Responsibility and Fairness in Health - How Causal Attributions Shape Inequality Aversion

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This paper investigates how responsibility framing shapes public aversion to socioeconomic health inequalities. Using a nationally representative experimental survey of 4,508 respondents, we elicit preferences across eight scenarios capturing disparities in preventive care, access to providers, waiting times, avoidable hospitalizations, and mortality. Respondents are randomly assigned to a control group receiving neutral descriptions or a treatment group exposed to fram- ing that emphasizes individual responsibility for health outcomes. Results show that respon- sibility framing significantly reduces inequality aversion across all domains, indicating greater acceptance of health disparities when presented as self-inflicted. The effect is heterogeneous: men are consistently less inequality-averse than women, and framing further widens this gender gap. Income is negatively associated with aversion but plays a smaller moderating role. Pre- existing responsibility beliefs do not significantly interact with framing, suggesting that framing operates as a general heuristic rather than reinforcing prior attitudes. These findings highlight the power of framing to shift distributive preferences and raise concerns about its potential to weaken public support for equity-oriented health policies.