Being an immigrant, a teenage mother or a child born into poverty can dramatically impact your health throughout your entire life. The Netherlands is perceived internationally as an equitable country with a thriving middle class, and that is mostly true, but income inequality is growing, and more and more people are finding themselves in poverty even as the economy booms. It can take four generations for someone born into low socioeconomic status to reach average earning levels, and even if you manage that feat, poverty and hardship in your formative years, or even before you were born, can lead to health problems like cardiovascular issues and depression later in life.

Associate professor Viola Angelini’s research examines how life course factors like childhood hardship manifest themselves throughout our lives, even if we manage to be upwardly mobile. In the latest episode of podcast Econ 050, associate professor Viola Angelini discusses her research into how factors like childhood hardship can have an impact on the course of an entire life. You can hear the full episode online on Linsyn.com (note: the page does not exist any longer), or in your favourite podcast app such as Spotify or iTunes. Don't forget to subscribe!

What is generational poverty?

Viola Angelini: Well, generational poverty has to do with the transmission of inequality. So we call it generational poverty when a family lives in poverty for at least two generations. So, for example, if you're born from poor parents, you are also going to be poor in your life later on.

On the impact of nature versus nurture on health:

Traci White: To what extent is the poverty aspect being sort of transmitted? Is that nature or nurture? Not to say that some people are genetically disposed to be poor, but how much of it is just the conditions that they're born into or literally something that they inherit?
Angelini: That is a very long discussion among scientists. So “nature” is your genetics, your genetic makeup, and the environment is more “nurture”. I think it’s both, and actually nature and nurture also interact with each other. In some cases, even if you have a genetic predisposition, for example some people have a genetic predisposition to smoking or to obesity, but actually, higher education and higher income have a protective effect on that. So it is nature and nurture, but they also interact with each other.

What is Lifelines?

Angelini: Lifelines is very large scale cohort and bio-bank which collects the individuals in the three northern provinces of Groningen, Drenthe and Friesland. This is more than 167,000 individuals, which is very many people. We started out collecting data on individuals aged between 25 and 50, which were recruited through their GPs, so the GPs invited people aged between 25 and 50 to participate in Lifelines. And then these participants were asked to invite their family members, so parents and children, and it's very interesting because it's a three generation study and there are three generations in the data.

On whether or not living in a rural or urban environment is better for your health:

White: So since Lifelines is focused primarily in the northern provinces, obviously there are some big cities like Leeuwarden, Groningen and Emmen as well, but it's perceived as a more widely rural sort of area. So does it make a difference if you're in an urban environment or a more rural environment in terms of the impact that poverty can have on your health outcomes?
Angelini: It might make a difference, but the relationship is not clear. So first of all, it depends on whether we're talking about rural Groningen, or rural Alaska. There are benefits from a rural environment, for example there is less pollution, you might spend more time outdoors and have more space to do outdoor activities. But you might also be more isolated and lonely, especially for older people. You might have to take the car to commute, you might have less access to job opportunities and you might be farther away from health facilities. So the relationship is not really clear, and it's also changing over time because of course now, cities used to be much more polluted, but now there’s a little bit more control on the pollution in cities.

On why early intervention is perhaps even more important than health ageing:

Angelini: All of my research shows that really, the conditions even around the birth can have a long term impact on health.
White: How long term? Literally your whole life?
Angelini: Yes, your whole life. I mean, it can also have an effect on your risk of cardiovascular diseases when you're 50 or 60. So that's quite striking. From a policy perspective, it also implies that you should really focus on intervening very early in life, because there is a big discussion about healthy aging, but it may be too late to intervene. You should start really early.

On the ways that a recession could have at least some unintentional health benefits:

Angelini: During recessions like the recent financial crisis, income goes down, and this might imply that for example you had to cut back on your consumption. But when you cut back on your consumption, maybe you cut back on consumption of both healthy and unhealthy goods. So for example, you don't have enough money, so you stop smoking and you stop drinking alcohol.
White: So that amounts to a healthy outcome in your lifestyle.
Angelini: Yeah, and it’s been shown that during a recession, there's less traffic accidents and pollution. You have to compare it to a period of boom, where people work too much. It is not clear if you are cutting back on health consumption or cutting back on your unhealthy consumption, but they did they find a negative effect of recessions on health.

On how becoming a mother in your teens can impact your health much later in life:

Angelini: So we looked at teenage mothers around Europe, and we show that teenage mothers are more likely to develop depression later in life, and what the mechanism is, is a little bit complicated. It can be because as we just discussed education and income have a protective role. So teenage mothers may be more likely to stop their education, for example, which implies lower income and worse job opportunities, so it's a chain of events.

Why money may not be able to buy happiness, but it might be able to buy good health:

White: Much of your other research really does show the role of equality in an economic sense. Is it safe to say that that can kind of cure a lot of issues, or kind of prevent them from happening in the first place?
Angelini: Well, I believe that indeed the socioeconomic mechanisms are very important. And that's interesting, because especially for a social science perspective, you know, if it was only genetics, then there’s not much we can do about that, but if instead it is related to nutrition, to lifestyle, to education, to income, then we also design interventions to basically stop the transmission of inequality.