Embodiment of inequality : the translation of childhood social inequality to alcohol related health disparities later in life

Abstract: This thesis aims to increase knowledge regarding the translation of childhood social inequality to alcohol related disparities later in life. Four empirical studies focus on different dimensions of childhood social inequality and identify a clear connection between childhood social disadvantage and alcohol related disorders in young adulthood. The studies are based on data from Swedish national registers which include a large number of social, demographic and health related variables for the entire population born between 1973 and 1984 (n= 948 518). This cohort is followed from birth to adulthood using Cox and logistic regression analyses to measure the association between the childhood factors and alcohol related hospital care later in life. Low socioeconomic position, low school performance and experience of childhood household dysfunction were associated with alcohol related disorders to varying degrees in both men and women. School performance in particular was strongly related to the outcome and adjustment for school marks led to a complete attenuation of the socioeconomic gradient in alcohol related disorders. Alcohol related disorders result from a combination of two factors: high exposure and high vulnerability to alcohol. National public health surveys report very modest socioeconomic differences in total consumption levels and prevalence of binge drinking, which does not reflect the large alcohol related health inequalities presented and discussed in this thesis. Instead, this thesis emphasises social inequality in vulnerability to alcohol as a plausible mechanism explaining the results. A privileged socioeconomic background without any experience of household dysfunction provides children with good opportunities for school success, which paves the way for a good higher education and a well-paid profession. The many resources that such a person accumulates over the lifetime may serve as a buffer that compensates for the potentially adverse health effects of high alcohol consumption. In contrast, a person from disadvantaged social circumstances may be more likely to face poverty, stress and general health problems which can increase the probability that high alcohol consumption will lead to illness. The relationship between childhood social inequality and alcohol related health disparities later in life can be conceptualised as a form of embodiment of social privilege and disadvantage. During this process the physical and social environment is biologically incorporated and may materialise as health conditions. The embodiment of inequality makes individuals more or less vulnerable to the adverse consequences of alcohol and may partly explain the alcohol related health inequalities found in Sweden.