ABSTRACT
Decades of research have shown that poor health is primarily determined by the so-called wider determinants of health, such as damp housing, poor education, lack of employment, reduced social support, limited access to green space and inadequate financial resources (1). Uncontrolled debt can be the instigation, outcome or mechanism for these conditions. It may be the initial event that forces an individual into poor housing or making compromises on education, access to green space or social connections. Alternatively, job insecurity or unemployment may lead to uncontrolled debt. More likely, it is a dynamic interaction between a precarious financial position and social circumstances that limits the options to an individual or household and, over time, leads to poor housing, reduced access to green space, low disposable income for fresh food and limited educational opportunities. Beyond the lack of material resources, debt reinforces power hierarchies across society. These power hierarchies have been posited as a reason why poor health outcomes persist even when risk factors, such as smoking and obesity, are reduced (2).
