences based on the descriptors of the hypothetical client across the two vignettes. These perceived social class differences, however, did not impact participants' attributions toward the client for causing or solving her problems, level of Global Assessment of Functioning score ascribed to the client, or willingness to work with the client.

CONCLUSIONS

There was no evidence that participants differentially ascribed attributions based on social class. Implications and directions for future research are provided.

How do people attribute income-related inequalities in health? A cross-sectional study in Ontario, Canada

Context

Substantive equity-focused policy changes in Ontario, Canada have yet to be realized and may be limited by a lack of widespread public support. An understanding of how the public attributes inequalities can be informative for developing widespread support. Therefore, the objectives of this study were to examine how Ontarians attribute income-related health inequalities.

Methods

We conducted a telephone survey of 2,006 Ontarians using random digit dialing. The survey included thirteen questions relevant to the theme of attributions of income-related health inequalities, with each statement linked to a known social determinant of health. The statements were further categorized depending on whether the statement was framed around blaming the poor for health inequalities, the plight of the poor as a cause of health inequalities, or the privilege of the rich as a cause of health inequalities.

Results

There was high agreement for statements that attributed inequalities to differences between the rich and the poor in terms of employment, social status, income and food security, and conversely, the least agreement for statements that attributed inequalities to differences in terms of early childhood development, social exclusion, the social gradient and personal health practices and coping skills. Mean agreement was lower for the two statements that suggested blame for income-related health inequalities lies with the poor (43.1%) than for the three statements that attributed inequalities to the plight of the poor (58.3%) or the eight statements that attributed inequalities to the privilege of the rich (58.7%).

Discussion

A majority of this sample of Ontarians were willing to attribute inequalities to the social determinants of health, and were willing to accept messages that framed inequalities around the privilege of the rich or the plight of the poor. These findings will inform education campaigns, campaigns aimed at increasing public support for equity-focused public policy, and knowledge translation strategies.

An attributional analysis of reactions to poverty: the political ideology of the giver and the perceived morality of the receiver

An attributional analysis of reactions to poverty is presented. The article begins by discussing the perceived causes of poverty and their taxonomic properties (locus, stability, and controllability). One antecedent of causal beliefs, political ideology, is then examined in detail, followed by a review of the effects of causal beliefs on emotions and behavior. It is contended that helping the poor is a moral issue, but the moral evaluation concerns the targeted recipient of aid rather than the potential help giver. Persons perceived as responsible for their plight, a dominant construal for conservatives, elicit anger and neglect. In contrast, those seen as not responsible for their financial hardship, an outlook predominantly endorsed by liberals, arouse sympathy and help giving. Sympathy is the most important proximal determinant of aid. This analysis is extended to reactions to achievement failure, abortion, and rape. Policy implications are also examined.

Reward and Punishment Allocation in the Indian Culture

Two scenario studies examined justice perceptions in Indian samples. Study 1 investigated the effect of allocator-recipient relationship and internal/external locus of merit and need on both reward and punishment allocation in a distributive context, involving a meritorious and a needy recipient. Between merit, need and equality, subjects showed a clear equality orientation, in both allocation rule preference and perceived fairness of a given allocation. This finding was inconsistent with the strong need orientation reported in several Indian studies. In order to obtain more information on punishment alone, Study 2 was conducted in order to investigate a non-distributive context, involving internal/external locus of merit and need, and choice of punishment and perceived fairness of a given set of punishments, seriousness of the offence, guilt of the offender and the importance of need and merit. In both studies, the effect of situational variables did not emerge as expected. The apparent absence of effects of the situational variables was interpreted as the expression of a cognitive strategy to combine all the contextual information. The equality orientation found in Study 1 was interpreted as the resultant of such a combination. One part of this combination was in terms of the merit and need rules. It was suggested that subjects thought in terms of merit and need, instead of merit or need. Some evidence for this suggestion was obtained in Study 2. Need and merit were rated as being similar in importance when deciding a fair punishment. Attention was drawn to several aspects of justice perception, especially those related to punishment that requires further detailed investigation with modified methods.