Poverty gets into your skin: Lifepath issue 12

The increase of socioeconomic differences may provoke biological changes that in turn translate into health inequalities. A recent study published on Aging by a group of scientists of the Lifepath project revealed that low education might have an impact on health at older age comparable to that of well-known risk factors such as obesity and alcohol abuse. According to the researchers, this effect is mediated by epigenetics modifications associated to biological aging.Poorer people are more likely to experience worse health throughout the course of their life, especially in older age. The risk of poor health is associated with a step-by-step decrease in socio-economic position, creating what has come to be known as a social gradient in health [Figure 1]. Lifepath is a European project that studied the biological processes underlying this association, in order to understand how socioeconomic conditions can “get under the skin”, as Paolo Vineis (Imperial College, London) synthesized during the final meeting of the project he coordinates, held in Geneva (CH).
Early age is a veritable game changer, and it is crucial to intervene to support poorer families and children to make them more resilient to adverse circumstances during life and to ensure a healthy ageing. “Studies from Lifepath show that children and adolescents from low socio-economic backgrounds were more likely to be overweight, having a higher Body Mass Index from as young as the age of three, then affecting health in adulthood. Biological markers in children, such as epigenetic age acceleration, were affected by the social position of the family as well, while living in disadvantaged neighbourhood negatively impacts on several cardiometabolic risk factors.
One of Lifepath’s goals was also to assess the impact of the 2008 recession in Europe. Lifepath researchers completed a study of health inequalities in 27 European countries that included the period of the 2008 banking crisis. “Most European countries have experienced many decades of mortality decline and the evidence suggests this was not derailed by the recession”, comments Johan Mackenbach (Erasmus Medical Centre, Rotterdam). “This study likely reflects a level of resilience in most European countries built up through the provision of financially accessible health care and social support systems. However, mortality from smoking-related causes increased for younger less educated women and mortality from alcohol-related causes went up among less educated men and women”
Studies from Lifepath can be very useful to understand the real causes and biological mechanisms of growing health inequalities affecting our societies, but can also give useful suggestions to policy makers about timing of interventions in order to break the intergenerational transmission of health injustice”, says Michael Marmot (UCL, London). “Undoubtedly, the effects of education and social support in early life is as crucial as interventions on life style factors and on social conditions in adulthood”.

