Understanding the roots of health inequality: The impact of social mobility on longevity

Abstract Background Today, people with higher socio-economic positions (SEP) live longer lives than people with lower SEP. There is also evidence that these differences have widened over the twentieth century. The reasons why this has occurred are not precisely known. Previous theoretical research has proposed an untested explanation: that rising intergenerational mobility has led to greater homogeneity within lower socioeconomic groups, concentrating personal characteristics associated with poor health. Our study is the first to test this hypothesis empirically. Gaining a deeper understanding of how and why these inequalities between socioeconomic groups have developed over time can help academics and policymakers address the root causes of poor health across generations and better anticipate future trends in population health. Methods This study uses a unique intergenerational sample of Dutch people living and dying between 1883 to 2021. The dataset includes 60,369 descendants and ancestors. We investigate how intergenerational trajectories of socioeconomic status and health interact, and how the composition of the changing social strata shifts regarding personal characteristics. We do this by constructing intergenerational mobility typologies to examine whether the distribution of health-related characteristics varies across mobility groups. Subsequently, Cox proportional hazards models will be employed to assess how longevity differ by mobility trajectory, thereby testing the association between mobility-driven group composition and lifespan. Findings and conclusions Our preliminary findings primarily suggest that downward mobility and stable-low status are associated with decreased longevity, even when accounting for respondents’ socioeconomic status and health. This work enriches the evidence base regarding how health inequalities emerge and persist and may help to inform strategies to reduce them. Key messages • Understanding mobility's role in health can inform strategies to reduce long-term health inequalities. • Downward and stable-low mobility are linked to decreased longevity, independent of individual SES and health.