Eleven and six years – those are the differences researchers have identified in the life expectancy of individuals in the lowest and highest income quintile.
For men, the difference is eleven years and means that men in the highest income quintile live over a decade longer than men in the lowest quintile. For women, the corresponding figure is six years.
The differences in life expectancy are considerable, says Assistant Professor Joni Lindbohm of the University of Helsinki, whose work focuses on the reduction of social and health inequalities.
Lindbohm is heading a research programme launched at the University of Helsinki’s Faculty of Medicine in early 2023. The programme explores population-level social and health disparities and develops ways of tackling them.
As seen above, the most dramatic difference at the population level is that people with low incomes die earlier than their high-income counterparts. But this is not the only difference.
People in the lowest income quintile are affected by diabetes and cardiovascular and other diseases more often than those in the highest quintile. Illness often has a significant effect on quality of life, particularly during the last years of life.
– Years of ill health are [alongside life expectancy] another major factor we’re trying to address through our research. We’re striving to identify, at the population level, the persons at risk of major public health problems.
In other words, Lindbohm’s programme also investigates strategies for preventing the risks associated with health inequalities – in a cost-efficient way.
– Health and social services spending has been all over the headlines. For example, if we suggest a new population-level screening test for certain groups, its efficacy must first be ascertained so that it doesn’t just put more strain on the system.
The research programme works in collaboration with, and thanks to a major donation from, the Päivikki and Sakari Sohlberg Foundation. Between 2020 and 2024, the foundation is donating €2 million to the University of Helsinki’s fields of medicine and pharmacy.
The University has used the donation to establish the research programme on reducing social and health inequalities.
Director Ulla Nord of the Päivikki and Sakari Sohlberg Foundation explains that, since its founding, the foundation has been supporting the wellbeing of children, adolescents and older adults.
– Minimising social and health disparities lies at the heart of our operations, and cross-disciplinary collaboration can offer versatile knowledge and concrete steps for research. We believe that both individual research grants and more significant contributions such as this donation can shape outcomes in the long term, she adds.
How to identify the right people
Two approaches are available to address health inequalities effectively. The first involves population-level measures to reduce risk factors comprehensively. The second requires identifying high-risk individuals early and effectively and offering them targeted preventive treatment.
Lindbohm describes how previous observational studies have demonstrated that systematic healthcare investment in more effective and targeted risk-based cardiovascular screening could lead to significant cost savings without the need to reduce the scope of health services.
In other words, the incidence of disease could be lowered if, for example, high blood pressure or cholesterol levels were detected promptly in at-risk individuals. Discovering early warning signs would mean that current treatment methods could be used before the onset of disease.
– Current methods, such as cholesterol and antihypertensive drugs, work well if we can recognise people without delay and encourage them to commit to treatment. We’re also trying to confirm our previous observational finding that intensified cardiovascular screening could prevent up to eight per cent of all heart attacks and strokes at the population level.
An observational study involves observing causalities in an extensive dataset without any experimentation.
– We’re now seeking a wellbeing services county and a few health centres as collaboration partners to be able to approach things from the other direction and find out whether our idea based on prior data and the screening model we propose are cost-effective and able to reduce socioeconomic health disparities.
Covid pandemic as a stress test
As social and health inequalities involve a range of fields, their research too should ideally be multidisciplinary. Lindbohm’s research programme cooperates with partners including health centres and the University’s Faculty of Social Sciences.
The covid pandemic tangibly demonstrated the connections between socioeconomic and health differences.
– The pandemic can be described as a stress test that starkly showed how vulnerable some people are. They were first hit by unemployment and financial difficulties when on-location employees were, for example, laid off. If family income dropped and eliminated any previous leeway, this often affected all family members, manifesting as, for instance, physical and mental health issues.
In addition, people in lower income brackets did not necessarily have the same opportunities to work remotely as knowledge workers, which increased their direct exposure to the virus.
– And as the prevalence of illness is in general higher among persons of lower socioeconomic status, they are at greater risk of a more serious coronavirus infection and related complications.