The “double jeopardy” lifestyle effect

How individual and neighbourhood socioeconomic disadvantages jointly affect health-related behaviour

Yinjie Zhu

In our study recently published in the IJE, we found that socioeconomically disadvantaged individuals were more likely to have worse health-related lifestyle behaviour than their neighbours, even if they lived in neighbourhoods with little overall socioeconomic disadvantage.

We also observed a “double jeopardy” effect: an unhealthier lifestyle was found among people with greater individual disadvantage residing in disadvantaged neighbourhoods.

Why is lifestyle behaviour important to health?

Negative lifestyle behaviours — such as unhealthy diet, smoking, insufficient physical activity and alcohol misuse – can result in chronic diseases, such as obesity and diabetes, and are associated with lower life expectancy and higher mortality. Modifying these behaviours can treat a range of diseases. However, neighbourhood socioeconomic status is equally important for health and wellbeing.

How is socioeconomic disadvantage related to lifestyle behaviour?

Socioeconomic disadvantage usually exists at two ecological levels: individual and neighbourhood. Individual disadvantage is often influenced by education and income, while the neighbourhood serves as a platform for health resources and the spread of certain health beliefs and social norms.

Studies have shown that individual disadvantage is associated with poor diet, smoking, more sedentary time and less physical activity. Neighbourhood disadvantage, as a contextual factor, is also related to negative lifestyle behaviour.

In our study, using the Lifelines cohort and Biobank of 77,244 participants residing in the northern Netherlands, we estimated socioeconomic disadvantage at the individual and neighbourhood levels. Neighbourhood disadvantage was based on income and social security benefits, while individual disadvantage additionally considered education and unemployment.

We investigated the joint effect and interrelation of these disadvantages on health-related lifestyle behaviours (diet quality, smoking, alcohol consumption, hours of sleep, hours of watching TV and physical activity). These behaviours were summed to create a lifestyle risk index, with a higher index representing an unhealthier lifestyle.

What is the “double jeopardy” effect?

Simply put, in our study, people with the unhealthiest lifestyles had the highest levels of both individual and neighbourhood disadvantages. However, the impact of individual disadvantage was stronger in more disadvantaged neighbourhoods.

People who are less individually disadvantaged will be more resilient and resistant to their neighbourhood disadvantage because they are more likely to access health resources, have a higher level of self-perceived control and have greater knowledge of how to avoid unhealthy lifestyle behaviour.

What is the lesson for policy makers?

The double jeopardy effect can provide practical guidance to policy makers and public health practitioners. It tells us that practising an unhealthy lifestyle depends on both individual and neighbourhood disadvantages. This calls for integrated public policies focusing on, and engaging with, people’s surroundings as well as the people themselves.

For example, a public policy aiming to increase physical activity could involve building more sports facilities and enlarging the neighbourhood’s playground area, as well as organising sports activities and disseminating health information about physical activity to people living in the neighbourhood.

Moreover, future public health initiatives should consider providing more health resources, and enabling better access to them, as well as increasing social opportunities, such as education and cultural activities, for socioeconomically disadvantaged neighbourhoods, while also targeting individual behaviour. Only then can we work towards achieving a healthy lifestyle for all and mitigate society’s persistent health inequalities.

Read more:

Zhu Y, Duan M-J, Riphagen IJ, et al. Separate and combined effects of individual and neighbourhood socio-economic disadvantage on health-related lifestyle risk factors: a multilevel analysis. Int J Epidemiol 2021; 24 April. doi: 10.1093/ije/dyab079.


Yinjie Zhu holds a Master’s degree in nutrition and rural development from Ghent University and is a PhD candidate in the Department of Internal Medicine (Division of Nephrology) at the University Medical Centre Groningen, The Netherlands. She is interested in how socioeconomic status affects lifestyle, nutritional status and health outcomes in a general population.

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