From Straight Lines to Twists and Turns: Finding Patterns Between Socio-Economics and Unequal Health Outcomes in the Life Course.

Despite welfare state expansion in liberal democracies during the 20th century, health inequalities between socio-economic groups persist. Understanding individuals' lived experiences can inform policy for reducing unequal health outcomes in these lives. We build on Fundamental Cause Theory (FCT), which posits that low socio-economic status is the fundamental cause of health problems in (later) life. We argue that this theory is incomplete in developing policy interventions to tackle unequal health outcomes, because it assumes the relationship between socio-economic status and health to be linear and unidirectional. Based on our findings from biographic interviews of 15 disadvantaged individuals in the Netherlands, we propose a refinement of FCT by taking into account the complex life trajectories of individuals experiencing unequal health outcomes. Specifically, we argue that these individuals' trajectories can be broken down into at least five distinct patterns (ping-pong, snowball, escalator, quicksand and lever) between socio-economic and health issues. These patterns provide a theoretical addition to the existing FCT on the dynamics of life trajectories, the intensity with which problems develop and the importance of external factors. This helps not only to understand the emergence of health problems, but also to imagine more suitable policy responses.