Paper short abstract:

The paper connects social class, social mobility and access to health insurance in Kenya. Both middle-class status and health coverage can be short-lived due to high social mobility and income gaps. The descending middle class falls back on out-of-pocket payments and solidarity networks.

Paper long abstract:

This paper develops the connection of social class, social mobility and access to health insurance. The paper presents three cases documented in Kisumu, Kenya, where I conducted ethnographic research on class mobility: One lady in a relatively stable middle-class position argues that her private health coverage indicates her social status. The second lady has always been lower class but maintains close networks with medical doctors and therefore feels well covered. The third lady recently slipped from the middle into the lower class (or floating class) and lost her statutory health coverage due to her social descent. She relies on little pockets of resources and social networks until she can register again for the statutory health insurance. The cases show that health coverage options differ with class, but high social mobility among the Kenyan middle class results in gaps in coverage. Both middle-class status and health insurance coverage can be short-lived due to high social mobility and income gaps. Social descent can lead to pauses in the health coverage, and the descending middle class falls back on out-of-pocket payments and solidarity-based options.

Despite class differences, the three ladies attend the same church and expect mutual help and solidarity in times of hardship from the congregation. The congregation is a mental and material resource the communal orientation of brethren is far from ceasing with class mobility. The three ladies listed the church and their kinship network as their paramount resource; insurances form complementary sources of support to abovementioned paramount ones.