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BEDREHELSE-Bedre helse og livskvalitet

Tracing causes of inequalities in health and well-being: Analysis of rich longitudinal data

Alternative title: Sporing av årsaker til ulikheter i helse og velvære: Analyser basert på Tromsø-undersøkelsene

Awarded: NOK 10.7 mill.

The aim of this project is to expand existing knowledge on how childhood circumstances and later health related behavior and socioeconomic condition impact on adult health and wellbeing, as well as their ability to bounce back after a health shock. The Tromsø Study represents a unique data set to trace causes of inequalities in health. It includes a wide range of observed health information as well as self-reported valuations of health-related quality of life and wellbeing. Our analyses show a consistent positive health gradient along each of three socioeconomic indicators (education, occupation, income). Furthermore, we show that childhood living standard and parents’ morbidities are more important determinants of health than own education. Furthermore, we show that social inequalities to a large extent are associated with systematic differences in health behaviour. Based on survey data from Norway and Australia, we seek to explain variations in individuals’ subjective assessment of their social status depending on their education, occupation, income as well as their childhood socioeconomic conditions. While income is relatively more important in Australia, occupation and education are relatively more important in Norway. Fortunate childhood circumstances, such as high living standard and mother with tertiary education, increase subjective social status, even after adjusting for own education, occupation and income.

Two PhD-candidates have completed and defended their thesis, and one candidate has submitted her thesis. So far, nine articles are published in relevant international peer-reviewed journals. In addition to the main data from The Tromsø Study, some papers have applied data from Norwegian and Danish registries. Furthermore, small-scale online surveys have been carried out in Norway, Australia, Canada, UK, and US that have addressed specific topics related to: i) explaining subjective socioeconomic status, and; ii) the inclusion of psycho-social domains in health outcome measures. We show the existence of a social health gradient in Norway, along each of the three most widely applied indicators of socioeconomic position; education, occupation and income, for each of three measures of health and wellbeing. We show that the education health gradient is wider when health is measured by quality-adjusted life expectancy, than life expectancy alone. A consistent finding in several papers is that difficult childhood financial circumstances have lasting effects on adult health and wellbeing, as well as labour market participation, even after adjusting for relevant variables such as education, occupation and income. We combine educational attainment and household income into a composite measure of socioeconomic position. We find that childhood financial circumstances matter for subjective social status in adulthood, even after adjusting for education, occupation and income. We find that resilient individuals are more likely to return to work after experiencing a health shock, and that labour market participation after a health shock varies with the severity of the health shock and is consistently higher among individuals with tertiary education. We find that parental wealth and health explain more of observed health variations than education. We find that parental education have lasting effects on adult health behaviours, and that partner’s education is significantly associated with health and health behaviours. Preliminary analyses suggest that health inequalities are more strongly associated with individual variations in their level of healthy behaviours than their level of education.

How patients experience adverse health events, and how they can partake through own efforts to improve their health, is of central importance for healthcare planners worldwide. Based on panel data that include a broad range of diagnostic information together with quantitative measures of patient reported health related quality of life (HRQoL) and subjective well-being (SWB) expressed along internationally validated instruments, the Tromsø Study offers a unique opportunity to answer vital research questions. Objective and subjective measures of health including descriptions of sudden health events allow us to study how health shocks may lead to changes in key health determinants such as, individuals' health related behaviours and job market participation. By linking data on health and well-being with information on early life events, health related behaviour, socio-economic characteristics, and social support, we will explore how individuals' early life circumstances and life course impact on their ability to 'bounce back' and cope with adverse health events. There is evidence on the direction of associations between the key health determinants (socio-economic factors, life style, and social network), and current health and wellbeing, yet the strengths and relative importance of the associations require more knowledge. Our access to an existing extensive panel data set including both survey data and registry data, as well as information on childhood circumstances, provides a unique opportunity to investigate causal pathways. This project will generate new evidence to be published in high ranking international journals. This project will strengthen collaborative research across strong international research environments. It will also foster stronger ties to stakeholders (patients and social workers) through dissemination of results in workshops. Through these workshops we hope to generate new ideas for interventions targeting both young adults and the elderly.

Funding scheme:

BEDREHELSE-Bedre helse og livskvalitet