Does Money Only Matter in Low-to-Middle Income Countries? Public Health Policymakers’ Assessments of Material Social Determinants in Different Development Contexts

There has historically been a paradox in public health policymaking. In international development, there has been a working assumption that improving the quantity, security and predictability of people’s material resources leads to overall improvements in health, education, employment and other outcomes. However, in domestic policy within high-income societies, opinion has been divided on causality. This has appeared contradictory: if poverty harms health and if development mechanisms in low-to-middle income countries include transfers of resources, why would the same considerations not apply in high-income societies and why would improving people’s resources via policies such as Basic Income not improve their health? In this article, we explore this apparent distinction through semi-structured interviews with 14 UK-based public health policymakers. We find that the distinction is not clear, with UK-focused policymakers viewing the UK as a ‘poor country with rich people in it’, subject to similar considerations as low-to-middle income countries.