The silent burden of stigmatisation: a qualitative study among Dutch people with a low socioeconomic position.

BACKGROUND: In-depth qualitative research into perceived socioeconomic position-related stigmatisation among people living at the lower end of our socioeconomic hierarchy is necessary for getting more insight in the possible downside of living in an increasingly meritocratic and individualistic society. METHODS: Seventeen interviews were conducted among a group of Dutch people with a low socioeconomic position to examine their experiences with stigmatisation, how they coped with it and what they perceived as consequences. RESULTS: Social reactions perceived by participants related to being inferior, being physically recognisable as a poor person, and being responsible for their own financial problems. Participants with less experience of living in poverty, a heterogeneous social network and greater sense of financial responsibility seemed to be more aware of stigmas than people with long-term experience of poverty, a homogeneous social network and less sense of financial responsibility. Perceived stigmatisation mainly had emotional consequences. To maintain a certain level of self-respect, participants tried to escape from reality, showed their strengths or confronted other people who expressed negative attitudes towards them. CONCLUSION: Despite the good intentions of policies to enhance self-reliance, responsibility and active citizenship, these policies and related societal beliefs might affect people at the lower end of our socioeconomic hierarchies by making them feel inferior, ashamed and blamed, especially when they cannot meet societal expectations or when they feel treated disrespectfully, unjustly or unequally by social workers or volunteers of charity organisations.

Perceived classism and its relation with socioeconomic status, health, health behaviours and perceived inferiority: the Dutch Longitudinal Internet Studies for the Social Sciences (LISS) panel.

OBJECTIVES: Classism might be the downside of the prevailing ideologies of individual responsibility for success. However, since studies into perceived classism have mainly been qualitative, little is known about its association with socioeconomic status, health, health behaviours and perceived inferiority, especially in more egalitarian countries. This study, therefore, examined the associations of perceived classism with socioeconomic status, health, health behaviours and perceived inferiority. METHODS: We used cross-sectional data (2012/2013) from the Dutch Longitudinal Internet Studies for the Social Sciences (LISS) (n = 1540; age 16-90; 46.9 % men). RESULTS: We found that classism was perceived by 18.2 % of the participants, with the lowest income and occupation group most likely to perceive classism (22.0 and 27.5 %, respectively). Perceived classism was significantly associated with poor health (e.g. self-rated health OR = 2.44, 95 % CI = 1.76-3.38) and feelings of inferiority (e.g. shame OR = 4.64, 95 % CI = 3.08-6.98). No significant associations were found with health behaviours. CONCLUSIONS: To further examine the role of perceived classism for socioeconomic differences in health and its association with country-level socioeconomic inequalities, prevailing ideologies, and objective opportunities for social mobility, we recommend more longitudinal and international studies with comparable measures of perceived classism.

Low socioeconomic status and perceptions of social inadequacy and shame: findings from the Dutch SMILE study.

BACKGROUND: Based on presumed negative social comparisons in lower socioeconomic status groups, we set out to examine whether notions of 'internalized inferiority' are more common in these groups. METHODS: Dutch Studie naar Medische Informatie en Leefwijzen in Eindhoven (SMILE) data on 1323 participants, aged 58-94 in 2008, were used to estimate odds ratios (ORs) of internalized inferiority by childhood and adulthood socioeconomic indicators. Questionnaires for social inadequacy and shame were used to measure internalized inferiority. RESULTS: Both adulthood low educational level [OR 1.58; 95% confidence interval (CI): 1.04-2.40] and low income level (OR 1.88; 95% CI: 1.23-2.88) had substantial associations with reports of social inadequacy. Recalled childhood poverty was strongly associated with reports of shame (OR 2.20; 95% CI: 1.39-3.48). CONCLUSIONS: The socioeconomic patterning of social inadequacy and shame suggests that notions of internalized inferiority in the individual, psychological makeup might be important in the generation and maintenance of socioeconomic inequalities in health.

Socio-economic inequalities in all-cause mortality in Europe: an exploration of the role of heightened social mobility.

The larger than expected socio-economic inequalities in health in more egalitarian countries might be explained by a heightened social mobility in these countries. Therefore, the aim of this explorative study was to examine the associations between country-level social mobility, income inequality and socio-economic differences in all-cause mortality, using country-level secondary data from 12 European countries. Both income equality and social mobility were found to be associated with larger socio-economic differences in mortality, particularly in women. These findings suggest that social mobility and income equality, beside their shiny side of improving population health, might have a shady side of increasing socio-economic health inequalities.

Income-related health inequalities: does perceived discrimination matter?

OBJECTIVES: Because of their meritocratic ideology, Western countries might promote the belief that every individual is responsible for his or her socioeconomic position. These beliefs might enhance discrimination which, in turn, might affect health. Therefore, the aim of the study was to investigate the role of perceived discrimination within income-related health inequalities. METHODS: Two-year follow-up data (2008-2010) from the Dutch Longitudinal Internet Studies for the Social sciences panel (N = 2,139) were used to examine the relation between income, perceived discrimination, and self-rated health and feeling hindered by health problems. RESULTS: Results showed that poor health was more prevalent in the low income and in the discriminated group. Participants from the low income group were also more likely to perceive discrimination (OR = 1.57, 95 % CI = 1.03-2.42). However, there was no substantial evidence for a mediating effect of perceived discrimination on the income-health association. CONCLUSIONS: The results emphasise the importance of a more in-depth study of discrimination in relation to socioeconomic health inequalities. Since ethnicity was a major confounder, it is recommended to take account of the complex interplay between discrimination and both the socioeconomic and ethnic background.