Abstract
BackgroundPoverty and ill-health are closely inter-related. Existing studies on the poverty-health vicious cycle focus mainly on less developed countries, where the identified mechanisms linking between poverty and ill-health may not fit the situations in developed Asian regions. This study aims to qualitatively explore the perceived mechanisms and drivers of the poverty-health vicious cycle among major stakeholders in the healthcare setting in Hong Kong.MethodsData were collected via focus group interviews with social workers (n = 8), chronically ill patients (n = 8), older adults (n = 6), primary care doctors (n = 7) and informal caregivers (n = 10). The transcribed data were then closely read to capture key themes using thematic analyses informed by social constructivism.ResultsIn this highly developed Asian setting with income inequality among the greatest in the world, the poverty-health vicious cycle operates. Material and social constraints, as a result of unequal power and opportunities, appear to play a pivotal role in creating uneven distribution of social determinants of health. The subsequent healthcare access also varies across the social ladder under the dual-track healthcare system in Hong Kong. As health deteriorates, financial hardship is often resulted in the absence of sufficient and coordinated healthcare, welfare and labour policy interventions. In addition to the mechanisms, policy drivers of the cycle were also discussed based on the respondents’ perceived understanding of the nature of poverty and its operationalization in public policies, as well as of the digressive conceptions of disease among different stakeholders.ConclusionsThe poverty-health vicious cycle has remained a great challenge in Hong Kong despite its economic prosperity. To break the cycle, potential policy directions include the adoption of proportionate universalism, social integration and the strengthening of medical-social collaboration.
Highlights
Perceived social determinants of health: lifestyle, psychosocial impact and the healthcare system Most of the participants agreed that unhealthy lifestyle led to poor health and that people living in poverty tended to have a less healthy lifestyle, which is, as they recognized, driven by a greater material and social constraint
Most of the older adults in our study claimed that individual factors rather than the social environment are more important, and their rationale was based on a lower difficulty in altering individual factors than the social environment in practice. They generally supported the notion that the poor have lower bargaining power and control over broader determinants of health inequities: Dynamics between individual’s perceptions and the social context Perceived poverty and the social environment Our results clearly demonstrated a lack of power and opportunities among the poor to overcome and change the social environment that potentially promotes and reinforces unfavourable intermediary determinants of health
The poverty-health vicious cycle has remained a great challenge in Hong Kong despite its economic prosperity
Summary
In addition to the mechanisms linking between poverty and ill-health, structural determinants of health inequities, in terms of socioeconomic, political and cultural contexts as illustrated in the World Health Organization (WHO) Conceptual Framework for Action on the Social Determinants of Health [5], play a significant role in generating social stratification, shaping the distribution of the more down-stream intermediary determinants of health These contextual environments differ substantially between developed and less developed settings. While absolute material living standards may be critical drivers to ill-health in less developed countries, poor lifestyle choices and psychological stress, as a result of relative deprivation, are expected to link more closely to the great burden of non-communicable diseases in the developed world [6] Their investments on healthcare and social welfare are not comparable due to differential economic capacities and policy initiatives. Given the complex dynamics of the influence of structural determinants and their interactions with the down-stream intermediary factors, it is necessary to adopt qualitative research methods for an in-depth understanding of the poverty-health vicious cycle
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