NWO Open Competition grant for study into the role of environmental injustice and chronic stress in type 2 diabetes
Hans Bosma (RL Health Inequities and Societal Participation) was awarded 750,000 euros from the NWO 2020 Open Competition SSH funding round to carry out research into the role of environmental injustice and chronic stress in type 2 diabetes.
People with lower incomes are more likely to develop diabetes. They often point out their unhealthy exercise and diet patterns. The proposed project, on the other hand, wishes to shift attention to the unequal environments in which rich and poor people live and work and the chronic stress that poor people experience as a result. The study will be carried out within the Maastricht Study.
Summary of the research project
People in lower socioeconomic positions have heightened risks of type 2 diabetes (T2D). Instead of focusing on individual health behaviours (e.g. unhealthy diet), the project aims to describe how socioeconomic inequities extend to inequities in the exposome. People are differentially exposed to unhealthy residential (e.g. amount of green space), work (e.g. job control), and societal (e.g. classism) environments. Also independent of individual health behaviours, such environmental injustice is hypothesised to result in perceptions of powerlessness and inferiority, which both contribute to a chronic stress-induced heightened risk of T2D in people with lower socio-economic positions. The Maastricht Study (n > 9.000) allows longitudinal analyses of incident T2D. T2D is measured by clinical and self-reported measures and wider questionnaires measure the relevant concepts in the project. Hair cortisol is measured as an indicator of chronic stress. In addition to measuring the inhabitant’s perceptions of their neighbourhoods, data from Statistics Netherlands (CBS) and GECCO (Geoscience and health cohort consortium) allow matching to a multitude of objectively measured environmental characteristics. Multilevel analyses will take account of the nested data (individuals within neighbourhoods). A focus on environmental injustice and chronic stress will reframe T2D into a disease that does not develop in a social vacuum. The new insights will increase the evidence-base and the awareness of the fundamental influence of upstream factors on disease development. In lay people and physicians alike, the project will thus help in de-stigmatising T2D. By providing (policy) recommendations, it will help in tackling environmental injustice and socioeconomic inequities in T2D.
Other UM researchers collaborating in the research project are Annemarie Koster and Angelique de Rijk (both CAPHRI - RL Health Inequities and Societal Participation), Maria Jansen (CAPHRI - RL Creating Value-Based Healthcare) and Coen Stehouwer (CARIM - Maastricht Study).