Life Trajectories, Biomedical Evidence, and Lessons for Policies

Abstract

Here I compare two types of evidence that have recently emerged from the literature. This Commentary is a contribution to the Frontiers Research Topic on social disparities in aging, and aims to draw attention to the novel connections that link social disparities, the biological capital of individuals, and policy strategies. The biological capital (as defined in the paper), accrued since conception by individuals, in turn affects their social, cultural, and economic capitals, and thus creates a positive feedback loop. In a large network funded by the European Commission, Lifepath, we have shown that the determinants of health inequalities start in early life and cumulate throughout the life-course. For example, exposure to adverse childhood experiences (ACEs) influences the likelihood of later in life health effects, including poor aging. In this paper I compare two types of evidence that have recently emerged from the literature. One addresses the role of early vs. late exposures to risk factors for aging and mortality, including ACEs, using e.g., microsimulation models. The second type of evidence, provided in a recent document of the WHO European Regional Office, is based on the analysis of five broad determinants of health inequalities and eight different macroeconomic policies to tackle such inequalities. Six of the policies, if enacted, have the potential to reduce inequalities in the short term by increasing public expenditure on housing and community amenities, increasing expenditure on labor market policies, reducing income inequality, increasing social protection expenditure, reducing unemployment, and/or reducing out-of-pocket payments for health. Both of these lines of evidence suggest that there are ample opportunities for policy interventions. I also discuss the need for analytical methods to bridge the two types of analyses (biomedical and macroeconomic), i.e., fill the gap between analyses based on individual determinants of health inequalities and those based on societal determinants, to help create more effective policy-making. Also, I propose that before launching large projects to reduce health inequalities, well-designed experiments must be conducted to test their efficacy. These experiments, though, are challenging when addressing social policies, in consideration of ethical constraints and timescales.

Effect of Expanding the Earned Income Tax Credit to Americans Without Dependent Children on Psychological Distress

“…Mental health problems are associated with the development of socioeconomically patterned physical illnesses ( 21 ). These findings underscore the importance of intervening early in the life course on factors that drive social deprivation, such as employment and income ( 22 ). Second, the absence of an impact on psychological distress in the overall sample might be additionally explained by the modest effects of Paycheck Plus on earnings and employment ( 9 , 13 ).…”

Dynamics of Health Financing among the BRICS: A Literature Review

“…Healthcare schemes would be facilitated to become more strategic consumers of healthcare, i.e., need-based purchasing of healthcare services to prevent wastage in low-resource contexts [87,88]. Nevertheless, these strategies will be successful only if outcomes are continuously monitored through benchmarking and the identification of best practices [89,90].…”

Is Academic Medicine Prepared to Teach About the Intersection of Childhood Experiences and Health? An Exploratory Survey of Faculty

“…[14][15][16][17][18] At the same time, an emerging literature reveals that multilayered strategies for prevention and treatment of childhood adversity and trauma include equitable distribution of resources, family support, prioritizing positive human connections, and mind-body regulatory practices. 4,[19][20][21][22][23] This emerging literature also demonstrates that positive childhood experiences support health and well-being across the lifespan and may have even more impact than childhood adversity. 4,5 Despite all the research, there has been a critical lag in translating this essential science into practice and integrating it into medical education, including understanding how diseases arise, creating effective strategies for prevention and treatment, and designing successful health education.…”

“…14–18 At the same time, an emerging literature reveals that multilayered strategies for prevention and treatment of childhood adversity and trauma include equitable distribution of resources, family support, prioritizing positive human connections, and mind–body regulatory practices. 4,19–23 This emerging literature also demonstrates that positive childhood experiences support health and well-being across the lifespan and may have even more impact than childhood adversity. 4,5…”