Intergenerational social mobility and health: the inequality paradox

Patrick Deboosere, Vrije Universiteit Brussel

Systematic and persistent differences in health and mortality according to socio-economic position have been established for decades. Since the Black Report (1980) formulated several hypotheses to explain the persistence of these inequalities in the UK (artefact, health selection, behavioural and materialist causation), a consensus emerged mainly based on longitudinal studies. "Causation" is largely accepted as the main explanation for socio-economic inequalities in health with "health selection" being of minor importance. However, there is some evidence that health selection processes are becoming more important over time, especially to explain the persistence in inequality among the lowest educated groups in the younger part of the population. Besides making the society more egalitarian, policies promoting higher education, also give rise to a small group of extremely low educated young adults with an adverse health profile. By linking the parental characteristics of the birth cohorts of 1972-1976 to their educational attainment and their self-assessed health in the 2001 census, we were able to document the importance of the phenomenon in the association between parental social position, intergenerational mobility and health. Although our data are not suited to analyze causal relationships, they do describe the recent trends well and allow for the formulation of hypotheses on the evolution of the relationship between "causation" and "health selection". The emerging pattern of the relationship between the transition matrix of intergenerational educational mobility and health for both men and women is in this regard very informative. It makes clear that an egalitarian policy may reinforce the association between bad health and low education and has implications for the assessment and the measurement of social health inequalities.