Centre for Economic Demography

Lund University School of Economics and Management

Pathways to Health and Wellbeing: significant results since 2006

Our research concerning social contexts and geographic areas/neighbourhoods and their effects on health and social inequalities in health is internationally acknowledged. This research includes a number of aspects covering all stages of the disease process including common contextual effects (e.g. therapeutic traditions) on prescriptions (Ohlsson 2009). In one study (Chaix, Rosvall, Lynch & Merlo 2007), a multilevel longitudinal approach was applied in order to investigate the association between on the one hand neighbourhood socioeconomic deprivation and residential instability and on the other individual risk of ischemic heart disease (IHD) and survival after acute myocardial infarction (AMI). Dissimilar contextual effects at various stages of the disease process (i.e. on the incidence of and the survival after AMI) were found. In another study (Chaix, Lindström, Rosvall & Merlo 2008), the association between the social interactions of a neighbourhood and the risk of acute myocardial infarction was investigated. Beyond commonly evoked effects of the physical environment, neighbourhood social interaction patterns may have an independent influence on IHD. However, the stronger influence on survival after AMI supports the role of material factors as mediators of the effects of neighbourhood social characteristics. In a recent study (Yang, Eldridge & Merlo 2009), multilevel survival analyses were used to investigate the role of different socioeconomic contexts on individual life expectancy. We found that much variability in individual life expectancy occurred at the household and individual levels rather than at the administrative geographical levels normally studied in public health, which gives a new perspective for public health policies.

The research concerning social contexts and socioeconomic conditions and how they affect population health also involved social capital, i.e. a characteristic of social relations and trust between individuals, groups, organisations and institutions. In the international debate, the social capital literature in public health has been criticized by so-called neo-materialists for neglecting active material conditions/material deprivation, welfare politics and public health policy (see Lindström 2011). Studies including material factors as opposed to social capital contextual determinants have been conducted in longitudinal studies (e.g. Giordano and Lindström, 2010a, 2011a, b; Lindström et al. 2006a,b). We have analysed family/household as a context for the generation of social capital and health by including family/household as a second level between individuals (first level) and geographic areas (third level) in three-level analyses based on the unique British Household Panel Survey (BHPS), which is sampled on family/household rather than individuals (Giordano, Ohlsson & Lindström 2011). This multilevel design will also be applied to other outcomes such as mental health and smoking. The association between social capital and health may reflect confounding by factors such as personality or early childhood environment, which are not usually measured and almost never taken into account in previous studies.

Our research also concerns the impact of early life factors on health. Investigations by Rosvall et al. on questionnaire data from Region Skåne reveal an association between exposure to some early-life factors (smoking during pregnancy, passive smoking and high birth weight) and overweight/obesity at age 4 (Mangrio, Wremp, Moghaddassi, Merlo, Bramhagen & Rosvall 2009). In another study, boys, children of parents with low education, and children born abroad were found to be overrepresented among children who were prescribed antibiotics during their first year (Mangrio, Lindström & Rosvall 2010). The findings are of interest since some studies have suggested an inverse association between use of antibiotics during the first year of life and development of atherosclerosis later in life. An association between early exposure to passive smoking and development of allergy was also found among children with heredity for allergy in the same data material (Hansen, Mangrio, Lindström & Rosvall 2011). In a study using multiple indicators of socioeconomic position (SEP) over the life-course on the whole population of Scania, the importance of three different conceptual models (critical period, social mobility, and cumulative life-course models) was tested in the same setting (Rosvall et al. 2006). The results showed a strong relation between SEP and cardiovascular and all-cause mortality, irrespective of the conceptual model used. That is, one model could not be pointed out as the “best” model to describe the links between life-course SEP and mortality risk.

Studies of the influence of early-life conditions on adult height have also been conducted on a data material of 9,000 brothers who migrated to Sweden at different ages during their childhood. These studies revealed certain critical ages of migration as well as associations with the education level of the mother (Van den Berg, Lundberg, Nystedt & Rooth 2009).

A study of effects of conditions in early-life on mortality using the Swedish Longitudinal Immigrant Database (SLI) revealed that current SEP in Sweden was more strongly associated with mortality than the two early-life indicators infant mortality rate (IMR) and GDP per capita in the year of birth in the country of birth (Klinthäll & Lindström 2011). Another study using the SLI shows strong effects of IMR in the birth country on income in Sweden, in particular for children of low educated parents (Helgertz 2010), suggesting that indirect effects of early-life conditions on mortality dominates. This work overlaps with Research Area 4 and a number of new studies using migration as an instrument to analyse education, height, and well-being is under way.

