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The association between income distribution and measures of health has been well established such that societies with smaller income differences between rich and poor people have increased longevity (Wilkinson, 1996). While more egalitarian societies tend to have better health, in most developed societies people lower down the social scale have death rates two to four times higher than those nearer the top. Inequities in income distribution and the consequent disparities in health status are particularly problematic for many women, including single mothers, older women, and women of colour. The feminization of poverty is the rapidly increasing proportion of women in the adult poverty population (Doyal, 1995; Fraser, 1987).

This chapter provides an overview of the role of socioeconomic status (SES) in health, including disease, health behaviors, and access to health. The literature on the social determinants of health is reviewed. The chapter then provides a review of the health status of the homeless, poor, and near-poor. The incidence and mortality rates for leading diseases and health behaviors are reviewed, in addition to issues of environmental exposures, access to care, and health literacy. SES is one of the strongest predictors of health status (Kahng, 2010; Kawachi & Kennedy, 1997; Link & Phelan, 1996). SES is important to health regardless of a person's social status and in general, the more advantaged individuals are, the better their health, and the more disadvantaged individuals are, the greater their chances of increased morbidity and mortality (Adler et al., 1994; Adler & Coriell, 1997, Kidder, Wolitski, Campsmith, & Nakamura, 2007; Zlotnick and Zerger, 2009).

The chapter provides an overview of strategies and policies to address the health needs of the poor and vulnerable in our society, including workplace wellness strategies and school-based health clinics. The authors suggest ways to extend these innovative practices. This chapter emphasizes an approach to addressing the health of the poor and near-poor that acknowledges the significant role that access to social and economic resources plays in the acquisition and maintenance of health. Recommendations for health interventions are focused on strengthening the utilization of community institutions to deliver needed services.

Data from different countries suggest a higher prevalence of anxiety, depression and suicides among manual and trade workers in the construction industry than in the general population. The present review examines the causes and effects of poor mental health and the effectiveness of interventions to improve manual and trade workers' mental health in the construction industry. It also identifies gaps in research and makes several suggestions for practice and future research.

A systematic literature review was conducted to examine and consolidate evidence reported in 54 relevant journal articles published between 2010 and 2021 on the mental health of manual and trade workers.

Three major themes emerged in the review of the 54 journal articles: causes of poor mental health, effects of poor mental health and interventions to improve mental health. The leading causes of poor mental health among construction manual and trade workers are poor work-life balance, high job demand, poor cultural norms and mental health stigma, chronic bodily pain, lack of social support, workplace injustice and job insecurity. The prominent effects of poor mental health are suicidality, drug and alcohol addiction, poor workplace safety and poor work performance. Moreover, the study found that some of the strategies recently implemented in the construction industry to improve mental health are deemed ineffective, or their effectiveness remains inconclusive.

The review's scope is limited to research on manual and trade workers, and it did not investigate the mental health of construction professionals and construction management students.

The review provides valuable insights into the causes and effects of poor mental health among manual and trade workers and the effectiveness of mental health interventions in the construction industry.

The purpose of this paper is to examine the association between immigrants’ sense of community belonging and self-rated general and mental health status in Canada as well as estimate how this relationship is moderated by sex differences.

This cross-sectional study used pooled data from seven cycles of the Canadian Community Health Survey (N = 98,011) conducted between 2005 and 2018. Data were pooled to increase the sample size of the immigrant population. The surveys covered content areas such as well-being, sociodemographic, chronic diseases, self-rated general and mental health. A binary logistic regression fitted the model. Both univariate and multivariate analyses were performed between predictor variables and immigrants’ self-rated general and mental health. Descriptive statistics and adjusted odds ratios and 95% confidence intervals were estimated. Sex differences were also assessed.

This study found that slightly more than half of the respondents were female (53.2%). Generally, immigrants with a weak sense of community belonging were more likely to rate their general and mental health as poor although the association is stronger in mental health. Also factors such as older age, lower educational level, those single or never married, smoking status, physical inactivity, overweight or obesity and life stress were predictors of both poor self -rated general and mental health among immigrants. Sex differences in these risk factors were also noted.

