Chronic disease and healthy ageing at the intersections: social locations, biomarkers, and health practices;

点击翻译按钮获取中文摘要

Chronic diseases entail huge personal and societal costs and pose a significant challenge for public health. Furthermore, they are key drivers of inequalities in later life (50+) health. So far, health inequalities research has tended to focus on how health varies according to single categories of difference, such as gender or socioeconomic status. Yet in the real world we know that any given person is not just a man or woman, poor or rich, etc., but a combination of attributes, so that we might describe an older, poorer, ethnic minority man, for example (or any other combination that exists).This project takes up a theory which addresses this complexity called intersectionality. In particular, it focuses on how each of the combinations possible from the interaction of gender, age, socioeconomic status, and ethnicity (and in ageing research, also typically retirement and marital status), is associated with a particular location in the social structure, which brings with it particular (yet overlapping) resources, policy effects, processes, and types of discrimination. In turn, each position is associated with a particular (yet overlapping) set of social determinants of health, with differential consequences for chronic disease outcomes. Different intersectional positions might also entail different cultural and social identities. For example, there might be distinctive aspects to the identity of a younger unemployed man that cannot be reduced to age, employment status, or gender alone.In this project, we are particularly interested in the chronic diseases of type 2 diabetes, heart disease and obesity. These conditions are highly prevalent and have shared social determinants. We will analyse survey data from the English Longitudinal Study of Ageing, the Survey of Health, Ageing and Retirement in Europe, Understanding Society and the UK Biobank to identify which intersectional positions are at particular risk of these conditions. We will then investigate which factors might lead to this excess risk. We plan to focus on two types of factors. The first is events over the lifecourse, since we know that dis/advantage from womb to tomb is crucial to later life health outcomes. The second is health practices (i.e. health behaviours in social context) since there is strong evidence that these influence chronic disease outcomes. We will use a newly developed multilevel modelling technique and growth curve models; these methods allow for socially 'mapping out' health outcomes, and examining how they vary on time.In this work, we plan to analyse biomarker data which is increasingly collected in inter/national surveys. Biomarkers are objective measures of underlying pathology. Commonly-known biomarkers include blood pressure, BMI, and for diabetes, HbA1c. The advantage is that biomarkers are objective, valid measurements of health. Furthermore, by analysing biomarker outcomes at intersectional positions, we are advancing a highly novel biosocial approach, bringing together sociological theory with medical measurements. In effect, we will be able to see how social disadvantage 'gets under the skin' where factors such as gender, age and ethnicity interact with each other.What is the benefit of this research? It will highlight fine-grained inequalities that have previously escaped attention. It will suggest new ways to design, target and tailor public health policies and interventions. Academically, it takes up and runs with a theory which is currently seen as holding great promise to move health inequalities research forward. It will generate new conceptual, methodological and empirical knowledge which will be of substantial interest to the research community across multiple disciplines. Ultimately, the project offers a significant opportunity for a new approach to tackle the growing chronic disease burden negatively affecting the lives of many older people, but especially those in particularly deprived positions.