Social heritage can influence health

What does social heritage have to do with health? Can grandparents’ lives affect their grandchildren’s health? The research group Twin Cities is studying these and other questions dealing with social affiliation and health.
Moa Martinson staty i NorrköpingThe statue of Moa Martinson, one of Sweden's most noted authors of proletarian literature, in the old Norrköping industrial landscape. Foto: Thor Balkhed
Residents of Norrköping run the biggest risk of dying from cardiovascular disease compared with residents of other large Swedish cities. Women are particularly afflicted.

“This is a puzzle. Now, we’d like to test the hypothesis whether this has something to do with the history of Norrköping. Perhaps we can track morbidity back to the city’s past as a woman-dominated industrial city,” says Tomas Faresjö, professor of Medical Sociology.

He is part of the interdisciplinary research group Twin Cities, where the twinned cities of Norrköping and Linköping have been compared from a public health perspective for many years. Statistics show, in black and white, that public health is significantly worse in the old working-class city of Norrköping than in white-collar Linköping, including the prevalence of cardiovascular disease, injuries, COPD, and suicide, as well as mothers who smoke and teenage abortions.

Studies by the team of researchers also show that children born into socially and economically vulnerable families are afflicted more by the most common childhood illnesses than children from socially and economically secure environments.

Tomas FaresjöRecent data also shows that cardiovascular mortality in Norrköping is the highest among Sweden’s 15 largest cities.

“This is very alarming. And the question is whether the explanation lies in Norrköping’s status as an old industrial city with tough working conditions, bad pay, and a lot of stress.”

Faresjö’s research colleague Hans Nilsson has just received SEK 2.4 million to study the medical consequences of the crises Norrköping’s residents have had to endure. Over the past few years, the question has arisen whether inherited changes influenced by the environment can be passed down to future generations.

“So it’s a question, simply put, of studying whether the lives of grandparents influence the health of their grandchildren. Our human genes haven’t changed for tens of thousands of years, but in the research field of epigenetics we’ve begun to see that 'expressions in genes' can be changed between generations, which means that certain messages can likely be sent between generations. Community medics, historians, and geneticists will be collaborating on this study.”

In another Twin Cities project, researchers have interviewed women under the age of 65 who have suffered heart attacks. It is unusual for women at that age to be stricken, because the hormone oestrogen has a protective effect. Last year a total of 60 women in Linköping and Norrköping were afflicted, and a number of them were interviewed.
The recent results from the study show that it is impossible to determine patterns having to do with the different social environments in the cities. On the other hand, there are certain common patterns and personality types among the women afflicted.

“Every one of them was involved in serious life events, for example violence or other criminal acts. They often also behave in a self-sacrificing manner, are kind of ‘good girls’ and stand by everyone else, but are really quite alone. They have also often had important goals in life that went unfulfilled, and are often a little cynical in their attitudes towards their surroundings,” Faresjö says.

Historisk bild från väveri i Norrköping.The World Health Organization (WHO) estimates that upwards of 70 % of all cardiovascular disease can be prevented because it is due to how we live.

“By identifying this group of women who suffered heart attacks previously, and seeing them as a risk group, it also becomes possible for health care to step in with preventive measures.

Recent results produced by the team of researchers also inclue development of a method for measuring cortisol content in hair; thereby determining how stressed a person has been over the past few months.

“Otherwise the normal method is to measure cortisol with a saliva test, but that kind of test only shows the stress levels for the day it was run. With the hair test we can go several months back in time, like with the rings on a tree, and see what stress levels have been.”

A benefit of this is that health care with a biological marker can determine a person’s stress level further back in time, and not just on stress perceived in the patient.

“This could make diagnosing illnesses easier, for example. A large number of today’s illnesses are related to stress,” Faresjö says, and emphasizes that the method is still only at the research laboratory stage for now.

What will be done with all the knowledge the researchers produce?

A general problem is translating research results into concrete measures, Faresjö argues.

“Our task as researchers is also to disseminate the results of research. And the interest in them is huge, especially from politicians and other representatives of society. They’re incredibly interested! But that doesn’t mean that social issues connected to people’s health is always prioritised in political decisions when they are put up against things like the need for schools, roads, and housing.”

Faresjö does, however, have an example where society’s conscious efforts led to an improvement in public health.

“Twenty-five years ago, in Norsjö in Västerbotten, they worked assiduously to reduce cardiovascular mortality, which was then among the highest in the country. Municipalities, the county council, and researchers were involved, as were local merchants, sports clubs, and other associations. An important part of the effort was that residents, like those between the ages of 50 and 55, were regularly called to health examinations and dialogues at their district health care centres. This yielded good effects, and mortality decreased.”

Faresjö was installed as a professor at the Commencement Ceremony November 11.

Published 2011-11-08