Welfare State Biographies: Interactions of health and wealth across different life stages

Not only the healthcare sector, but the whole of the welfare state is related to health outcomes in society. The Social Determinants of Health framework summarizes research confirming that socio-economic factors and health are interlinked (Marmot, 2005; CSDH, 2008). However, we still lack theorization and research on mechanisms through which social policies affect health and vice-versa, establishing a link between the macro-level of the welfare state and micro-level health outcomes. For this paper we have conducted biographic narrative interviews to create welfare state biographies of fifteen individuals in the Netherlands. The selected participants constitute a diverse group of people: male and female, young and old, living in rural and urban areas, from a minority and Dutch background. As such these biographies give a unique insight in the diverse ways health plays a role in people’s reliance on the welfare state across different life stages. We observe that there is no uniform causal trajectory which explains the interaction of socio-economic and health issues across different life stages. Instead, we find that the individual trajectories each are a unique chain of different mechanisms: ping-pong, snowball, quicksand, escalation and lever. These results challenge existing theories of health inequality and offer directions for future research and policy development.