Health problems and social problems often go hand in hand and can be seen in families in different generations. This is shown by Nienke Slagboom’s recent PhD research. Slagboom conducted research into health inequality in families in Katwijk aan Zee, as can be read on the LUMC website.
Our society has major differences in health. It appears to be difficult to reduce these health differences, according to research by Slagboom. In neighborhoods where residents have a lot of concerns about living, income or work, there is a higher risk of poor health. This accumulation of health and social problems is also referred to as a ‘syndemics’.
Accumulation of health and social problems
Slagboom conducted her PhD research into health inequality in families in Katwijk. She investigated the generation-to-generation transmission of stacked problems on the basis of this syndemic theory. Which social mechanisms contribute to vulnerability to transmission and which help to prevent complaints from developing? What can we do to break through this kind of intergenerational pattern and what are the starting points for early interventions? The interaction between living environment and disease was central to the research in Katwijk.
In conversation with Katwijk families
For her research, Slagboom first looked at Katwijk’s figures, then she went in search of the life stories behind the figures. With the history and decline of the fishery in mind, she spent four years talking to families across three generations and taking a look at everyday life. She also interviewed professionals who work with families. Together with residents and professionals, Nienke researched what is important in a family-oriented approach to common health problems.
The research therefore shows, among other things, that health problems and social problems often go hand in hand. The three most common clusters of disorders in Katwijk always include a combination of psychological stress, cardiometabolic diseases such as cardiovascular disease, diabetes and high blood pressure, and pain in the musculoskeletal system, such as osteoarthritis or rheumatism. This accumulation of these three conditions is more common in people who suffer from financial stress, loneliness, do not have a paid job, have limited exercise and are overweight (a BMI over 25).
Passed down generation to generation
This so-called ‘syndemic vulnerability’ may pass through generations (intergenerational), but it can also be broken. A complex interplay of unfavorable social circumstances, bad life events, lifestyle habits and life lessons characterizes the histories of families in which this vulnerability is passed on from generation to generation. Education, social support and the ability to dream are factors that play a role in decreasing syndemic vulnerability.
Slagboom’s research also showed that family-oriented prevention can have positive effects on the health and well-being of the family. Although in practice it turned out to be challenging to organize this family-oriented prevention. It also became clear that prevention aimed at overweight children can provoke protest reactions. Slagboom studied why conversations about weight become exciting in an instant. What’s behind instant jokes, ridicule, or angry responses when it comes to weight? Her conclusion? The jokes and anger are a form of resistance against a government that does not care about what is important to the population and a protest against a government that interferes with education and lifestyle.
Immerse yourself in the history of the area
In her dissertation, Slagboom indicates that a thorough understanding of local history and socio-historical relationships is indispensable for understanding and tackling this intergenerational transfer of stacked problems locally. Using the so-called syndemic theory makes it possible to understand and address health outcomes in the light of the (historical) living environment of a community.
