Special Report: The Biology of Inequalities in Health: The Lifepath Consortium

Abstract

Funded by the European Commission Horizon 2020 programme, the Lifepath research consortium aimed to investigate the effects of socioeconomic inequalities on the biology of healthy aging. The main research questions included the impact of inequalities on health, the role of behavioral and other risk factors, the underlying biological mechanisms, the efficacy of selected policies, and the general implications of our findings for theories and policies. The project adopted a life-course and comparative approach, considering lifetime effects from childhood and adulthood, and pooled data on up to 1.7 million participants of longitudinal cohort studies from Europe, USA, and Australia. These data showed that socioeconomic circumstances predicted mortality and functional decline as strongly as established risk factors currently targeted by global prevention programmes. Analyses also looked at socioeconomically patterned biological markers, allostatic load, and DNA methylation using richly phenotyped cohorts, unraveling their association with aging processes across the life-course. Lifepath studies suggest that socioeconomic circumstances are embedded in our biology from the outset-i.e., disadvantage influences biological systems from molecules to organs. Our findings have important implications for policy, suggesting that (a) intervening on unfavorable socioeconomic conditions is complementary and as important as targeting well-known risk factors, such as tobacco Vineis et al. The Biology of Inequalities in Health: The Lifepath Consortium and alcohol consumption, low fruit and vegetable intake, obesity and a sedentary lifestyle, and that (b) effects of preventive interventions in early life integrate interventions in adulthood. The report has an executive summary that refers to the different sections of the main paper.

Life Trajectories, Biomedical Evidence, and Lessons for Policies

“…Life expectancy has always and steadily increased after WWII, with the notable exception of Russia and neighbor countries after the collapse of the USSR. Case and Deaton's paper has attracted much attention and has led to similar analyses by the Lifepath consortium in Europe (described below) (3,4), showing that in this continent there has been no decline in life expectancy after the recession, and in fact life expectancy has continued to rise, including in Eastern European countries. Average life expectancy in the WHO European Region increased from 76.7 years in 2010 to 77.8 years in 2015, though this trend obscures huge within-country differences (of course these estimates need to be revised after the dramatic COVID-19 epidemic).…”

“…It is clear that one size does not fit all. For example, CCTs were effective in Central and South America in reducing the health effect of social disadvantage, but less so in New York (4). There is no systematic comparison across the different alternative policies, and randomized controlled trials are very few.…”

Reducing Health Inequalities in Aging Through Policy Frameworks and Interventions

“…Many existing policies and interventions will help reduce inequalities in aging although they may not have been designed initially to do this. As an example, Table 1 shows some of the existing relevant policies and interventions in the UK (27). Other countries across Europe will have similar measures.…”

“…Existing and proposed universal and targeted health and social care policies or interventions for four age groups which reduce health inequalities (Early Years 0-4, Childhood 5-18, working age 19-66, and 67 years+) in the UK(27).…”

Role of Damage-Associated Molecular Patterns in Light of Modern Environmental Research: A Tautological Approach

“…It includes both external and internal factors, as well as the human body’s response to these factors (Rappaport and Smith 2010 ; Wild 2012 ). Hence, under the exposome paradigm, all non-genetic factors contributing to disease are considered to be “environmental” including chemicals, drugs, infectious agents such as viruses, and psychosocial stress [for reviews and competent articles on the exposome, see Rappaport and Smith ( 2010 ), Wild ( 2012 , 2005 ), Rappaport ( 2011 ), National Research Council (NRC) ( 2011 ), Miller and Jones ( 2014 ), Smith et al ( 2015 ), Siroux et al ( 2016 ), Johnson et al ( 2017 ), Patel ( 2017 ), Rattray et al ( 2018 ), US ( 2019 ), Escher et al ( 2017 ), Vineis et al ( 2020 ), Vermeulen et al ( 2020 ) and Santos et al ( 2020 )].…”