The figures are as plain as day: individuals with lower incomes live seven years shorter than people with good salaries. During that shorter life, they are also laid up sick for a large portion of that time; they suffer from disorders and limitations no less than nineteen years more.
How is that possible? People are quick to point to the lifestyle of this group. It is – on average – unhealthier. They are more likely to smoke, have a poorer diet and exercise less often. In short, it is their own fault. If they were to live healthier, the problem would be solved. “This idea is not only prevalent among people who occasionally read about it in the newspaper, but also among researchers,” says Hans Bosma, professor of Social Epidemiology. “But it is an oversimplification. They fail to look at the underlying causes. Why do these people have an unhealthy lifestyle? The current trend is to stress individual responsibility; older people have to remain independent, underprivileged people must be empowered, everyone has to become a ‘self-manager’. Health interventions are focused on this too and if you want a subsidy for your research project, then this should be the topic.” That’s bad, Bosma thinks. “Of course, good things are also being done, but by placing so much emphasis on the individual, you overlook the circumstances in which a person lives.”
Take working conditions, for example. “Everybody talks about stressed managers, but employees in low positions also experience stress.” For them, there is a different reason. “They have very little autonomy in their work, little control over what they do. Someone else determines for them what task they must carry out and when, and also how long they may take to do it.” This results in a low level of control awareness. “They feel that they have little influence on their own lives. It happens to them. When you have that feeling, you also don't believe that you can stop smoking or lose weight. It makes you passive – I have no say in the matter anyway, so there is no point in me trying.”
The social and living conditions, in turn, contribute to the very existence of smoking addictions and weight problems. “When your parents and friends all smoke, there is a great chance that you will start to smoke too. Fitness training is expensive, as is healthy food in many cases. And the neighbourhoods in which these people live, often have fewer facilities.”
Not everything, however, can be blamed on circumstances. “Research among children, for example, has shown that sometimes the low level of control awareness was already there, regardless of the socioeconomic status of their parents – as a characteristic – with major adverse consequences. So, individual characteristics do play a role, but the circumstances should also be included in the comparison. Income inequality obviously, but also the competitive element in society – the rat race in which everyone participates – and the lack of solidarity that I see more and more. These people have sometimes been captured within vicious circles for decades – it is a very complex phenomenon that we do not yet fully understand. There is no simple solution.”