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Degree of solidarity with lifestyle and old age among citizens in the Netherlands: cross-sectional results from the longitudinal SMILE study
  1. Linda H A Bonnie1,
  2. Marjan van den Akker1,
  3. Ben van Steenkiste1,
  4. Rein Vos2
  1. 1Department of General Practice, CAPRHI School for Public Health and Primary Care, Maastricht University, The Netherlands
  2. 2Department of Health, Ethics and Society, School for Public Health and Primary Care, Maastricht University, The Netherlands
  1. Correspondence to Dr Marjan van den Akker, Department of General Practice, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands; marjan.vandenakker{at}


Background and aim With the increasing interest in lifestyle, health and consequences of unhealthy lifestyles for the healthcare system, a new kind of solidarity is gaining importance: lifestyle solidarity. While it might not seem fair to let other people pay for the costs arising from an unhealthy lifestyle, it does not seem fair either to punish people for their lifestyle. However, it is not clear how solidarity is assessed by people, when considering disease risks or lifestyle risks. The aim of this study was to investigate the degree of solidarity with lifestyle as well as with other factors that are related to health outcomes—for example, old age—and the relation between this degree of solidarity and various characteristics.

Methods This cross-sectional study is part of the Dutch longitudinal SMILE study. Data on the degree of solidarity with different lifestyles and old age, and the relation between the degree of solidarity and various demographic and other variables were obtained in a questionnaire survey.

Results Solidarity with smokers and overweight people was moderate, as was solidarity with older people. Respondents were ambivalent about athletes. Respondents who were younger, male and highly educated, and those with a healthy lifestyle, a small social network, high quality of life and an internal locus of control, showed low solidarity.

Conclusions Solidarity with an unhealthy lifestyle and old age is moderate and the degree of solidarity varies among the different subgroups.

  • Solidarity
  • lifestyle
  • social aspects

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  • Competing interests None.

  • Ethics approval The medical ethics committee of Maastricht University Hospital approved the SMILE study, which supplied the database used in this study.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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