Exploring Preferences and Acceptbaility of Policies to Reduce Socioeconomic Inequalities in Health Across Various Social Groups - A Cross-Sectional Study in the Netherlands

Abstract

This study explores acceptability and preference for policy approaches addressing socioeconomic inequalities in health in the Netherlands. Sixteen relevant policies were classified as structural, agento-structural, agentic, and process policy (public involvement). A cross-sectional study was conducted in May 2023 among Dutch-speaking individuals aged 18 and above, living in the Netherlands. A non-probability (snowball and convenience) sampling method was used to distribute the survey via various social media channels and existing contacts. Acceptability was measured on a seven-point Likert scale. To assess the preference of policies, respondents were required to pick three policies they considered most important in reducing socioeconomic inequalities in health. Educational level, measured by the highest degree, was used to assess respondents´ socioeconomic status (SES), categorised in two groups. Covariates included were age, gender, employment status, being a welfare recipient, working in the social or health domain and perceived responsibility. 87% of the participants (N=331) had high and 13% low or middle education backgrounds. In general, agento-structural policies received high acceptability and preference scores. The quality of social housing and public involvement received high scores of acceptability, respectively preference. Education did not show any differencesin the acceptability of either of the policy types. Differences were observed in the preference: individuals with low/ middle educational levels scored higher on structural policies while individuals with high educational levels scored higher on agento-structural policies. Yet, the regression analysis did not show educational level as a significant predictor of acceptability and preference. Age, gender, and perceived responsibility were positively related with all four policy types, serving as covariates. Non-welfare recipients showed higher acceptability towards agentic policies and lower preference towards structural policies. Dutch policymakers should prioritize agento- structural policies and particularly focus on improving the quality of social housing. A participatory approach involving various stakeholders is recommended to reduce socioeconomic health disparities.