(Un)healthy lifestylesEducation as a dividing line

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Accumulation of risk factors

Authors: Stéfanie André, Roza Meuleman and Gerbert Kraaykamp

Health-related behaviour is unlikely to be determined by one single good or bad habit, but rather by an accumulation of healthy and unhealthy behaviours. These are ingrained habits, which form part of someone’s personal lifestyle. Over time, these behaviours can have consequences for a person’s health.

A further important aspect is the tendency to combine several healthy/unhealthy habits, which means that health-related behaviour is not expressed in just one area, but in several domains. To study this phenomenon, we have created an accumulation index of three unhealthy lifestyle factors: drinking regularly, smoking and being overweight. The question is how often these aspects occur in combination and whether this accumulation bears any relation to educational level.

On average, 45.7% of 25-70-year-old respondents exhibit one risky behaviour, 29% combine two such behaviours and 4.7% combine all three; 20.6% do not exhibit any of the risk factors included in this study.

Unhealthy behaviour: accumulation and educational differences

Figure 8.1 shows that an accumulation of risk factors is related to education; combining several risky behaviours is associated with a wider education gap. The difference between those with a low, intermediate and higher educational level is fairly small for having one risky behaviour; the high score for those with the highest educational level is mainly attributable to their regular consumption of alcohol. The picture changes completely when we look at those who combine three risky habits: this time, we find more than six times as many people with a low educational level as people with a higher professional education. This illustrates that the group with a low educational level more often combines several risk factors than the highly educated group.

Figure 8.1Cumulative index of unhealthy behaviour

Index risicogedrag low higher secondary higher professional (HBO) university (WO)
1x 50,4 43,9 41,6 52,4
2x 28,5 32,3 28,4 16
3x 7,3 4,7 1,1 2,2

Source:European Social Survey Netherlands, Round 7, 2014-2015 (N=1,415)

Healthy behaviour: accumulation and educational differences

Figure 8.2 illustrates the accumulation of healthy behaviours. We have created an index consisting of daily consumption of fruit, daily consumption of vegetables and engaging in intensive physical activity at least once per week. Only 3.1% of respondents report that they have no healthy habits. Those with the highest educational level include the most healthy behaviours in their lifestyle: no fewer than 61.5% of all university graduates report that they combine all three of the healthy behaviours studied here.

Generally speaking, the accumulation of healthy behaviour increases with rising educational level, and is found least often among those with the lowest educational level.

Figure 8.2Cumulative index of healthy behaviour by educational level

Index gezond gedrag low higher secondary higher professional (HBO) university (WO)
1x 18,8 17 11,6 8,2
2x 33,5 27,2 28,7 30,3
3x 42,2 53,3 57,5 61,5

Source:European Social Survey Netherlands, Round 7, 2014-2015 (N=1,415)

A concurrence of healthy and unhealthy behaviour?

Finally, it is interesting to consider whether and how healthy and unhealthy behaviours occur together. A single index was created for this (figure 8.3), in which unhealthy behaviours are mirrored as healthy behaviours (i.e. as not smoking, not drinking regularly and not being overweight).

The first clear observation is that there is a very strong cumulation of healthy behaviour among those with the highest educational level: 59.1% of university graduates report five or more healthy lifestyle behaviours. This compares with just 32.7% of the group with a low educational level. The figure also shows that 2.4% of the lowest-educated group exhibit no healthy behaviours at all – something that does not occur in the highly educated group, demonstrating once again that unhealthy lifestyle behaviours tend to cumulate. It also illustrates that we need to look at the education gap in health behaviours as a whole; it is not simply the case that certain groups display one or more specific behaviours, but rather that inequalities in unhealthy behaviour accumulate mainly in the group with the lowest educational level.

Figure 8.3Cumulation of healthy behaviour

0x 1x 2x 3x 4x 5x 6x
low 2,4 3,6 8,2 19,8 33,4 25,7 7
higher secondary 0,3 2,4 10 16 30,8 28 12,4
higher professional (HBO) 0 1,7 4,5 15,3 28,1 31,7 18,7
university (WO) 0 0,8 1,7 10,5 27,8 39,6 19,5

aNot smoking, not drinking regularly, not overweight, eating vegetables, eating fruit, physical activity

Source:European Social Survey Netherlands, Round 7, 2014-2015 (N=1,415)

The map of Europe shows the education gap in relation to the cumulation of (un)healthy behaviour in various countries included in the European Social Survey. Figure 8.4 plots the percentage of respondents reporting five or six healthy behaviours against the percentage reporting four or fewer healthy behaviours. Our results show that the education gap in accumulation of health-related behaviour is smallest in Switzerland (5.4%) and greatest in Lithuania (42.9%). The Netherlands also has a relatively small education gap (16.4%).

Figure 8.4The education gap in cumulation of healthy behaviour in Europe

low education intermediate education high education
Switzerland 49,7 58 55,7
Germany 36,7 40,4 48,9
Czech Republic 24,2 36,7 40,1
Belgium 35,7 42,2 51,7
The Netherlands 36,5 42,5 52,8
Austria 31,8 47,9 48,3
Ireland 44,3 58,2 62,4
Spain 28,6 36,6 48
France 34,5 47,4 54,6
United Kingdom 37,2 39,2 57,6
Denmark 38,4 44,2 59,5
Norway 40,9 48,3 63,4
Sweden 42,6 47,5 65,5
Portugal 30,5 39,2 54,7
Finland 43,2 54,6 67,6
Poland 33 51,7 61,7
Slovenia 37,2 49,3 66,7
Estonia 28,1 44,1 63,1
Lithuania 21,2 38,8 64,1

Source:European Social Survey Netherlands, Round 7, 2014-2015 (n=25,538)

Cite this card

André, S., R. Meuleman and G. Kraaykamp (2018). Accumulation of risk factors. In: (Un)healthy lifestyles: Education as a dividing line. Retrieved [datum vandaag] from https://digital.scp.nl/lifestyles/accumulation-of-risk-factors.

Information notes