BackgroundUnhealthy lifestyles in early childhood are a major global health challenge. These lifestyles often persist from generation to generation and contribute to a vicious cycle of health-related and social problems. This design article presents a study evaluating the effects of two novel healthy school interventions. The main outcome measure will be changes in children’s body mass index (BMI). In addition, lifestyle behaviours, academic achievement, child well-being, socio-economic differences, and societal costs will be examined.MethodsIn close collaboration with various stakeholders, a quasi-experimental study was developed, for which children of four intervention schools (n = 1200) in the southern part of the Netherlands are compared with children of four control schools (n = 1200) in the same region. The interventions started in November 2015. In two of the four intervention schools, a whole-school approach named ‘The Healthy Primary School of the Future’, is implemented with the aim of improving physical activity and dietary behaviour. For this intervention, pupils are offered an extended curriculum, including a healthy lunch, more physical exercises, and social and educational activities, next to the regular school curriculum. In the two other intervention schools, a physical-activity school approach called ‘The Physical Activity School’, is implemented, which is essentially similar to the other intervention, except that no lunch is provided. The interventions proceed during a period of 4 years. Apart from the effectiveness of both interventions, the process, the cost-effectiveness, and the expected legal implications are studied. Data collection is conducted within the school system. The baseline measurements started in September 2015 and yearly follow-up measurements are taking place until 2019.DiscussionA whole-school approach is a new concept in the Netherlands. Due to its innovative, multifaceted nature and sound scientific foundation, these integrated programmes have the potential to form a template for primary schools worldwide. The effects of this approach may extend further than the outcomes associated with well-being and academic achievement, potentially impacting legal and cultural aspects in our society.Trial registrationThe study protocol was registered in the database ClinicalTrials.gov on 14-06-2016 with the reference number NCT02800616.

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The socioeconomic patterning of social inadequacy and shame suggests that notions of internalized inferiority in the individual, psychological makeup might be important in the generation and maintenance of socioeconomic inequalities in health.

BackgroundIn-depth qualitative research into perceived socioeconomic position-related stigmatisation among people living at the lower end of our socioeconomic hierarchy is necessary for getting more insight in the possible downside of living in an increasingly meritocratic and individualistic society.MethodsSeventeen interviews were conducted among a group of Dutch people with a low socioeconomic position to examine their experiences with stigmatisation, how they coped with it and what they perceived as consequences.ResultsSocial reactions perceived by participants related to being inferior, being physically recognisable as a poor person, and being responsible for their own financial problems. Participants with less experience of living in poverty, a heterogeneous social network and greater sense of financial responsibility seemed to be more aware of stigmas than people with long-term experience of poverty, a homogeneous social network and less sense of financial responsibility. Perceived stigmatisation mainly had emotional consequences. To maintain a certain level of self-respect, participants tried to escape from reality, showed their strengths or confronted other people who expressed negative attitudes towards them.ConclusionDespite the good intentions of policies to enhance self-reliance, responsibility and active citizenship, these policies and related societal beliefs might affect people at the lower end of our socioeconomic hierarchies by making them feel inferior, ashamed and blamed, especially when they cannot meet societal expectations or when they feel treated disrespectfully, unjustly or unequally by social workers or volunteers of charity organisations.

ObjectivesClassism might be the downside of the prevailing ideologies of individual responsibility for success. However, since studies into perceived classism have mainly been qualitative, little is known about its association with socioeconomic status, health, health behaviours and perceived inferiority, especially in more egalitarian countries. This study, therefore, examined the associations of perceived classism with socioeconomic status, health, health behaviours and perceived inferiority.MethodsWe used cross-sectional data (2012/2013) from the Dutch Longitudinal Internet Studies for the Social Sciences (LISS) (n = 1540; age 16–90; 46.9 % men).ResultsWe found that classism was perceived by 18.2 % of the participants, with the lowest income and occupation group most likely to perceive classism (22.0 and 27.5 %, respectively). Perceived classism was significantly associated with poor health (e.g. self-rated health OR = 2.44, 95 % CI = 1.76–3.38) and feelings of inferiority (e.g. shame OR = 4.64, 95 % CI = 3.08–6.98). No significant associations were found with health behaviours.ConclusionsTo further examine the role of perceived classism for socioeconomic differences in health and its association with country-level socioeconomic inequalities, prevailing ideologies, and objective opportunities for social mobility, we recommend more longitudinal and international studies with comparable measures of perceived classism.