Unravelling the Social Gradient in Cause-Specific Mortality in the Netherlands, 1811-2024

Sara Wiertsema , Wageningen University and Research
Kristina Thompson, Wageningen University & Research

Over the past two centuries, the Netherlands has experienced a striking improvement in longevity, but these improvements have not been experienced evenly throughout society: The wealthiest and highest educated in society tend to live longer lives than the poorest and lowest educated. While this social gradient in mortality has been well documented for some time, evidence indicates that its magnitude has intensified over the past several decades. Why health inequalities have widened is not precisely clear. One of the more compelling arguments relates to the changing pattern of mortality voiced in Omran’s epidemiological transition theory. With an increase in preventable illness, individuals in more favourable socioeconomic status draw on their resources, whether intentionally or not, to protect themselves. Thus, in theory, as societies move from the pre-modern to the modern phase, socioeconomic inequalities in health will rise due to the increase in preventable illness. The present study seeks to empirically test this proposition. We employ an exceptional linked sample of the Historical Sample of the Netherlands, consisting of individuals from the late nineteenth and twentieth centuries, and the register data Social Statistical Datasets, with individuals from the late twentieth century in the Netherlands. Drawing on this novel data, initial analyses reveal preliminary support for the hypothesis. If historical evidence undermines the idea that health inequalities are inherent or natural, it can imply that the health gradient is a socially constructed phenomenon and, as such, amenable to social and policy intervention.

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 Presented in Session 38. Flash Session Social Inequalities in Mortality