Più di due anni di vita persi a causa delle scarse condizioni socioeconomiche

Milano/Bruxelles. Vivere in condizioni sociali ed economiche povere, per esempio avendo un basso profilo professionale, può privare una persona di 2,1 anni di vita, in media. Questa è la conclusione di uno studio appena pubblicato sulla rivista The Lancet da LIFEPATH, un progetto finanziato dalla Commissione Europea con lo scopo di individuare i meccanismi biologici che stanno alla base delle differenze sociali nella salute. Uno status socioeconomico basso può essere letale quanto fumare, avere il diabete o condurre una vita sedentaria. Il tabacco è associato alla perdita di 4,8 anni di vita, che diventano 3,9 per il diabete, 2,4 per l’inattività fisica e meno di uno per l’elevato consumo di alcol.Quello condotto da LIFEPATH è il primo studio che confronta l’aspettativa di vita fra persone appartenenti a diverse categorie socioeconomiche e correla queste differenze con quelle dovute a sei ben noti fattori di rischio per la salute, come il fumo o il diabete. Fattori considerati fra gli obiettivi principali della strategia di riduzione della mortalità globale dell’Organizzazione Mondiale della Sanità. Che però non include lo status socioeconomico.“Ci siamo sorpresi quando abbiamo scoperto che vivere in condizioni sociali ed economiche povere può costare caro quanto altri potenti fattori di rischio come il fumo, l’obesità e l’ipertensione” afferma Silvia Stringhini, ricercatrice all’University Hospital di Losanna, in Svizzera, e coordinatrice dello studio. “Queste circostanze possono essere modificate con interventi politici e sociali mirati, per questo dovrebbero essere incluse fra i fattori di rischio su cui si concentrano le strategie globali di salute pubblica”.
I ricercatori del progetto LIFEPATH hanno raccolto e analizzato dati da 48 coorti indipendenti di Gran Bretagna, Italia, Portogallo, Stati Uniti, Australia, Svizzera e Francia, per un totale di più di 1,7 milioni di partecipanti. Lo status socioeconomico di queste persone è stato valutato sulla base dell’ultimo impiego lavorativo al momento dell’ingresso nello studio e i partecipanti sono stati seguiti per una media di tredici anni. I dati ottenuti da questa lunga fase di osservazione sono stati analizzati con appositi metodi statistici e confrontati con quelli relativi ad alcuni dei principali fattori di rischio inclusi nel piano strategico globale dell’OMS chiamato “25×25”.“È noto che educazione, reddito e lavoro possono influire sulla salute, ma pochi studi avevano cercato di valutare quale fosse il peso effettivo di questi fattori. Per questo abbiamo deciso di confrontare l’impatto dello status socioeconomico sulla salute mettendolo a confronto con quello di sei fra i principali fattori di rischio” dice Mika Kivimaki, professore all’University College London e co-autore dello studio.Un basso livello socioeconomico può quindi essere un efficace indicatore di un calo nell’aspettativa di vita. Ciò nonostante, i decisori politici spesso non lo considerano fra i fattori da prendere di mira con interventi specifici. Le condizioni socioeconomiche e le loro conseguenze sono modificabili tramite politiche a livello locale, nazionale e internazionale. Intervenire su fattori “a monte”, come il lavoro o l’educazione infantile, può avere una maggiore efficacia, in termini di miglioramento della salute, rispetto a interventi “a valle”, focalizzati su singoli fattori di rischio come l’assistenza per chi vuol smettere di fumare o i consigli alimentari. Che sono importanti, questo sì, ma tendono anche a favorire le fasce sociali più alte, che possono accedervi più facilmente e che hanno meno difficoltà nel correggere eventuali abitudini poco salutari.“Lo status socioeconomico è importante perché include l’esposizione a diverse circostanze e comportamenti potenzialmente dannosi, che non si limitano ai classici fattori di rischio come fumo o obesità, sui quali si concentrano le politiche sanitarie” conclude Paolo Vineis, professore all’Imperial College London e coordinatore di LIFEPATH. “L’obiettivo principale del nostro progetto è quello di capire attraverso quali processi biologici le disuguaglianze sociali si traducono in disuguaglianze per la salute. Così facendo potremo fornire accurate prove scientifiche a istituzioni sanitare e decisori politici, che a loro volta potranno migliorare l’efficacia delle loro strategie di intervento sulla salute pubblica”.

Scientists find that poor socioeconomic circumstances are associated with the loss of more than two years of life

