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Background: The persistence of health inequalities may be driven by differences in education and income, but also by other economic and non-economic factors. Our aim was to explore how the association between single-dimensional health and socioeconomic status (SES) changes when including health-related person capital, economic capital, social capital, cultural capital and attractiveness and personality capital. Methods: We used a capital-based approach to understand health inequalities. It presumes intertwined relationships between broadly measured health (‘health-related person capital’) and embodied resources (‘attractiveness and personality capital’) on the one hand, and ESC capital, i.e., economic, social, and cultural resources on the other. We used cross-sectional data on 152,592 participants from the Dutch Lifelines cohort study and estimated correlations using partial least squares structural equation modelling. Results: The correlation between SES and health-related person capital (r = 0.15) was stronger than the correlations between SES and single-dimensional health (physical and mental health; r = 0.12 and r = 0.04, respectively). ESC capital, combining economic, social and cultural capital, showed a correlation of 0.34 with health-related person capital. This was stronger than the correlation between health-related person capital and economic capital alone (r = 0.19). Lastly, the correlation between health-related person capital and ESC capital increased when health related, attractiveness and personality resources were combined into a single person capital construct (from r = 0.34 to r = 0.49). Conclusions: This exploratory study shows the empirical interconnectedness of various types of resources, and their potential role in the persistence of health inequalities. Our findings corroborate the idea of considering health as a multidimensional concept, and to extend conventional SES indicators to a broader measurement of economic and non-economic resources.

This thematic issue aims to shed light on the connections between institutions (and related forms of organisation) on social inclusion and exclusion. In this editorial we briefly introduce the concepts, summarise the various articles and provide some general conclusions.

The social exclusion of children is problematic for two reasons. Young people typically inherit their marginal position from their family, and therefore cannot be held responsible for their hardship themselves; and social exclusion in childhood may affect their wellbeing and subsequent development, possibly leading to a “scarring effect” in later life. In this contribution we develop an instrument for measuring social exclusion among children. Social exclusion is regarded as a theoretical construct with four sub-dimensions: material deprivation, limited social participation, inadequate access to social rights, and a lack of normative integration. First we analyse data from a survey of 2,200 Dutch children, which contains a large set of social exclusion items. We applied nonlinear principal components analysis in order to construct a multidimensional scale. Measured in this way, the prevalence of social exclusion among children is 4.5%. Boys and children living in large families are more likely to experience social exclusion than girls and children with few siblings. The parental level of education and dependency on social security benefits are also important driving factors of childhood social exclusion. Subsequently we investigate the scarring effect. Longitudinal administrative income and household data covering 25 years were combined with a new survey of just under 1,000 Dutch adults, a third of whom were poor as a child. The survey assessed their past and current degree of social exclusion, and their health and psychosocial development, educational career, past family circumstances, etc. In an absolute sense scarring turns out to have been limited during this period: a very large majority of those who were poor or excluded as a child are above the threshold values in adult life. However, the “descendants of hardship” are still more likely to be socially excluded as adults than people who grew up in more favourable conditions. A causal analysis suggests that low educational achievements are the main mediator of scarring risks.

The academic and public debate on social inequality has recently been fuelled by large disparities in income and wealth, profound changes in the labour market, and other emerging cleavages in post-industrial societies. This article contributes to the discussion by arguing that class divisions are theoretically based on four types of capital: people's economic means, their social capital, their cultural resources, and the combination of their health and attractiveness ('person capital'). From this premise, the social structure of the Netherlands is examined. A dedicated survey was linked to microdata from the national population register, tax authorities and benefit agencies. Using latent class analysis, we assess contingencies in the distribution of the different resources, and identify a structure consisting of six capital groups. The established upper echelon (15.5% of the adult population) has the most capital, followed by the privileged younger people (12.7%), the employed middle echelon (26.9%) and the comfortable retirees (16.6%). Total capital is lowest among the insecure workers (13.5%) and the precariat (14.8%). Each social class has a distinctive mix of the four types of capital, highlighting the need to look beyond economic differences in order to comprehend structural inequality. The results of this study also indicate that resource disparities between classes coincide with other forms of social hierarchy and contrasts by age. Moreover, the contemporary class structure is associated with divergent views and experiences among the Dutch. Classes with little capital tend to rate politics, society, and their own social position more negatively. In addition, they value self-enhancement and hedonism less than today's upper classes and report lower levels of well-being.