A topology of health inequalities in Germany and Poland: Towards a spatial comparative approach

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Abstract

This article develops a spatial comparative approach to health inequalities in Germany and Poland. We ask how health practices, attitudes, and satisfaction with the healthcare system vary by social position (class), age, and gender in both countries. Using a mixed-methods design, the study first draws on data from the International Social Survey Programme (ISSP, Health and Health Care modules). With Multiple Correspondence Analysis, we reconstruct a multidimensional health space for Germany and Poland, identifying how social and cultural differences intersect with health. These quantitative insights are then linked to 24 qualitative interviews (12 per country), which serve to locate individuals within the constructed space and to analyze narratives relationally, allowing for a deeper understanding of dispositions and motives. We situate our analysis within a Bourdieusian framework of classed and gendered habitus (Bourdieu 1984, 2001), extended to include the notion of ‘national’ habitus, and draw on Boltanski’s (2025) concept of “medical competence” to highlight the socially structured capacity to perceive, interpret and articulate bodily sensations as medically legitimate symptoms.
The findings highlight that health is a multidimensional phenomenon. Germany and Poland occupy distinct positions in the health space with respondents shaped by different lifestyle patterns and dispositions toward psychological well-being, reflecting post-materialist versus materialist societies. While in Germany, social class primarily structures the general division of health in society (healthy – unhealthy), in Poland, however, the class division is two-dimensional, running along both the general health dimension and the lifestyle axis. The class-health divide appears more pronounced in Poland, with the potential to generate broader social tensions, including those linked to cosmopolitan liberalism versus nationalist populism or debates surrounding healthcare privatization.

Authors

• Stephanie Beyer, Leibniz University Hanover

• Tomasz Warczok, University of Warsaw