Private Wealth – A Neglected Social Determinant of Health

Background

Wealth is very unequally distributed, which might be a threat to health equity. Very little is known about wealth inequality in health in Germany. We examined the association between wealth and self-rated health (SRH) and if this association remains after adjustment for other socioeconomic determinants.

Methods

Using the latest data of the German Socio-Economic Panel (wave 2019), we estimated age-adjusted prevalences (aP) of poor SRH via logistic regression models for four categories of private net wealth (debts, no wealth, wealth below the highest quintile, wealth in the highest quintile). We calculated adjusted prevalence ratios (aPR) of poor SRH by wealth category by using Poisson regression and adjusting first for age, gender and region of residence and then additionally for income, education, employment status, and migration history.

Results

Of 25,962 included individuals aged ≥18 years (13,573 women), 21% had debts or no wealth. Individuals with debts (aP 28%, 95% CI 24–32%) and with no wealth (aP 30%, 95% CI 27–32%) had considerably higher rates of poor SRH than those with some wealth (aP 18%, 95% CI 17–19%), or high wealth (aP 12%, 95% CI 11–13%). Compared with individuals with high wealth, those with debts (aPR 2.36, 95% CI 1.93–2.89), no wealth (aPR 2.39, 95% CI 2.05–2.79), and some wealth (aPR 1.46, 95% CI 1.28–1.66) had elevated risks of poor SRH. The PRs were attenuated after adjustment for further socioeconomic variables but remained elevated for those with debts (aPR 1.86, 95% CI 1.49–2.32), no wealth (aPR 1.63, 95% CI 1.38–1.93) and some wealth (aPR 1.29, 95%CI 1.12–1.47).

Discussion

This first analysis of wealth inequality in SRH in Germany reveals a clear social gradient, with poorer health among individuals with less wealth. Wealth shows a strong association with health that goes beyond the impact of other socioeconomic determinants and should receive greater attention in future social epidemiological research and policy interventions.

Key messages

• This first analysis of wealth-related inequalities in health in Germany show that private wealth is associated with general health independent of and beyond other social determinants.

• Wealth inequalities should receive more attention in social epidemiological research and can inform future policy interventions to reduce health inequities.