Wealth does not always predict health14 years, 10 months ago
Posted on Jul 28, 2005, 9 a.m.
By Bill Freeman
Children from wealthier, better-educated families are not necessarily healthier than their poorer contemporaries, according to a European study. It finds that health inequalities may be based on cultural factors as well as income levels. The findings predict worrying health trends for millions of people living in nations with newly burgeoning economies.
Children from wealthier, better-educated families are not necessarily healthier than their poorer contemporaries, according to a European study.
It finds that health inequalities may be based on cultural factors as well as income levels. The findings predict worrying health trends for millions of people living in nations with newly burgeoning economies.
The more-educated and richest people around the world are generally also the healthiest, but researchers looking at children in three very different European countries found the opposite may be true for societies emerging from poverty.
Epidemiologists looked at health data for more than 3000 children across Denmark, Estonia and Portugal, between 1997 and 2000. The children, aged 9 to 15, underwent a physical assessment including blood tests, and their parents' education levels and incomes were recorded. The researchers looked at levels of insulin resistance in the children, high levels of which are a precursor of coronary heart disease.
Danish children from poorer families and with low parental education had greater insulin resistance than those from wealthier, better educated families in Denmark – as they had expected.
However, they were surprised to discover that in Estonia and Portugal –Europe's two poorest nations – it was the children of better-off families with better-educated parents that had the highest levels of insulin resistance.
Estonia and Portugal are both relatively poor nations that are rapidly moving from rural to market economies, explains lead researcher Debbie Lawlor from the department of social medicine at the University of Bristol, UK. “They're at the stage Britain was at around the turn of the 20 th century, and we're seeing a repeat of the same health patterns. The wealthiest people were the first to embrace new technologies such as car ownership and to afford to eat out more.” As a result, these people were the first to suffer the health effects of an increasingly sedentary lifestyle and poor diet, she says.
However, as countries become wealthier still, the trend is for the better-off to eat a healthier diet, while the poorer increasingly follow the lifestyles left behind by the rich. Thus, in Denmark, it is the poorest families that eat the most junk food, while richer families can afford to choose healthier foods.
“Even though the Estonian and Portuguese group was well educated, it seems the fashion – the cultural norm – to eat Western junk food and to drive instead of walk overrode their better knowledge.” Lawlor suggests. It is worrying that the same thing is happening in countries like India and China, she adds. “Health officials know the risks involved, and yet they seem unable to stop the growing problem of obesity as their societies become richer.”
But Denny Vågëro, professor of health equity studies at Stockholm University, Sweden, who wrote a commentary accompanying the research in the British Medical Journal , thinks other factors may involved.
“A recent study showed that ageing, higher educated Estonians have a much lower mortality from heart disease than their poorly educated counterparts,” he says. But since, in the present study, the better educated children are now showing much higher levels of insulin resistance, something radical must have happened in the 1990s to reverse this previously healthy pattern in the better-educated, Vågëro believes. Estonia's shift towards become a modern European nation may be to blame.
“Better-educated Estonians have also been shown to have a higher occurrence of low-birthweight babies, which could explain the health differences found in this new study,” Vågëro told New Scientist . He suggests that since low-birthweight infants born to richer people were more likely to survive – as their parents could afford the post-natal medical costs – while similar babies born to poorer families may not have survived.
But Vågëro notes that “some diseases are tied to educational levels – for example, breast cancer is more common in highly educated women, as is melanoma. However, as a disease becomes more common, it does tend to become more class-based”. He highlights that lung disease related to smoking used only to be a disease of the upper classes, whereas now it is more common among the lower classes.
Journal reference: British Medical Journal (vol 331, p183)
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