Population Health

Research Area

Social and Economic Determinants in Health and Life Expectancy

Keywords: Ageing, Mortality and Longevity; Health Care, Public Health, Medicine, and Epidemiology

European societies are changing rapidly. Changes in the proportion of the very old, the emergence of new family forms, changes in living arrangements, and changes across cohorts’ experiences of labor markets and socioeconomic environments over the life course are diversifying the experience of different life stages at an accelerating pace. While these themes emerge elsewhere in the Laboratory for Population Health’s projects, this research area specifically focuses on how these profound social changes have become fundamental determinants of the risk of disease, healthy life expectancy, and mortality.

The effects of socioeconomic and familial circumstances on ill health and mortality are a challenge for public health. Reducing these differences will improve the mental and physical health of the nation and reduce inequity. Most of the studies documenting and explaining these differences focus on middle-aged or working populations. With increasing longevity, the burden of these differences has shifted to older ages. Thus, the level of and trends in these inequalities are also driven by the development of ill health and mortality at these ages. The urgency of understanding these differences is further amplified by the evidence of increasing health disparities by socioeconomic position and living arrangements. Conventional wisdom about the causes of health differences in middle age is not directly applicable to either older or younger people.

Conceptual models of social differences in mortality have been based on competing hypotheses of selection and causation. In the past 15 years, the explicit incorporation of the ideas of “life course” and “life pathways” has made an important contribution to the field. The life-course approach posits that poor health and premature death are not only determined by current circumstances, but are also preceded by the long-term accumulation of health-degrading factors, chains of events that lead to health-damaging situations, or critical exposures in early life that have harmful effects many decades later. Accordingly, inequalities in mortality are due to social status influencing the differential accumulation of health insults among individuals of different social strata. Life-course theory and a longitudinal framework will guide all analyses in this Research Area.

Our research currently focuses on three main areas that will have major repercussions for the future. First, we assess longitudinally the effects of social factors on mental and cognitive health, with a specific interest in the contribution of changing socioeconomic and familial characteristics. Second, we quantify and explain levels and trends in social differences in physical health, mortality, and life expectancy at different stages of life. Third, we   evaluate the significance of behaviors, particularly alcohol and smoking, on social differences in health and mortality over time.

The long-term aim is to gain a deeper understanding of the causes of these trends and differences by elucidating the structural, psychosocial, and behavioral pathways through which social circumstances affect the risk of disease, healthy life expectancy, and mortality. This goal can be best achieved by applying focused study designs and analytical approaches, such as the G-formula, which combine and contrast the societal and individual characteristics that may have an impact on the study outcomes.

Projects of this Research Area:

  • Social and Economic Determinants of Hospital Use, Morbidity, and Mortality over the Life Course Project details
  • Social and Economic Determinants of Mental and Cognitive Health Project details
  • The Role of Health Behaviors in Social Differentials in Mortality Project details