Our health is affected by the world around us – how we developed as children, where we live, how much money we have, how stressful our lives are – all have lasting consequences for our health and lives as we age. Equally, our health affects our ability to engage in all other aspects of our lives – employment, family, school and our social lives. At a more fundamental biological level the genes that we inherit from our parents influence our health and lives, and in turn the environments in which we live can alter the way in which our genes operate.
To understand the two way relationships between our social and economic circumstances and our health, we need to have studies that measure both social factors and health well. Too often medical or clinical studies provide a wealth of rich information on different aspects of health, but little on the rest of people’s lives, while social studies provide rich data on every aspect of people’s lives but only one or two general questions on health. What is required is studies that measure both of these dimensions equally well.
To do this a number of studies now collect ‘biomarkers’, i.e. objectives indicators of biological processes, to combine with their social and economic information. Perhaps the most ambitious of these is Understanding Society, the ESRC’s landmark longitudinal study, which follows 40,000 households every year to understand changes in people’ lives. Recently Understanding Society included a nurse interview to measure biomarkers, such as height and weight, measures of how well different aspects of the body, such as lungs or blood pressure, function, and measures taken from blood samples and DNA.
What can biomarkers tell scientists?
Biomarkers are valuable in lots of ways. Not only do they provide better information on different dimensions of health than questionnaire data, but they tell us about people having an illness or being at risk of one before they experience any symptoms. For example, a biomarker called HbA1c tells us how well people process sugars and is used to diagnose diabetes. We also ask people whether they have diabetes and are being treated for it, and so we can identify those at risk but not yet aware of the condition, those who report having diabetes and whether they are effectively managing it. We can then look at their circumstances, now and in the past, to predict to whom, when and why these things happen, which helps policymakers develop approaches to preventing diabetes or supporting people to better manage the condition if they have it.
How does this link with socio-economic situations?
Secondly, lots of studies show that people experiencing different kinds of social and economic disadvantage have poorer health than others, but why is this? Measuring biomarkers can help us understand the pathways from having low income, losing your job, or feeling lonely to the stress and other psychological or behavioural changes that these result in to biological changes in the body to ill health. Such an understanding of the biological pathways helps to strengthen our understanding of how different social and working environments influence health and hence helps identify ways of preventing their health damage.
What about the environment?
Finally, we are increasingly understanding that the way the environment affects us may be influenced by our genes – for example the extent to which air pollution causes us to have breathing problems – but we are also beginning to see that our environment can affect the way our genes work in the body. Getting a better understanding of the two way relationship between our genes and our environment in real life situations may help us identify those at particular risk from different hazards.
While Understanding Society is not the first study to measure health in these ways, it is the most comprehensive – covering people of all ages from all parts of the United Kingdom – so that we can observe how different aspects of health develop at young ages, when they peak and how quickly they decline for different types of health in different groups and places. This knowledge can help policy makers identify key stages of life or particular places and population groups to intervene to strength the development of different aspects of health and slow the decline.
The Study also has other unique features. It enables us to examine different aspects of health within households, we know that children may inherit health conditions from their parents but how are the daily lives of siblings or couples influenced by the health of each other? Within the UK, the health of the Scottish population is well known to be poorer than the rest of the UK. But why is that? Few studies provide rich health and social data measured in the same way across all four countries of the UK to enable us to explore these questions. In Understanding Society we do, so that differences between countries in health, and the causes of these, can be investigated.
These new data in Understanding Society create exciting opportunities to better understand how people’s health and lives interact, and hence improve the health of the nations in the future.
Read more about Understanding Society, the support and resources we have developed to help researchers use these data, and findings from them.
Michaela Benzeval is Professor of Longitudinal Research and Director of Understanding Society, and Meena Kumari is Professor of Social and Biological Epidemiology and leads on health and biomarker research for the Study. Both are based at ISER, University of Essex.
mbenzeval@essex.ac.uk, mkumari@essex.ac.uk
This article first appeared in ISER’s annual review Taking the Long View – click here to read the whole report.