Nominally, the Imperium is bound by ancient, binding, laws laid down by the God-Emperor Himself to provide for the health and wellbeing of all its citizens. The reality of delivering this across the Imperium means many worlds are dependent on additional trade and local production to supplement the meagre and infrequent supplies provided to them by the Tithe Fleets of the Administratum in exchange for a mandated percentile of a planet’s natural output (be that resources, products or, in some cases, people). All but the wealthiest and self-sustaining worlds are constantly teetering on the brink of famine and supply exhaustion. This is not to say that the Imperium is malicious in its failure at its duties towards its citizens, but inefficiency, ineptitude and corruption across the Imperium often mean that supplies do not go where they are needed, or arrive in suitable quantities. It is entirely plausible that due to tragically comical ineptitude a planet with a starving population might well suddenly receive vast quantities of medical supplies rather than the food it needs because of an incorrectly processed form. Providing for a territory as vast as the galaxy, and a population as humongous as humanity’s, is simply just a logical impossibility no matter how honest the Imperium’s efforts to do so are.
This welfare, when it does arrive, is the lifeblood of most lowborn Imperials; after all, they are largely unpaid and receive payment in the form of ‘scrip’ or credit which they can exchange for basic necessities from welfare offices. For this reason, very few lowborn see anything other than the products of Imperial welfare, most of which is surplus military clothing and ration packs. This very much contributes to the ‘fashion’ demonstrated by most Lowborn citizens reflecting military stylings, often personalised in creative fashions with local dyes,stolen fabric and paint on worlds where there are no locally produced textiles. It takes a lucky Lowborn – elevated into the service of a Highborn or one of the Adeptus Terra, or granted a small business or military pension – to escape dependence on the Imperial state, and even then Lowborn in better situations often still need its support.
Healthcare is provided by the Imperial State, though it varies from world to world in the quality and quantity provided. Where a civilized world might well have a large Hospital Imperialis, most frontier planets are dependent on a single Administratum-posted Medicae operating out of a small understaffed clinic in the planet’s sole starport. State-provided medical care is supplemented by privately run establishments as well as those provided by the State Church of the Adeptus Ministorum, which are often staffed by the stern and talented Hospitaliers of the Adepta Sororitas. Most citizens, if they could afford to, would choose to opt for the latter options over state medical care but unless they can afford the fees, or the considerable donations to the Faith, they are usually forced to use overtaxed, run-down state facilities.
Despite all the difficulties, the Imperium does its best to keep its citizens alive, more so than any natural resource it possesses. Humans, though abundant, are also its most valuable resource with its constant need for workers and soldiers.