So far only limited work on various types of intergenerational transfers on health has been performed (see Research Areas Family, Fertility and Gender, and Immigrant Integration for studies on intergenerational transfer of economic outcomes). However, in a historical study using SEDD, associations between longevity of parents and children are investigated taking other factors into account. It revealed a significant but rather weak inheritance effect after controlling for social and economic factors (Bengtsson & Broström 2008; see also Bengtsson & Mineau 2009).



Bengtsson T, Broström G. (2009) "Do Conditions in Early Life Affect Old Age Mortlaity Directly and Indirectly? Evidence from 19th Century Rural Sweden." In Bengtsson T, Mineau G.P. (eds.) Early Life Effects on Socio-Economic Performance and Mortality in Later Life. A full Life-Course Approach Using Contemporary and Historical Sources. Part Special Issue of Social Science & Medicine, 68(9), 1583-1590.

Bengtsson T, Mineau G.P. (2009) "Early-life effects on socio-economic performance and mortality in later life: a full Life Course Approach using Contemporary and Historical Sources". 68(9), 1561-1564.

Chaix B, Lindström M, Rosvall M, Merlo J. (2008) "Neighbourhood social interactions and risk of acute myrocardial infarction." Journal of Epidemiology and Community Health, 62(1), 62-68.

Chaix B, Rosvall M, Merlo J. (2007) "Neighborhood socioeconomic deprivation and residential instability: effects on incidence of ischemic heart disease and survival after myocardial infarction." Epidemiology, 18(1), 104-111.

Giordano GN, Lindström M. (2011a) "The impact of social capital on changes in smoking behaviour - a longitudinal cohort study." European Journal of Public Health, 21(3). 347-354.

Giordano GN, Lindström M. (2011b) "Social Capital and change in psychological health over time- a panel study." Social Science & Medicicne 72(8), 1219-1227.

Giordano GN, Lindström M. (2010) "The impact of changes of different aspects of social capital and material conditions on self-rated health over time: A longitudinal cohort study." Social Science & Medicine, 70(5), 700-710.

Giordano GN, Ohlsson H, Lindström M. (2011) "Social capital and health - Purely a question of context?" Health and Place, 17(4), 946-953.

Hansen K, Mangrio E, Lindström M, Rosvall M. (2011) "Early exposure to second hand tobacco smoke and the development of allergic diseases in 4 year old children in Malmö, Sweden" BMC Pediatrics, 10, 61.

Helgertz J. (2010) "Immigrant Careers- Why Country of Origin Matters" Lund studies in Economic History, 53.

Klinthäll M, Lindström M. (2011) "Migration and Health: A study of effects of early life experiences and current socioeconomic situation on mortality of immigrants in Sweden." Ethnicity and Health, (Epup ahead of print)

Lindström M. (2011) "Marital status and generalized trust in other people: Apopulation based study." The Social Science Journal, Accepted.

Lindström M. (2011) "Social Capital, Trust, Desire to Increase Physical Activity and Leisure Time Physical Activity: A Population-Based Study." Public Health, 125, 442-47.

Lindström M, Axén E, Lindström C, Beckman A, Moghaddassi M, Merlo J. (2006a) "Social capital and neo-materialist contextual determinants of lack of access to regular doctor: A multilevel analysis in southern Sweden." Health Policy, 79, 153-164.

Lindström M, Lindström C, Moghaddassi M, Merlo J. (2006b)" Social capital and neo-materialist contextual determinanats of of sense ocf insecurity in the neighbourhood: A multilevel analysis in southern Sweden." Health and Place, 12, 479-489.

Mangrio E, Lindström M, Rosvall M. (2010)" Early life factors and beeing overweight at 4 years of age among children in Malmö, Sweden" BMC Public Health, 10(1), 764.

Mangrio E, Wremp A, Moghaddassi M, Merlot J, Bramhagen A-C, Rosvall M. (2009) "Antibiotic use among at the age of 8 months in Malmö, Sweden" BMC Pediatrics, 8(9), 31.

Rosvall M, Chaix B, Lynch J, Lindström M, Merlo J. (2006) "Contribution of main causes of death to social inequalities in mortality in the whole population of Scania, Sweden." BMC Public Health, 6, 79.

Van den Berg G, Lundborg P, Nystedt P, Rooth DO. (2009) "Critical Periods During Childhood and Adolescence: A study of Adult Height Among Immigrant Siblings", European Association for Labour Economics conference in Tallin, Estonia.

Yang M, Eldridge S, Merlo J. (2009) "Multilevel survival analysis of health inequalities in life expectancy." International Journal for Equity in Health, 23(8), 31.