This study proposes ideological climates as a novel contextual factor that can impact status-based health inequalities.

Based on the minority stress hypothesis, we expect health gaps to be smaller in economically progressive places within Switzerland.

Against expectations, low status individuals in economically progressive places report markedly lower health and life satisfaction.

We interpret these results in terms of collective inefficacy and system frustration, which we argue is the corollary of system justification.

Low socioeconomic status (measured both objectively and subjectively) is systematically associated with worse health. Amid renewed interest in contextual influences on health inequalities, we ask whether variation in the prevailing ideological climate moderates the size of the health gap between low and high status individuals. Based on the minority stress hypothesis, we expect that living in an economically progressive place within Switzerland – places where more residents endorse the need for change to the economic status quo – will reduce the magnitude of the health gap. Multilevel modelling of MOSAiCH 2015–2020 data shows the opposite: low status individuals in progressive places report markedly lower subjective health and life satisfaction than similarly low status individuals in conservative places, such that status-based health inequalities are maximised in progressive places. We interpret this apparent progressive place paradox in terms of collective inefficacy and system frustration, which we argue is the corollary of system justification.

Health inequalities

Subjective social status

Objective social status

Minority stress

Contextual effects

Ideological climates

© 2024 The Authors. Published by Elsevier Ltd.