We don’t choose our parents, their jobs or their health. And we don’t have a say in whether or not they smoke, nor in what they ate when we were children. However, our recent study found that these things strongly determine our own lifestyles and health, even into adulthood.
For our study – involving 21,000 participants aged 50 and above from 13 European countries – we compared the participants’ current smoking, obesity and lack of exercise with their parents’ job, longevity, smoking status and alcohol problems during the participants’ childhoods.
We showed that parents’ characteristics when participants were ten years old explained between 31% and 78% of their adult health, with a European average at 50%. The countries where health was largely determined by parents’ characteristics were Czech Republic (78%), Germany (72%), Spain (70%), France (66%) and Austria (64%). However, parental factors mattered less in Belgium (31%), the Netherlands (34%) and Switzerland (41%).
The importance of parents’ characteristics for their children’s health is explained by two mechanisms. First, poor living conditions in childhood lead to poverty in adulthood – which affects health. Second, health is transmitted from parents to children. Beyond the obvious common genetic inheritance across generations, parents’ health also has an impact on their children’s health by imparting habits and lifestyles.
Our research found that if a parent smoked when their child was young, the child was much more likely to smoke as an adult, in all countries except Sweden. A person’s obesity in later life was more frequent when their parents were smokers and had a problem with alcohol when the child was ten in Germany, Greece and Austria. In Denmark, obesity was only associated with parents having a problem with alcohol; in France it was associated with parents being smokers.
We also investigated the odds that a person would smoke – using national survey data from France – based on their parents’ smoking and social background. We found that if a person’s father smoked when they were 12, they were almost twice as likely to smoke than people whose father did not smoke at all, controlling for education level and parents’ job.
If mothers smoked, it increased the risk of their daughters smoking – but not their sons. The risk that a person would smoke was also higher among those whose father was a manual worker, and who had experienced periods of poverty during their childhood.
Our findings should give pause for thought to those who devised the new NHS plans to stop smokers or obese patients from having surgery unless they quit smoking or lose weight. The decision assumes that these patients’ poor health is self induced, so they are made to choose between facing the consequences of their lifestyle or demonstrating a commitment to change.
These sorts of public health policies don’t take into account that lifestyle is strongly associated with circumstances beyond a person’s control, especially their childhood circumstances and their parents’ health and lifestyles. Restricting their access to treatment appears especially unfair when people do not have equal opportunities to be in good health and to adopt healthy lifestyles.
According to the American economist, John Roemer, a way to ensure equality of opportunities is to respect the true responsibility of people for their efforts independently of factors beyond their control. In other words, people would only be responsible for the share that isn’t linked to their childhood conditions or their parents’ choices.
Our study shows that, even without making this distinction between responsibility and true responsibility, the control of people on their health choices and their health status is limited – family and parents’ circumstances matter more in most European countries.
While the campaign to encourage people to eat five portions of fruit or veg a day, or experiments that give shopping vouchers for smoking cessation, guide and nudge people towards healthier lifestyles without apportioning blame, a ban or an imposed delay on surgery because of lifestyles divides people into deserving and less deserving patients – and this is clearly wrong.