Abstract
BackgroundInequalities in health and wealth distributions are becoming pressing societal problems in many countries. How these inequalities are perceived and to what degree perceptions are aligned with actual distributions, is important for trust in public health services, social and economic policies, and policymakers. This study aims to assess perceived and desired levels of inequality in health and wealth in Germany and the UK.MethodsThe online-survey was filled out by 769 volunteers (322 from Germany, 447 from the UK), recruited from an existing commercial panel (Prolific Academic) or via Facebook advertisements in 2019. Perceived and ideal national health and wealth distributions were assessed and compared to actual health indicators (i.e. days absent from work, number of visits to general practitioners (GPs) and self-rated health), and actual wealth distributions with t-tests.ResultsA pronounced gap emerged between the estimated, ideal and actual inequality. Both samples strikingly underestimated the proportion of (very) good health in the national distribution by a factor of ~ 2.3 (participants estimated that 34% of the German and 36% of the UK population respectively are very healthy or healthy, while the actual proportion in the population was 75% in Germany and 84% in the UK, P < 0.001 for all). Moreover, actual health distributions were much closer to the desired than the perceived health distributions (78% of German and 72% of UK participants ideally being very healthy or healthy). A reversed pattern of results emerged for wealth in both samples, with wealth inequality being strikingly worse than desired and inequality being underestimated by a factor ~ 1.7 (P < 0.001 for all). Results were consistent across demographic groups.ConclusionsRespondents in both Germany and the UK have profoundly negative misperceptions regarding the distribution of health, which contrasts with starkly positive misperceptions regarding the distribution of wealth, indicating that the public is healthier but poorer than they think. More importantly, from a public health perspective, a high level of consensus emerged, with both healthy and wealthy participants misperceiving health and wealth distributions.
Highlights
Health and wealth inequalities are observed in all societies
Data for the objective national health distributions were drawn from the European Health Interview Survey (EHIS) [18] provided by Eurostat, which is compulsory for all European member states based on the European Commission Regulation 141/2013
Ideal and actual health distributions in Germany and the United Kingdom (UK) The estimates for the actual distribution of health and the desired ideal distributions across all five health categories in both countries are presented in Fig. 1, along with the actual distributions for health indicators
Summary
Health and wealth inequalities are observed in all societies. some inequalities may be considered unavoidable, resulting from sociodemographic characteristics such as age and gender, many of these inequalities or disparities are potentially amenable to public health and policy interventions [1, 2]. Which distribution of health and wealth in a society are deemed just and to what degree they are aligned with actual distributions, is important for trust in public health services, social and economic policies, and policymakers [9,10,11]. Previous research showed that respondents from countries with relatively high levels of wealth inequality (e.g., the United States (US) and Australia) dramatically underestimated the actual level of wealth inequality [11,12,13]. Inequalities in health and wealth distributions are becoming pressing societal problems in many countries How these inequalities are perceived and to what degree perceptions are aligned with actual distributions, is important for trust in public health services, social and economic policies, and policymakers.
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