A model of how targeted and universal welfare entitlements impact on material, psycho-social and structural determinants of health in older adults

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Publisher: Elsevier Science Publishers
Document Type: Report
Length: 371 words

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To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.socscimed.2017.06.015 Byline: Judith Green (a), Stefanie Buckner (b), Sarah Milton (a), Katie Powell (c), Sarah Salway (c), Suzanne Moffatt (d) Abstract: A growing body of research attests to the impact of welfare regimes on health and health equity. However, the mechanisms that link different kinds of welfare entitlement to health outcomes are less well understood. This study analysed the accounts of 29 older adults in England to delineate how the form of entitlement to welfare and other resources (specifically, whether this was understood as a universal entitlement or as targeted to those in need) impacts on the determinants of health. Mechanisms directly affecting access to material resources (through deterring uptake of benefits) have been well documented, but those that operate through psychosocial and more structural pathways less so, in part because they are more challenging to identify. Entitlement that was understood collectively, or as arising from financial or other contributions to a social body, had positive impacts on wellbeing beyond material gains, including facilitating access to important health determinants: social contact, recognition and integration. Entitlement understood as targeted in terms of individualised concepts of need or vulnerability deterred access to material resources, but also fostered debate about legitimacy, thus contributing to negative impacts on individual wellbeing and the public health through the erosion of social integration. This has important implications for both policy and evaluation. Calls to target welfare benefits at those in most need emphasise direct material pathways to health impact. We suggest a model for considering policy change and evaluation which also takes into account how psychosocial and structural pathways are affected by the nature of entitlement. Author Affiliation: (a) Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK (b) Cambridge Institute of Public Health, University of Cambridge, Robinson Way, CB2 0SR, UK (c) Section of Public Health, ScHARR, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK (d) Institute of Health & Society, Newcastle University, Campus for Ageing and Vitality, Biomedical Sciences Building, Newcastle upon Tyne. NE4 5PL, UK Article History: Received 24 August 2016; Revised 13 June 2017; Accepted 14 June 2017

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Gale Document Number: GALE|A521847168