Understanding how social policy impacts health: a realist synthesis

Recognition that health should be considered in all policies is growing, highlighting the need to understand how social policies impact health. Social assistance benefits interventions (SABPI) and debt policy interventions (DPI) are particularly relevant, as they directly shape people’s access to resources and exposure to burdens, triggering responses that generate health outcomes. This study synthesizes the literature on how this works using a realist approach. A systematic search across four databases identified 36 relevant studies that were coded to create context-mechanism-outcome configurations. In addition, 18 stakeholder consultations were conducted to compare and extend the findings. The analysis yielded three distinct program theories. These results show that interventions in social assistance benefits can negatively and positively impact health and well-being through various pathways (e.g. through meeting psychosocial needs, lock-in effects, and psycho-emotional impact). Outcomes depend on the adequacy of resources offered, additional burdens imposed, and the context in which they are implemented. In addition, they showed that debt policy interventions that offer timely and pro-active help can have a positive health impact because they reduce administrative burdens. These theory-based findings highlight how the design and delivery of social policies can shape health outcomes. Further refinement through empirical testing is recommended.