Self-Rated Health Among Low-Income Households in South Korea: Does Material Hardship Matter?

Introduction

With rise in income inequality and social polarization in South Korea (hereafter Korea), academic and public concerns on poverty and related health inequality are rapidly growing. Although abundant research suggests the association between lower socio-economic status and negative self-rated health, research on this topic is scarce in Korea. With overcoming limitations of income measure (e.g., unable to consider diverse aspects reflecting the quality of life), the material hardship is able to capture critical financial struggles that low-income people face on a daily basis. In addition, given the negative effect of unemployment on health outcomes, the unemployed may be more likely to report poor health status when experiencing material hardship. Thus, we examine the association between material hardship and self-rate health among low-income households in Korea, and further explore whether this association varies across employment status.

Methods

The data used in this study came from the recent two waves (2014 and 2015) of Korean Welfare Panel Study (KOWEPS), a nationally representative annual panel survey. The final sample included 2,794 low-income household heads. A binary variable for self-rated health (1=poor/very poor vs. 0=fair/good/very good) was created as a main dependent variable. To measure material hardship, we created a dichotomous indicator (1=those experiencing any material hardship vs. 0=those experiencing no material hardship) of whether or not a respondent experienced any of thirteen items that assess the diverse areas of material hardship in households (e.g., skipped meals, unable to pay utility bill, unable to pay rent, lost health insurance, and had problems with credit). We controlled for a set of variables for demographic and socioeconomic characteristics and health-related behaviors. To address the issue of omitted variable bias, three logistic regression models were specified: 1) a logistic regression with controls, 2) a lagged dependent model (the main model), and 3) a fixed-effects model. The moderating role of employment was examined by adding an interaction term of material hardship with employment status to the main model.

Results

We found that low-income households experiencing material hardship reported 57 percent greater odds of having poor self-rated health (odds ratio=1.57, p<.001) than those not experiencing material hardship. The significant association between material hardship and poor self-rated health still remained in the lagged dependent (odds ratio=1.42, p<.05) and fixed effects (odds ratio=1.31, p<.05) models, indicating that our main finding was robust after accounting for unobserved characteristics. We also found that the association between material hardship and poor self-rated health was more pronounced for low-income households experiencing two or more material hardships than those experiencing one material hardship. Finally, we found that the association between material hardship and poor self-rated health was more pronounced among unemployed households, consistently for both the non-elderly and the elderly households.

Implications

Our findings indicate that experiencing material hardship may be a risk factor for self-rated health in low-income households in Korea, and that the risk may increase when coinciding with unemployment. We discuss various future implications of the economic and health conditions with which this population struggles in the Korean context.