This study has several limitations that should be noted. The first limitation is the fact that causality cannot be deduced due to the cross-sectional nature of our pooled data. Secondly, responses from this data are subject to recall bias given that the data were self-reported. Therefore, the interpretation of these results must be done with caution. Further, questions regarding the primary exposure variable of this study were restrictive. The definition of the local community which forms part of the one-item community belonging question did not define what is meant by local community, and as such, the question might be subject to different interpretations (i.e. urban or rural geography?). Lastly, this study’s findings did not stratify immigrants into countries or continents of origin. Immigrants from some countries or continents may be more prone to mental health than others.

This study shows a link between weak immigrants’ sense of community belonging and poor self-rated general and mental health status in Canada and provides suggestive evidence of how contextual factors influence health outcomes differently in society.

Poor health-related quality of life (HRQoL) is one of the important issues in the health sector. The purpose of this paper is to investigate the prevalence and socio-economic inequality in poor HRQoL in Tehran city, Iran.

In total, 562 adults were included in this cross-sectional study. The cluster sampling method was used for data collection from May to June, 2016 in Tehran city, Iran. Data on HRQoL, using EuroQol 5-dimensions questionnaire, and data on socio-economic and demographic variables were gathered. Convenience regression method was performed to measure the concentration index (CI). Decomposition analysis was performed to determine the contribution of variables on socio-economic inequality in poor HRQoL. All analyses were performed by Stata v.14.

The prevalence of poor HRQoL was 28.3 percent. The value of CI for “poor HRQoL” was −0.299 (95% confidence interval: −0.402 to −0.195). Socio-economic status (SES) was the largest contributor to socio-economic inequality in poor HRQoL (69.44 percent of inequality was explained by SES). Age, obesity and race had a positive contribution to socio-economic inequality in poor HRQoL among the participants. Nonetheless, sex and smoking intensity had a negative contribution to inequality in poor HRQoL.

There is little evidence about the prevalence of poor HRQoL in insured people. This study provided new evidence in this area through the investigation of socio-economic inequality in poor HRQoL and its determinants among people with health insurance in Iran using decomposition analysis.

Objective – This chapter assesses the extent to which previous economic and financial crises had a negative impact on health outcomes and health financing. In addition, we review evidence related to the effectiveness of different policy measures undertaken in past crises to protect access to health services, especially for the poor and vulnerable. The current global crisis is unique both in terms of its scale and origins. Unlike most previous instances, the current crisis has its origins in developed countries, initially the United States, before it spread to middle- and lower-income countries. The current crisis is now affecting almost all countries at all levels of income. This chapter addresses several key questions aimed at helping inform possible policy responses to the current crisis from the perspective of the health sector: What is the nature of the current crisis and in what ways does it differ from previous experiences? What are some of the key lessons from previous crises? How have governments responded previously to protect health from such macroeconomic shocks? How can we improve the likelihood of positive action today?

Methodology/approach – The chapter reviews the literature on the impact of financial crises on health outcomes and health expenditures and on the effectiveness of past policy efforts to protect human development during periods of economic downturn. It also presents analysis of household surveys and health expenditure data to track health seeking behavior and out-of-pocket expenditures by households during times of financial crisis.

Findings – Evidence from previous crises indicates that health-related impacts during economic downturns can occur through various channels. The impact in households experiencing reductions in employment and income could be manifest in terms of poorer nutritional outcomes and lower levels of utilization of health care when needed. Households may become impoverished, reduce needed health services, and experience reductions in consumption as a result of health shocks occurring during a time when their economic vulnerability has increased. Women, children, the poor, and informal sector workers are likely to be most at risk of experiencing negative health-related consequences in a crisis. Real government spending per capita on health care could decline due to reduced revenues, currency devaluations, and potential reductions in external aid flows. Low-income countries with weak fiscal positions are likely to be the most vulnerable.

Implications for policy – Past crises can inform policy-making aimed at protecting health outcomes and reducing financial risk from health shocks. Evidence from previous crises indicates that broad-brush strategies that maintained overall levels of government health spending tended not to be successful, failing to protect access to quality health services especially for the poor. It is particularly vital to ensure access to essential health commodities, which in many low-income countries are imported, in the face of weakening exchange rates. Focused efforts to sustain the supply of lower-level basic services, combined with targeted demand-side approaches like conditional cash transfers may be more effective than broader sectoral approaches. Low-income countries may need specific short-term measures to ensure that health outcomes do not suffer.

