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The health legacy: Promoting and enhancing a socially fair intergenerational transmission of ideal health

The relation between consecutive human generations has always played a central role in human history, its origins tracing back to the Oedipus myth. Over the past few months, new dramatic chapters have been added to the story, with the youngest, led by Greta Thunberg, strongly contesting the adult generation’s legacy regarding climate and environment. With the images of that protest vivid in the mind’s eye, we reviewed with great pleasure and interest the contribution by Komulainen and colleagues on the intergenerational association of ideal health behaviours published in the current issue of the European Journal of Preventive Cardiology. In the context of the Young Finns Study, the authors measured a health behaviour score (non-smoking, ideal physical activity, ideal diet and normal body weight) and three diverse socio-economic position (SEP) indices (educational class, income and occupation) in 2001, 2007 and 2011. Parental health behaviour score and SEP were assessed at study inception in 1980. The association between parental and offspring health behaviour score was estimated from random-intercept multilevel ordinal logistic regression models, adjusting for potential covariates and attrition. In addition, the authors investigated whether parental and offspring SEP was acting as an effect-modifier of the intergenerational transmission of the ideal health behaviour score. Overall, the parental legacy was estimated as a 28% increased likelihood of ideal health behaviour in the offspring (odds ratio 1.28, 95% confidence interval 1.17 to 1.39). In addition, a higher SEP either in the parental or in the offspring generation strengthened the intergenerational continuum of ideal behaviours, up to odds ratios of 1.56 vs. 1.19 for high vs. low parental education; of 1.32 vs. 1.04 for offspring high vs. low education; and of 1.33 vs. 1.07 for nonmanual vs. manual offspring occupation. This work poses challenging questions on the ‘health legacy’ we can build day after day with our professional and personal choices. To this extent, the first finding deserving attention is that Komulainen and colleagues estimated a 27% probability of transmission of ideal health behaviours from parents to their offspring. The number itself is a combination of genetic heritability and shared household components, without the possibility of further disentangling the specific contribution of each. However, current evidence indicates that unhealthy lifestyles are more likely to determine obesity and type 2 diabetes than is genetic susceptibility. In addition, parental engagement is a key aspect in interventions on children’s weight and healthy eating habits, thus suggesting that the role of environment may predominate over genetics in the ideal health behaviour transmission. Therefore, we should acknowledge the need to value every euro invested today in promoting healthy lifestyles, not only for the effect on the present, but also for the non-negligible return on the future generation as well. Investing in prevention becomes a way to establish an intergenerational virtuous circle. The second challenge posed by the paper by Komulainen and colleagues derives from the role played by a higher SEP in strengthening the intergenerational association of ideal health score, as compared with individuals with a similar ideal health profile but in a lower SEP class. In other words, the health legacy is not socially fair per se, and it may contribute to widening