Poorer people, on average, live shorter lives. This pattern can be seen even in wealthy countries with extensive welfare systems. In Norway, for example, 40-year-old men in the richest 1% could expect to live almost 14 years longer than those in the poorest 1%. In the US, the equivalent gap is nearly 15 years . A 2025 World Health Organization report warned that international targets for reducing health inequalities by 2040 are likely to be missed.
Author
- Philip Broadbent
Wellcome Multimorbidity PhD Fellow & Public Health Registrar, University of Glasgow
Efforts to explain these gaps have often focused on people's circumstances in adulthood, including their income and working conditions. Increasingly, though, researchers have looked further back, to the conditions in which people grow up.
Many studies have followed people from childhood into later life, tracking how their early circumstances relate to their health decades later. Yet the last review to bring together evidence on childhood socioeconomic circumstances and adult death rates was published nearly 20 years ago.
In our recent study , my colleagues and I systematically searched for relevant research and brought together the results of 102 long-term studies involving around 8.5 million people in 24 countries. The studies recorded aspects of participants' childhood circumstances, including their parents' occupations or education, household finances and housing, and then tracked deaths in adulthood.
Across 474 separate comparisons, more than eight in ten found higher death rates among people who had experienced greater disadvantage in childhood.
The largest body of evidence concerned fathers' occupations. That reflects the period in which many of the studies began: mid-20th-century research commonly treated the father's job as the main measure of a household's social position, while mothers' occupations were rarely recorded. As a result, this evidence provides an incomplete picture of family circumstances and may overlook women's contribution to a household's social and economic position.
When we combined the results of 18 studies, adults whose fathers had worked in the least advantaged occupations had a death rate around 26% higher than those whose fathers had worked in the most advantaged ones. The association extended across several causes of death, including cardiovascular and respiratory diseases and lung cancer.
Other measures of childhood circumstances pointed in the same direction. Lower parental education, financial hardship and overcrowded housing were all associated with higher death rates later in life, although these findings were based on fewer studies and should therefore be interpreted more cautiously.
The pattern also did not appear to be confined to children growing up in the very poorest households. Although we could not show that death rates rose with every step down the socioeconomic scale, the association was not limited to people who had experienced the greatest disadvantage.
There are important limits to what we can conclude. The studies in our review were observational, recording people's circumstances as they lived them. They can reveal strong patterns, but they cannot prove that childhood disadvantage directly caused earlier death. Families differ in many interconnected ways, including housing, neighbourhood conditions, parental health and exposure to stress, and it is difficult to separate the effects of these factors completely.
The quality of the evidence also varied. Around half of the studies were judged to have a high or very high risk of bias, meaning aspects of their design could have distorted the results. A common problem was that they did not fully account for other differences between families that might also influence health. However, when we looked only at studies with a lower risk of bias, the overall pattern was similar.
Childhood disadvantage can shape adult circumstances
Childhood disadvantage is also closely connected with what happens later. It can shape education, employment and income in adulthood, which may themselves affect health. Because relatively few studies took adult circumstances into account, our review cannot tell us how much of the association originates specifically in childhood and how much reflects disadvantage accumulating across a lifetime.
The geographical evidence is uneven too. Around three quarters of the studies came from Nordic or western European countries, and most participants were White Europeans. Evidence from low and middle-income countries remains limited.
Even with these limitations, the overall pattern was consistent. Childhood circumstances are associated with death rates many decades later, suggesting that attempts to reduce inequalities in how long people live should begin long before adulthood.
One approach is known as proportionate universalism : providing services and support to all families, while offering greater help as disadvantage increases. In practice, this could mean universal early-years services, education and healthcare, backed by extra resources for families facing greater financial or housing insecurity.
The people who will be older adults in the 2070s are children today. Improving the conditions in which they grow up may help reduce health inequalities decades before many of their consequences become visible.
Philip Broadbent receives funding from The Wellcome Trust 223499/Z/21/Z
