Transgenerational determinants of socioeconomic health differences in childhood and youth

Cardiometabolic diseases and depression are amongst the leading causes of disease burden worldwide (Hay et al., 2017) and are only expected to worsen (Tabák et al., 2014). Burden of disease is often measured using disability-adjusted life years (DALYs), which represent one year of healthy life lost, due to either fatal or non-fatal diseases (Hay et al., 2017). Within the Netherlands, depression is estimated to be the eleventh leading cause of DALYs, making it the leading cause of DALYs due to mental health. Additionally, ischaemic heart disease, stroke, and diabetes, which are the main cardiometabolic diseases, are estimated to be the second, fifth, and sixth leading causes of DALYs, respectively (IHME, 2018). In children, precursors and risk constellations for cardiometabolic diseases and depression can be assessed at relatively young ages in various etiologic pathways (Kassebaum et al., 2016). For example, metabolic syndrome and high body mass index have both been shown to be strong risk factors for cardiometabolic diseases at older ages (Mottillo et al., 2010, Umer et al., 2017). By focussing on these precursors of disease, interventions can ideally be implemented at an earlier stage, which may help reduce the large burden due to cardiometabolic diseases and depression. To reduce this burden, it is also important to not fall victim to lifestyle drift, in which interventions focus on an individual’s health behaviour instead of addressing the underlying causes of disease (Marmot and Allen, 2014). An example of lifestyle drift is when population-level obesity reduction initiatives solely focus on raising awareness of health promoting behaviour instead of addressing underlying issues within an individual’s food environment, which may expose certain groups to unhealthy foods linked with obesity  (Carey et al., 2016).