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

Lookup NU author(s): Professor Suzanne Moffatt



This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND).


© 2017 The Authors 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.

Publication metadata

Author(s): Green J, Buckner S, Milton S, Powell K, Salway S, Moffatt S

Publication type: Article

Publication status: Published

Journal: Social Science and Medicine

Year: 2017

Volume: 187

Pages: 20-28

Print publication date: 01/08/2017

Online publication date: 15/06/2017

Acceptance date: 14/06/2017

Date deposited: 10/07/2017

ISSN (print): 0277-9536

ISSN (electronic): 1873-5347

Publisher: Elsevier Ltd


DOI: 10.1016/j.socscimed.2017.06.015


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