Explaining social inequalities in health: Can maslow's hierarchy of needs help?

Background: Higher income is consistently associated with better health, yet whether material or psychosocial factors best explain the association remains unclear. Psychologist Abraham Maslow theorized greatest psychological well-being occurs by meeting needs in order: first, physiological (e.g. food, water) and safety needs, followed by social needs for love and belonging, and, finally, higher level needs for self-esteem and self-actualization. This exploratory analysis extends Maslow's theory hypothesizing material needs should best explain the income-health relationship at lower socioeconomic levels, whereas psychosocial needs should become more important as material needs are met. Methods: The sample included 12,314 working adults from the 2003 European Quality of Life Study (EQLS). Using weighted logistic regression, the association between household income and self-reported health was examined with and without material needs (e.g., unable to pay rent or buy food, lives in an unsafe neighborhood), social needs (e.g., has no one to turn to for advice or support, feels excluded from society), higher level needs (e.g., no control over work), and all needs together. All analyses were adjusted for age, gender, and country. Results: As predicted, material needs better explained the income-health relationship at the lowest income level. However, social and higher level needs followed similar patterns, counter to the hypothesis. Discussion: The application of Maslow's theory was only partially supported. Weak measures of the need constructs and wide country variation (GDP: $2,642-$64,532/capita) limited conclusions. Better-suited data are needed to determine whether Maslow's theory is useful for explaining the income-health association in the US.