Lauren Hilt

Dr. Hair

HSPM412-J11

5/26/2019

Current Issues Journal: MODULE 2

Health Disparities: A Product of Early Deprivation

In 1944, during WWII, the Dutch railway workers began a strike in effort to halt the

transportation of Nazi soldiers (Zimmer, 2018). This strike not only failed to aid the Allied forces but

brought down a severe punishment on the Netherlands (Zimmer, 2018). The Nazis blocked the food

supply and prompted the county to go into a famine that caused 20,000 people to die before they were

liberated in 1945 (Zimmer, 2018). Due to the shortness of the Dutch Hunger Winter, less than a year

long, a rare insight into human health was provided. Zimmer (2018) stated that the most vulnerable

people during the famine were pregnant mothers. The children carried during the famine experienced

more adverse health effects than a child carried before or after (Zimmer, 2018). These health effects

include higher levels of triglycerides and LDL cholesterol as well as higher rates of obesity, diabetes, and

schizophrenia (Zimmer, 2018). Not only that, but the children in utero during the famine also had a

higher mortality rate, about a 10% increase after 68 years (Zimmer, 2018).

Why were these people experiencing unfavorable health conditions? Zimmer (2018) stated that

one study published in a journal called Science Advances, claims that some genes were silenced in the

unborn children that were carried during the famine, and those genes have remained silent throughout

their entire lives. Some researchers on this topic have narrowed their focus in epigenetics, the study of

long-term gene control, to a molecular cap called a methyl group (Zimmer, 2018). Many have found that

silent genes either carry a methyl group or have some methyl groups close by (Zimmer, 2018). These

methyl groups can disrupt how cells normally use genes (Zimmer, 2018). Dr. Lumey, a researcher on the

Dutch Hunger Winter, took blood samples from those carried by their mothers during the famine, as
well as siblings who were born before or after (Zimmer, 2018). Researchers were able to look for

patterns in the DNA to see where methyl groups were different in those carried during the famine to

their siblings, and amongst the overweight (Zimmer, 2018). The gene found to be linked to a higher body

mass index, BMI, is called PIM3, which is involved in burning body fat (Zimmer, 2018). When a methyl

group is attached to PIM3 during gestation, the gene is less active and metabolism could be lowered

(Zimmer, 2018). However, there could still be other explanations; such as when one becomes

overweight a trigger may occur that changes PIM 3, a genetic variation in the survivors that was not

captured in this study could be present, or even a change in the quantity of certain cell types (Zimmer,

2018).

The theory that most closely relates to the health disparities that arose from the Dutch Hunger

Winter is the Thrifty Phenotype Hypothesis. This theory states that deprivation present in the early

stages of life activates “thrifty” genes that can optimize poor conditions (Hair, 2019). Like the results

found in the study of the Dutch Hunger Winter, these genes can cause people to be less effective at

achieving good health and can affect their entire lives (Hair, 2019). These “thrifty” genes can be

favorable in harsh times, such as a famine, but can predispose people to problems like obesity and type

2 diabetes later in life (Hair, 2019). According to Dr. Hair (2019), the Thrifty Phenotype Hypothesis also

states that “people with ‘thrifty’ genes face a lower rate of return on any and all investments in health”

(slide 20). This means that for the same amount of time spent improving health, a smaller increase in

health will occur for someone with the “thrifty” genes compared to someone without them (Hair, 2019).

Also, the same amount of increase in health requires a greater investment for someone with a “thrifty”

gene compared to someone without it (Hair, 2019). The theory states that there is an expected disparity

across people raised with different childhood income levels (Hair, 2019). Those raised with lower income

levels will be at a greater risk for facing deprivation like that of the Dutch Hunger Winter.
 This relates to the Grossman model because the production possibility frontier (PPF) of health,

H, and home goods, Z, shrinks to allow fewer attainable combinations of H and Z to choose from if one

has a “thrifty” gene (Hair, 2019). The shrink in the PPF is caused by the required increase in investment

to achieve the same amount of health and the lower returns on that same investment (Hair, 2019).

Those raised with lower income levels will have to choose a lower level of health and home goods than

those raised with a higher income level even if their preferences are the same (Hair, 2019). This is due to

the differences in the individuals’ PPFs. One must choose the combination of H and Z, based off their

PPFs and indifference curves, to maximize their utility (Hair, 2019). Since those raised with a lower

income will have a smaller PPF, they will have less H and Z than someone raised with a larger income

(Hair, 2019).

References

Hair, N. (2019). LECTURE-05-B: Comparative Statics [PowerPoint slides]. Retrieved from https://blackboa

rd.sc.edu/bbcswebdav/pid-12873472-dt-content-rid-92829941_2/courses/HSPM412-J11-SUMM

ER-2019/MODULE02-LECTURE05-B-Grossman%20Model.pdf

Zimmer, C. (2018). The famine ended 70 years ago, but Dutch genes still bear scars. The New York Times.

Retrieved from: https://blackboard.sc.edu/bbcswebdav/pid-128420-dt-blog-rid-91669660_2/co

urses/HSPM412-J11-SUMMER-2019/MODULE02_The%20Famine%20Ended%2070%20Years%20

Ago%2C%20but%20Dutch%20Genes%20Still%20Bear%20Scars_NYTimes_2018%281%29.pdf