A Bourdieusian approach to class‐related inequalities: the role of capitals and capital structure in the utilisation of healthcare services in later life

Abstract

This paper draws on Bourdieu's theory of economic, social and cultural capital to understand the relative effect of the volume and the composition of these capitals on healthcare service use in later life. Based on data from the fifth wave of the Survey of Health, Aging, and Retirement in Europe (n = 64,840), we first look at the contribution of each capital in the use of three healthcare services (general practitioner, dentist and hospital). Using cluster analysis, we then mobilise Bourdieu's concept of habitus to explain how the unequal distribution of material and non‐material capitals acquired in childhood lead to different levels of health and hospital care utilisation in later life. After controlling for demographic and health insurance variables, our results show that economic capital has the strongest individual association among the three capitals. However, the results of a cluster analysis used to distinguish between capital structures show that those with high non‐material capital and low material capital have higher levels of primary healthcare utilisation, and in turn lower levels of hospital use. Bourdieu's approach sheds light on the importance of capitals in all forms and structures to understand the class‐related mechanisms that contribute to different levels of healthcare use.

Individual Capital Structure and Health Behaviors among Chinese Middle-Aged and Older Adults: A Cross-Sectional Analysis Using Bourdieu’s Theory of Capitals

“…According to Bourdieu’s viewpoint [ 25 ], cultural capital includes three dimensions. “Institutionalized cultural capital” is measured by respondents’ current education [ 22 , 24 ], i.e., illiterate/uneducated = 0, primary school = 5, junior high school = 8, senior high/technical school = 11, 3-year college = 14, 4-year university = 15, masters = 18, doctor = 21. “Embodied cultural capital” is measured by the mother’s education, the father’s education and the number of books read in the past year.…”

“…“Embodied cultural capital” is measured by the mother’s education, the father’s education and the number of books read in the past year. According to prior studies, embodied capital means a state embodied by behaviors and dispositions learned over the life course [ 22 ], and it refers to a kind of cultural ethos that is cultivated over a long period of time. From this point of view, parents’ education can be a macro family environment for people to develop this cultural ethos from childhood, and the reading habit can be an active way to develop this cultural ethos over the life course.…”

“…In short, Bourdieu’s capital theory has been widely used to theoretically or empirically analyze health-related issues [ 18 , 38 , 41 , 42 ]. However, to the best of our knowledge, only a few studies have simultaneously analyzed the impacts of three forms of capital upon health status/health behaviors in European countries [ 22 , 23 , 24 ]. Relevant research in Chinese contexts is still limited.…”

“…Based on Bourdieu’s theory of capitals, the present paper tries to analyze the determinants of health behaviors among Chinese middle-aged and elderly people. In general, Bourdieu’s theoretical orientation places health behaviors within the family and social environment, with the particular emphasis that the components of individual capital structure, consisting of economic, cultural and social capital, could simultaneously impose complex effects on health behaviors [ 18 , 22 , 23 , 24 ]. In other words, different forms of capital possessed by individuals constitute the action resources that can be mobilized when there is a desire to improve one’s health.…”

Socioeconomic and behavioural factors associated with access to and use of patient Electronic Health Records: a cross-sectional analysis of four European countries.

“…Conversely, individuals from lower socioeconomic background express a feeling of cultural illegitimacy about using digital devices and generally feel that "the use of ICT oversteps their social position" (24:9 ). Although some of Bourdieu's concepts such as "choice of necessity" and "cultural illegitimacy" has been evidenced in the utilisation of healthcare services and digital self-tracking apps (24,25) they have not been studied in the field of use and access to EHR. Thus, while the digital divide approach is useful to understand which groups are disadvantaged in the use of new digital technologies and why, it is important to identify specific behavioural processes that lead to individuals' acceptance and intention to adopt the EHR.…”