Perceived poverty and health, and their roles in the poverty-health vicious cycle: a qualitative study of major stakeholders in the healthcare setting in Hong Kong

Abstract

Background: Poverty and ill-health are closely interrelated. Existing studies on the poverty-health vicious cycle focus mainly on less developed countries, where the identified mechanisms linking between poverty and ill-health may not fit the situations in developed Asian regions. This study aims to qualitatively explore the perceived mechanisms and drivers of the poverty-health vicious cycle among major stakeholders in the healthcare setting in Hong Kong. Methods: Data were collected via focus group interviews with social workers (n = 8), chronically ill patients (n = 8), older adults (n = 6), primary care doctors (n = 7) and informal caregivers (n = 10). The transcribed data were then closely read to capture key themes using thematic analyses informed by social constructivism. Results: In this highly developed Asian setting with income inequality among the greatest in the world, the povertyhealth vicious cycle operates. Material and social constraints, as a result of unequal power and opportunities, appear to play a pivotal role in creating uneven distribution of social determinants of health. The subsequent healthcare access also varies across the social ladder under the dual-track healthcare system in Hong Kong. As health deteriorates, financial hardship is often resulted in the absence of sufficient and coordinated healthcare, welfare and labour policy interventions. In addition to the mechanisms, policy drivers of the cycle were also discussed based on the respondents' perceived understanding of the nature of poverty and its operationalization in public policies, as well as of the digressive conceptions of disease among different stakeholders. Conclusions: The poverty-health vicious cycle has remained a great challenge in Hong Kong despite its economic prosperity. To break the cycle, potential policy directions include the adoption of proportionate universalism, social integration and the strengthening of medical-social collaboration.

COVID-19 related health inequality exists even in a city where disease incidence is relatively low: a telephone survey in Hong Kong

“…In addition to the direct disease burden, the COVID-19 outbreak and its associated containment measures such as economic lockdown, mandatory social distancing and change of work arrangements may also have unequal wider socioeconomic impacts on the general population, 2 especially in regions with pervasive existing social inequalities. Given the limited resources and capacity of the socioeconomically disadvantaged to respond to emergency and adverse events, 11 it is argued that their general health and well-being are likely to be disproportionately affected by the abrupt changes in their daily economic and social conditions (eg, job insecurity and anxiety) brought about by the COVID-19 outbreak. As such, focusing only on COVID-19 incidence or mortality as the outcomes of concern to address health inequalities may leave out important aspects of life that contributes significantly to people's health.…”

Differential Impacts of Multimorbidity on COVID-19 Severity across the Socioeconomic Ladder in Hong Kong: A Syndemic Perspective

“…As mentioned above, primary care in Hong Kong is primarily provided by the private sector, resulting in pro-rich inequalities in outpatient visits [16]. Patients of a lower socioeconomic position rely heavily on the almost free but limited public outpatient services with a long waiting time, whereas those of a higher socioeconomic position can afford fast-track access and regular sources of private primary care in addition to public services [18][19][20][21]. As reported by a previous local study, patients who receive primary care primarily from private general practitioners reported better primary care experiences compared with those receiving care primarily from public clinics, which was attributable to the higher accessibility (among those who can afford it) and better person-focused care in the private sector [18].…”

“…While the vast majority of inpatient services are provided by the public sector, which is tax-funded with low additional out-of-pocket fees at the point of care, primary care is largely provided by the private sector with over 70% market share [16]. The out-of-pocket payment for private primary care services casts a heavy burden on the socioeconomically disadvantaged, especially since they are more likely to suffer from multimorbidity [17], less likely to have private medical insurance or employer-provided medical benefits, and hence have lower access to timely and integrated primary care [18][19][20][21]. Taken together, they also tend to experience difficulty in managing their chronic diseases during the COVID-19 period [22].…”

Socioeconomic Patterns of COVID-19 Clusters in Low-Incidence City, Hong Kong

“…Our results shed light on the pervasive social inequalities deeply entrenched in society. The socioeconomically disadvantaged have limited resources and opportunities to overcome structural constraints of the social environment (14) and are the ones hardest hit in emergencies or adverse events. The wealthier groups are at risk for infection through entertainment activities, given the propensity for widespread Socioeconomic Patterns of COVID-19 Clusters dispersion and difficulty in COVID-19 containment in these settings (15).…”