By using the Lifelines cohort study and biobank comprising 77 244 participants currently residing in the Northern Netherlands, we found that people with individual socioeconomic disadvantage were more likely to have worse health-related lifestyle behaviours even if they lived in neighbourhoods with little socioeconomic disadvantage. In fact, a “double jeopardy” effect was observed: the unhealthier lifestyle was found for people with higher individual socioeconomic disadvantage residing in more socioeconomically disadvantaged neighbourhoods.

Why is lifestyle behaviours important to health?

Lifestyle behaviours have a strong effect on individual health. Negative lifestyle behaviours (such as an unhealthy diet, smoking, insufficient physical activity and alcohol abuse) could result in chronic diseases (such as obesity and diabetes), and relate to lower life expectancy and higher mortality. Modifiying negative lifestyle behaviours at the individual level can be used to treat a range of diseases, this is the so-called “lifestyle medicine”. Besides, neighbourhood environment is of equal importance as “lifestyle medicine” since it also has a substantial impact on people’s health and well-being.

How is socio-economic disadvantage related to lifestyle behaviors?

Socioeconomic disadvantage normally exists at two different ecological levels: individual and neighborhood. Individual socioeconomic disadvantages are often influenced by one’s education and income, while the neighbourhood serves as a platform for health resources and the spread of certain health beliefs and social norms. Studies have shown that individual socioeconomic disadvantages are associated with a poor diet, smoking, more sedentary time and less physical activity. At the same time, neighbourhood socioeconomic disadvantages, as a contextual factor, have also been related to negative lifestyle behaviors.

Our study, recently published in the International Journal of Epidemiology, innovatively investigated the joint effect and inter-relation of individual and neighborhood socioeconomic disadvantages on a broader range of health-related lifestyle behaviors (i.e., diet quality, smoking, alcohol consumption, hours of sleep, hours of watching TV and physical activity). These health-related lifestyle behaviours were summed together to create a lifestyle risk index and a higher index represented a more unhealthy lifestyle.

What does “double jeopardy” law in lifestyle mean in this study?

“Double jeopardy” is an empirical law that has been observed across a multitude of product services, showing that brands with lower market shares suffer both from low purchase orders and low brand loyalty. Simply put this in our study, people with the most unhealthy lifestyle suffered both from the highest individual and neighborhood socioeconomic disadvantages. Although both individual and neighborhood socioeconomic disadvantages were associated with practicing an unhealthier lifestyle, the impact of individual socioeconomic disadvantage on practicing an unhealthier lifestyle was stronger among more disadvantaged neighborhoods. This means that people who are less socioeconomically disadvantaged will be more resilient and resistant to their neighborhood disadvantage as they have more individual health resources, higher level of self-perceived control and knowledge for avoiding unhealthy lifestyle behaviours.

What is the lesson for policy makers?

Bringing it all together, the double jeopardy law in lifestyle provides a practical guide to policy makers and public health practitioners. It basically tells us that practicing an unhealthy lifestyle depends both on individual and neighborhood socio-economic disadvantages. This calls for integral public policies that not only focus on and engage individuals but also their surroundings. Moreover, future public health initiatives should consider providing more health resources and social opportunities for more socioeconomically disadvantaged neighborhoods while target individual lifestyle to address lifestyle-related socioeconomic health differences. Only then we can work towards achieving a healthy lifestyle for all and mitigate the persistent health inequality within the society.

Read the article here: https://academic.oup.com/ije/advance-article/doi/10.1093/ije/dyab079/6248208?guestAccessKey=75b50047-d53c-46ac-a6f9-cba54b1aac92

Author
Yinjie Zhu is a PhD candidate in the Department of Internal Medicine (Division of Nephrology) at the University Medical Centre Groningen, the Netherlands. She is interested in how socioeconomic status affects lifestyle, nutritional status and health outcomes in a general population. She holds a Master’s degree in nutrition and rural development (from Ghent University).