This chapter examines self-assessed health (SAH) data of 29 European countries using Eurostat data for the years 2009 and 2018. It first computes the indices recently introduced by Seth and Yalonetzky (2020) and provides confidence intervals for these indices. The ranking of these countries for the year 2018 is then summarized by Hasse diagrams. The chapter then examines first- and second-order stochastic dominance, based again on the recent work of Seth and Yalonetzky. Here also bootstrap confidence intervals were computed. The ranking of the countries in 2018 is then translated again into Hasse diagrams. It appears that Hungary and Latvia are respectively the poorest and least poor countries, both in 2009 and 2018, in terms of their SAH condition. While countries like Ireland, Luxembourg, Romania and Portugal are in the poorer segment of the distribution of countries, Norway, the United Kingdom, Denmark, the Netherlands and Austria are located on the less poor portion. As expected, the Hasse diagrams show also that there are quite a few instances where some countries cannot be ranked.

Reducing inequity in health between the poor and the rich is one of the challenges of the Iranian health sector. Access to health services in Iran is lower in the lowest-income quarter, and the rich use health services more. The purpose of this study is to provide a comprehensive framework for enabling financial access by the poor to health services in Iran.

Policy options were validated and approved by experts and specialists in two stages using the Delphi technique. The sample was consisted of 22 well-known experts on the subject who were selected based on purposive sampling. To evaluate the reliability of the questionnaire, a pilot study was conducted with five participants. Dimensional validity of the policy model, which was agreed upon by more than 75% of the participants was acceptable.

The main aspects of the model were divided into five categories: identifying the poor, policymaking to prevent the aggravation of health poverty, providing targeted funding, highlighting the importance of coherent regulation and ensuring financial accessibility to health services for the poor. This model could align the activities of all stakeholders in the form of a network and considers its prerequisites.

Prevention of dire financial consequences in the case of referral to follow up the treatment alongside exemption and financial protection policies through the networking activities of organizations involved in this field is a crucial step in securing financial support for the poor. Although the researchers included a wide range of policymakers in the Delphi study to gather all perspectives about options for financially support the poor, there may be some potential neglected policy advices.

Reducing health inequalities between the poor and the rich is one of the challenges that the Iranian healthcare sector is facing. One of the goals of the Iranian Government in the Healthcare Sector Evolution Plan (HSEP) is claimed to be creating an opportunity for the poor to use inexpensive services. The purpose of this paper is to provide an analysis of the status of the poor in the HSEP. Based on this evaluation, the authors will provide policy recommendations to improve the benefits of the HSEP for the poor people.

This paper is based on a qualitative study conducted in 2017. The research sample includes policymakers, experts and scholars at the macro-level of the Iranian healthcare system who were well-aware of the financial support for the poor. Overall, 35 semi-structured interviews were carried out. Data were analyzed based on the thematic analysis method.

The effects of the HSEP on the poor were studied in terms of their positive outcomes and challenges. Despite the achievements of the HSEP for all people, the most important challenge was the lack of targeted state subsidies for the poor. These subsidies should have included free insurance coverage, reducing inpatient payment and allocation of a separate budget for the poor.

Adopting some policies to target public health subsidies toward the poor such as free insurance specific for the poor (based on means testing), as well as user fee exemption and waivers could improve access to health services for them in Iran. In addition, separate funding for such policies, strengthening health prevention and health care services for marginalized populations, and improving their health literacy could help ensure the poor’s benefiting more from the health care services.

The purpose of this paper is to examine whether or not government health care spending reduces the poor‐rich differences in health status. Specifically, it aims to assess the health status of the poor vis‐à‐vis government health spending in Nigeria.

Regression analysis was carried out using the Ordinary Least Square method of estimation while secondary data was used.

It was found that despite the increase in most components of health care spending in Nigeria, the health status of the average Nigerian and the condition of health infrastructure has not improved appreciably. Also, the poor have significantly worse health status than the non‐poor and they (the poor) are more strongly affected by public spending on health care relative to the non‐poor. Thus, the difference in impact of spending between the poor and the non‐poor could be substantial.

This study provides information that will help reposition policies on government spending, especially on health care, so as to enhance and improve the heath status of the poor in Nigeria, thereby reducing the poor‐rich differences in health status.