Having poor socioeconomic conditions — such as a lower occupational position — can take away 2.1 years of life on average from a person. This is the conclusion of a study published in The Lancet by LIFEPATH, a project funded by the European Commission, which investigates the biological pathways underlying social differences in healthy ageing.Low socioeconomic conditions are almost as deadly as smoking, having diabetes, or being physically inactive. Smoking is associated with the loss of 4.8 years of life; diabetes, 3.9; and physical inactivity, 2.4. High alcohol intake can take away one year of life.This is the first study ever to compare life expectancy among people of different socioeconomic status, and cross-correlate it with six other major known risk factors like smoking and diabetes. These other six factors are already included in World Health Organization global mortality reduction strategy. Socioeconomic status is not.“We were surprised to find that poor social and economic circumstances seem to kill people at the same rate as powerful risk factors such as smoking, obesity, and hypertension. Because these circumstances are modifiable, they should be included in the list of risk factors targeted by global health strategies,” argues Silvia Stringhini, lead author of the study. She is a researcher at Lausanne University Hospital in Switzerland.
LIFEPATH researchers gathered and analysed data from 48 independent cohort studies from the United Kingdom, Italy, United States, Australia, Portugal, Switzerland and France. The lives were examined of over 1.7 million adults in total. Socioeconomic status was measured by their last known occupational title, and participants were followed for an average of 13 years. Statistics obtained were then compared to those of six risk factors included in the WHO “25×25 plan” for global health.“Education, income, and work are known to affect health, but few studies have examined how important these socioeconomic factors actually are. This is the reason why we decided to compare the importance of socioeconomic factors as determinants of health with six major risk factors targeted in global health strategies for the reduction of premature mortality,” says Mika Kivimaki, a professor at University College London, who is one of the two senior authors of the study.Low socioeconomic status is one of the strongest predictors of premature mortality worldwide, but health policymakers often do not consider it a risk factor to target. Socioeconomic circumstances and their consequences are modifiable by policies at the local, national, and international levels. Changing “upstream factors” such as earned income tax credits, occupation, or early childhood education, is more likely to have an impact, compared to changing “downstream” interventions like smoking cessation assistance or dietary advice. This is because focusing on downstream factors favours privileged persons, who can more easily change their habits.“Socioeconomic status is important because it is a summary measure of lifetime exposures to hazardous circumstances and behaviours that goes beyond the risk factors for noncommunicable diseases that policies usually address,” says Paolo Vineis, professor at Imperial College London and head of LIFEPATH. “The main aim of our consortium is to understand the biological pathways through which social inequalities lead to health inequalities in order to provide evidence for public health institutions and policymakers.”

Lifepath annual meeting in Paris

Paris. A two-day event will take place at the Faculté de Médecine Paris Descartes in Paris, on May 17-18, in order to assess and present what has been accomplished during Lifepath’s first year of research, and to discuss the future perspectives of the project.
Lifepath is an EU-funded project aimed to face one of the major challenges for modern societies: the dramatic inequalities in wellbeing and health conditions, and their underlying social and economic differences. Healthy ageing begins at conception, if not before, and it involves a progressive differentiation across social groups. A series of biological changes underpin the effect of complex environmental, behavioural and social patterns on health, and can be traced with modern research technologies. By investigating the biological consequences of socio-economic inequalities, Lifepath aims to lay ground for the development of future health policies and strategies.
“The project is highly innovative since it links together social sciences, biology and medicine”, says Paolo Vineis, coordinator of the project. “We are currently exploring not only the impact of low socio-economic status on ageing and mortality, but also on intermediate molecular events such as functional changes in DNA and metabolism”. The speakers will go further into several aspects of the complex relationship between socio-economic factors and their health consequences. One of the most striking is the effect that educational disparities may have on life and health expectancy. A recently published analysis in the British Medical Journal led by Lifepath research leader Johan Makenbach on the latest trends in mortality rates across Europe reveals that, while some progress has been made in reducing health inequalities since the 1990s, large health disparities by education are still apparent. For instance, in France over the period 2005-2009, mortality rates were twice as high among men with low levels of education compared to highly educated men, with similar differences observed in other European countries.
A series of key experiments will also be presented, like the conditional cash transfer (CCT) program carried out by New York City’s Center for Economic Opportunity, from 2007 to 2010.
The study aimed to determine if CCTs could help families break the cycle of poverty. It used a randomized controlled trial design and involved approximately 4,800 families and 11,000 children, half of whom could receive cash rewards if they met the required conditions, and half who were assigned to a control group that could not receive the rewards. The program tied cash rewards to pre-specified activities and outcomes in children’s education, families’ preventive health care, and parents’ employment. Early results indicated that CCT were effective in reducing poverty and hardship. Lifepath will further investigate the biological impact in those benefitting from the program through, for instance, the measurement of panels of inflammatory markers, reflecting the overall health of participants.
All these results and discussions will revolve around a key question that lies at the very heart of the project: how will we translate all the information we gathered into effective policies that may tackle the issue of socio-economic inequalities?
On May 17 at noon, a special event will be devoted to journalists, where they will have the chance to get further information by asking their questions directly to Lifepath experts, both in person or through video-connection.