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Are health inequities rooted in the past?

Research project Public health policies try to achieve two overall goals: a good overall health in the population, but also an equal distribution of health. When it comes to overall health, cardiovascular disease (CVD), the persisting leading cause of death in Sweden, has decreased during last decades. However, this promising development has not been matched by a similar improvement when it comes to reducing the socioeconomic inequalities. Consequently, the challenge is to identify which circumstances create both poor health and health inequalities, as well as to identify common risks factors that would be the most relevant targets for society to address.

Life expectancy has increased in Sweden during the last decades, owing first and foremost to reductions in cardiovascular disease (CVD) morbidity and mortality -the persisting leading cause of death in Sweden, as well as in most regions around the world-. However, this promising development has not been matched by corresponding improvements in health equity in Sweden –health inequalities deemed unfair and avoidable, such as between socioeconomic groups. There is therefore a need to create a knowledge basis for public health encompassing both improved overall population health and an equitable distribution of health. In approaching this topic from a life course perspective, this project aims to examine the life-course determinants of not only cardiovascular health, but also of socioeconomic inequity in cardiovascular health. The project will take advantage of the longitudinal data in the Västerbotten Intervention Programme (VIP) linked to the SIMSAM Lab, and will examine individual and contextual social determinants from childhood to adulthood, of both cardiovascular health and socioeconomic inequity in health in middle-age. The applicant will employ advanced statistical methods including multilevel modelling and decomposition analysis to address the aims. The results of this FIIP are expected to be beneficial for the public health research, by its focus on the understudied topic of determinants of health inequities, of life course determinants of health, and a novel integration of these approaches. Due to the project’s inclusive focus on determinants of health and of health equity, the results is expected to be valuable for the so far unsuccessful public health goal of achieving a good population health as well as an equitable distribution of health.

Project overview

Project period

2015-02-01 2017-01-30

Funding

Finansår , 2014, 2015, 2016

huvudman: Paola Mosquera Méndez, finansiar: COFAS Marie Curie Fellowship, y2014: 2725, y2015: , y2016: ,

huvudman: Paola Mosquera Méndez, finansiar: FORTE, y2014: , y2015: 995, y2016: 995,

Research subject

Public health and community medicine

Project description

Objective of the project:

The general purpose of this project is to generate and apply an integrated life course approach to social determinants of cardiovascular health and socioeconomic inequities in health. More specifically, the aim is to examine determinants from the earlier life course for cardiovascular health and socioeconomic inequities in cardiovascular health in a Northern Swedish population.

Research questions and methods:

To carry out the objective, three research questions will be addressed:

1) Do individual and contextual conditions of people’s past life course contribute to socioeconomic inequities in cardiovascular health in middle-age, independently from current conditions? Do past conditions contribute to health inequities through accumulation, sensitive period or social chain of risk life course models? Does the importance of determinants for health inequities differ between women and men?


2) Is cardiovascular health in middle-age influenced by individual and contextual conditions from the previous life course? Do one’s past areas of residence contribute to health differentials independently of personal living conditions? Do past conditions contribute to health through accumulation or sensitive period life course models? Does the impact of health determinants differ between women and men?


3) Are the life-course determinants of health and of socioeconomic inequities in health, similar or different? Which determinants are important for both health and health inequity and which thus may be particularly important target for intervention? Are the common determinants similar or different for women and men?


The first question will be approached by decomposing health inequities in 2008-2010 among middle-aged population (age 40 and 50 years), by socioeconomic and material conditions at approximate ages 30, 20, 15 and 10 years of age, also taking current conditions into account.

The second question will be approached by analysing CVRF in middle-aged population (age 40 and 50 years), by socioeconomic and material conditions at age 30, 20, 15 and 10 years of age, including one’s area of residence municipality, parish and neighbourhood, by life course models and multilevel regression models.

The third question will be addressed by a synthesis of the findings yielded from analyzing aim 1 and 2. These will serve as the basis for a framework on comprehensive social determinants of health approach, with a simultaneous focus on population health and health inequities from a life course perspective. The focus will be on the public health policy implications of the knowledge gained from this approach, and setting an agenda for future research.