The Inverse Care Law and Aporophobia: Exploring the Human and Institutional Roots of Health Inequalities

INTRODUCTION
This research explores social injustice in healthcare by examining the intersection of the inverse care law and aporophobia. The inverse care law, formulated by Julian Tudor Hart, describes how access to quality care is often poorest where it is most needed, a pattern still reinforced today by profit-driven systems. Aporophobia, introduced by Adela Cortina, refers to aversion or contempt toward the poor and continues to shape societal attitudes. Together, these concepts show how individual biases and institutional structures sustain healthcare inequalities. This study investigates the mechanisms linking aporophobia to institutional inequities, shedding light on how they perpetuate disparities over time.

OBJECTIVES
The overarching aim of this project is to understand the relationship between individual dispositions toward poverty and institutional healthcare inequalities. Specifically, it seeks to examine the extent to which aporophobia at the individual level correlates with the inverse care law at the institutional level, and vice versa. It also aims to identify the factors that contribute to or mitigate these relationships, while analysing how supply-side and demand-side dynamics of aporophobia intertwine to perpetuate the inverse care law.
The study is guided by two central hypotheses. First, the inverse care law is exacerbated not only by institutional policies but also by individual attitudes, encompassing both supply-side and demand-side factors. Second, aporophobia, as a universal human disposition, plays a pivotal role in sustaining healthcare inequalities.

METHODOLOGY
This study will adopt a mixed-methods research design, combining both quantitative and qualitative approaches to capture the complexity of healthcare inequalities. Data will be collected through surveys with approximately 400 participants, complemented by semi-structured interviews to provide qualitative depth. The sample will consist of individuals recruited from homeless institutions, such as the ASSIS Reception Centre.
The analysis will integrate quantitative statistical techniques applied to the survey data with thematic analysis of interview transcripts in order to identify recurring patterns of aporophobia within healthcare contexts. Ethical approval will be obtained prior to the commencement of the study, with careful attention given to informed consent, confidentiality, and the protection of vulnerable participants throughout the research process.

EXPECTED RESULTS
This project is expected to deliver both concrete research outputs and meaningful societal outcomes. It will produce a comprehensive analytical framework that links aporophobia with the inverse care law, supported by a new dataset providing both quantitative and qualitative evidence of aporophobia in healthcare. Building on this evidence, the project will generate policy briefs with actionable recommendations aimed at reducing healthcare inequalities, as well as academic publications and conference presentations to ensure broad dissemination of the findings within the scholarly community.
Beyond these research outputs, the project anticipates several important outcomes. It will deepen understanding of how individual and institutional factors interact to sustain healthcare inequalities, and raising awareness among policymakers, healthcare professionals, and the public about the role of aporophobia in perpetuating inequity. The evidence and recommendations provided will support the adoption of targeted strategies to mitigate aporophobia in healthcare practice and policy. Ultimately, the project aims to contribute to long-term progress toward more equitable healthcare systems and, by extension, the advancement of social justice.

WORK TEAM
• Roberto Cantoni (Ramón y Cajal Researcher - Associate Professor): Member of Sustainability, Economics and Ethics (SEE) research group. Specialises in energy justice, with a strong track record of publications and teaching on ethical and humanitarian issues.
• Juan Albacete Maza (Post-doctoral researcher): Member of SEE. Experienced researcher on aporophobia, with ongoing publications in the field.
The team combines conceptual expertise, empirical research skills, and established collaborations to ensure the project’s success.

JUSTIFICATION OF THE BUDGET
The total requested budget of €16,767.30 covers essential project needs and ensures cost-effectiveness:
• Teaching buyout (6 credits): To secure dedicated time for the principal investigator’s involvement in project coordination and analysis.
• Surveying expenses (approx. 400 participants): To cover recruitment, incentives, and data collection costs, enabling robust and representative findings.
• Publication fees: To guarantee open-access dissemination in high-impact journals, ensuring visibility and accessibility of results for both academic and policy audiences (e.g. Humanities and Social Sciences Communications).
• Conference participation fees: To support attendance at leading international conferences for dissemination of findings and to foster future collaborations within a wider research community (e.g. International Society for the Quality-of-Life Studies).
Each expense is directly tied to core project activities, ensuring efficient use of resources and maximising the impact of the research.