Intergenerational and life course determinants of socioeconomic health inequalities

Abstract

Despite many efforts, socioeconomic health inequalities in metabolic syndrome (MetS) and depression have proven to be persistent issues. To reduce these inequalities, we need to better understand the factors contributing to them. Therefore, in this thesis we assessed to what extent and by what modifiable pathways socioeconomic status (SES) influences health. We did so using data from the prospective multigenerational Dutch Lifelines Cohort Study. We found that the effects of parental SES on childhood MetS and depression were limited. In children, only parental health literacy explained the effects of parental SES on paediatric MetS; it accounted for 8.9% of the total effect. In adults, the effects of SES and both MetS and depression was stronger, and we found more modifiable factors: the combination of smoking, alcohol, diet, and health literacy explained about 20% of the inequalities in MetS. Similarly, the combination of quality of social contacts, health literacy, and smoking explained about 40% of the inequalities in major depressive disorder. In conclusion, we found several pathways which can be intervened on to reduce socioeconomic health inequalities in MetS and depression. Interventions could in particular regard improving the quality of social contacts, reduction of smoking, and strengthening health literacy. One avenue to achieve this through school-based interventions, which have the benefit of reaching most children regardless of their personal background, and of improving health and well-being throughout life. Intervening on these pathways could benefit both individuals and society.