Exploring the links between Cash Benefits Policies and Social Inequalities in Mental Health

This thesis examines the impact of policies which provide cash support for unemployed and workless persons on social inequalities in mental health. It contributes to a body of literature which has tended to assume that more generous cash benefits will reduce health gaps between advantaged and less advantaged groups. It notes that while there is some empirical support for this proposition, the evidence remains inconclusive. The thesis addresses this research problem by examining how cash benefits influence health inequalities. It defines three cash benefits 'design features' - generosity, activation and conditionality - and explores empirical connections with health inequalities through specific 'causal pathways'.

Chapter Four focuses on one causal pathway - the influence of cash benefits via social stress. Operationalising cash benefits policies in terms of 'welfare regimes', it explores evidence from the Survey of Health, Ageing and Retirement in Europe for a relationship between welfare regimes and inequalities in depressive symptoms. It finds evidence that the Scandinavian regime has the least inequalities in depressive symptoms, suggesting that cash benefits generosity remains an important buffer for stress among disadvantaged groups.

Chapter Five uses two more precise measures of cash benefits policies: passive and active labour market spending. Combining expenditure data from the OECD with individual-level data from the European Social Survey it uses regression and mediation analyses to explore a range of causal pathways from these policies to health inequalities. It finds some evidence that active labour market policies reduce inequalities in depressive symptoms by improving employment outcomes, while generous cash benefits may improve mental health during unemployment.

Chapter Six develops the approach yet further, by looking at conditionality requirements attached to receipt of benefits as well as generosity and activation. Focusing on sanctions and work requirements linked with receipt of Temporary Assistance for Needy Families policies in the United States, it looks at how variations across states in conditionality practices matter for health inequalities. There are indications that stringent conditionality may increase inequalities in mental health, although it is unclear why this is.