Friction Elasticity and Systematic Exclusion: How Progressive Policies Risk Reproducing Structural Exclusion

Despite substantial investment in progressive health policies, health inequalities persist and in some cases widen (Lorenc et al. 2013). Why do well-intentioned interventions, from smoking cessation programmes to environmental health policies, so often fail to narrow health gaps? We propose that policy makers design interventions they can navigate with ease, generating navigation burdens they do not experience and cannot readily perceive. These burdens function as non-monetary costs that vary systematically by structural position. We introduce the concept of friction elasticity (the rate at which utilisation falls as friction increases) and show this varies dramatically between those with economic buffers, temporal flexibility, and institutional navigation capacity and those without. When individual health interventions and environmental health policies operate simultaneously, they compound. Essential workers face barriers to accessing health services and barriers to working in the urban spaces where these services concentrate. The result is rational exit from both systems, producing the persistent inequalities that puzzle policy makers. We argue that policy evaluation, even with equity considerations, fails to account for differential friction costs. This systematically favours interventions accessible to those in secure professional positions while rendering populations with high friction elasticity invisible. This has implications for how we measure policy effectiveness and understand why evidence based interventions often widen the inequalities they aim to reduce.