A lifecourse perspective on socio-economic inequalities in health: the influence of childhood socio-economic conditions and selection processes

In this article a lifecourse perspective on socio-economic inequalities in health is presented. In a lifecourse perspective, cumulation of adverse socio-economic circumstances and selection are important mechanisms, which successively may cause a downward spiral. A conceptual model is examined with empirical data. Three processes in the explanation of socio-economic health inequalities are emphasised: the contribution of childhood socio-economic conditions, the contribution of childhood health and the contribution of health selection, Data were used from the longitudinal Study of Socio-Economic Health Differences (LS-SEHD) in the Netherlands. It was found that the relation between adult socio-economic status and adult health is influenced by childhood socioeconomic conditions. An independent effect of childhood socioeconomic conditions on adult health was partly explained by unhealthy behaviour and personality characteristics and cultural factors. Also, childhood health was found to play a role in the explanation of socio-economic health differences in early adult life. Health selection in childhood seems the most important mechanism in this process. With respect to health selection in adult life no effect of health problems on downward social mobility was apparent. Our results indicate that the occurrence of a downward spiral is likely to be significant during the period of childhood and youth.