Studying social determinants of health using fuzzy-set Qualitative Comparative Analysis : A worked example

Using fuzzy-set Qualitative Comparative Analysis (fsQCA), we present an alternative method for studying the social determinants of health (SDHs) that focuses on their configurational paths leading to population health outcomes. In our worked example, we examine the macrosocial determinants of infant mortality based on data covering 149 countries. First, we applied regression techniques to assess the net effects of key macrosocial determinants. Second, we used fsQCA to analyze the same data and identify the configurational paths. We calibrated the macrosocial determinants in terms of both advantages and disadvantages and revealed the configurations of (dis)advantages consistently linked to high infant mortality rates and low infant mortality rates. The regression analysis showed that the net effects of national economic performance, democracy level, inequality, and women's autonomy were all statistically significant. Together, they explained 83% of the variance in infant mortality rates between countries. Following the fuzzy-set analysis, the two main configurational paths to achieve low infant mortality rates were high women's autonomy together with high economic performance and high women's autonomy together with low inequality and full democracy. The main paths that left countries burdened with high infant mortality rates were low economic performance together with either low women's autonomy or high inequality. We conclude that different SDH configurations may lead to the same health outcomes. Therefore, it may not always be sufficient to say which variables matter the most universally, and by using fsQCA, it is possible to move from treating SDHs as competing independent variables to using them in configurations to explain health outcomes.publishedVersionPeer reviewe

Work ability of employees in changing social services and health care organizations in Finland

Objectives: In this study, we examined the connection between organizational changes and employees own evaluations of their work ability. Materials and Methods: In early 2010, we asked employees (n = 2429) working in the Finnish social services and health care industry to identify all the organizational changes that had occurred at their workplaces over the previous two years, and to evaluate their own work ability and whether different statements related to the elements of work ability were true or false at the time of the survey. For our method of analysis, we used logistical regression analysis. Results: In models adjusted for gender, age, marital status, professional education and managerial position, the respondents who had encountered organizational changes were at a higher risk of feeling that their work ability had decreased (OR = 1.49) than the respondents whose workplaces had not been affected by changes. Those respondents who had encountered organizational changes were also at a higher risk of feeling that several elements related to work ability had deteriorated. The risk of having decreased self-evaluated work ability was in turn higher among the respondents who stated they could not understand the changes than among those respondents who understood the changes (OR = 1.99). This was also the case among respondents who felt that their opportunities to be involved in the changes had been poor in comparison to those who felt that they had had good opportunities to be involved in the process (OR = 2.16). Conclusions: Our findings suggest that the organizational changes in social and health care may entail, especially when poorly executed, costs to which little attention has been paid until now. When implementing organizational changes, it is vital to ensure that the employees understand why the changes are being made, and that they are given the opportunity to take part in the implementation of these changes

“First, Do No Harm”: Have the Health Impacts of Government Bills on Tax Legislation Been Assessed in Finland?

As taxation is one of the key public policy domains influencing population health, and as there is a legal, strategic, and programmatic basis for health impact assessment (HIA) in Finland, we analyzed all 235 government bills on tax legislation over the years 2007–2014 to see whether the health impacts of the tax bills had been assessed. We found that health impacts had been assessed for 13 bills, bills dealing with tobacco, alcohol, confectionery, and energy legislation and that four of these impact assessments included impacts on health inequalities between social classes. Based on our theoretical classification, the health impacts of 40 other tax bills should have been evaluated

Developing a work well-being questionnaire for social- and health-care managers

Objectives: There is a need for up-to-date research on health-care and social managers' work well-being. The purpose was to develop a questionnaire for measuring health-care and social managers' subjective work well-being and to determine whether their background factors are connected to their work well-being. Material and Methods: The authors developed a questionnaire based on their previous health-care and social managers' work well-being framework. It covers 5 separate categories: 1) individual factors, 2) social factors, 3) professional support from one's own manager, 4) organizational factors, and 5) work-related factors. Using statistical methods, the authors examined the questionnaire's internal validity, its fit with the framework, and the connections between several background factors and work well-being. The survey data (N = 281) were collected from South Osthrobothnia and Central Osthrobothnia in Finland. Results: The questionnaire's internal validity was good, and it fit rather well with the authors' previous framework. Managers' work well-being was highest for the category of “professional support from one's own manager” and lowest for “organizational factors.” The authors found connections between different categories of work well-being and a) years of managerial experience, b) level of management, and c) occupational group. Conclusions: The questionnaire gives a holistic view of managers' work well-being and is suitable for measuring work well-being in the social- and health-care context. An examination showed that there is a need to improve the individual situations of the social- and health-care managers. The questionnaire can be used to assess managers' work well-being and to build a knowledge base for developing organizational policies.publishedVersionPeer reviewe

Occupational class and the changing patterns of hospitalization for affective and neurotic disorders : a nationwide register-based study of the Finnish working-age population, 1976–2010

This study aimed to examine the long-term changes and socioeconomic disparities in hospitalization for affective and neurotic disorders among the Finnish working-age population from 1976 to 2010. Register-based study, consisting of a 5-year follow-up of 3,223,624 Finnish working-age (18-64-year old) individuals in seven consecutive cohorts. We calculated the hazard ratios of psychiatric hospitalization for different occupational classes using Cox regression models. The risk of hospitalization for affective and neurotic disorders increased in all occupational classes after the economic recession in the 1990s, and then decreased in the 2000s. Before the 2000s, the risk was the highest among manual workers. In the 2000s the disparities between upper-level non-manual employees and other occupational classes increased. Hospitalization rates remained high among female manual workers and non-manual lower-level employees. This study revealed important similarities and differences between occupational classes in terms of long-term changes in hospitalization for affective and neurotic disorders. The results suggest that the labor market changes and healthcare reforms during the 1990s and 2000s in Finland have been more beneficial for higher than for lower occupational classes.Peer reviewe

Kansanterveys ja ekologinen kuorma

Ihmiskunta on saavuttanut merkittäviä kansanterveyden edistysaskeleita eri puolilla maailmaa. Terveyden edistymisestä on kiitetty muun muassa talouskasvua. Talouskasvuun liittyvällä kuluttamisella on kuitenkin ekologinen kääntöpuolensa: samaan aikaan kun ihmiskunnan terveys on parantunut, on ihmiskunnan ekologinen jalanjälki kasvanut ja ekosysteemit ajautuneet kriisiin. Tarkastelemme kansanterveyden kehitystä ja ekologista kuormaa 33 OECD- ja BRICS -maassa 53 vuoden ajanjaksolla. Tarkemmin kysymme, miten kansanterveys ja ekologinen jalanjälki ovat kehittyneet vuodesta 1960 vuoteen 2015. Tavoitteemme oli selvittää, onko löydettävissä maita, joissa sekä elinajanodote tai vastasyntyneiden eloonjäänti että ekologinen jalanjälki ovat kehittyneet positiivisesti. Pohdimme tuloksia ympäristövaltio -kirjallisuuden valossa. Tutkimuksessa käytetty paneeli-aineisto sisälsi tiedot 33 maan ekologisesta jalanjäljestä, imeväiskuolleisuudesta ja elinajanodotteesta vuosilta 1960–2015. Ekologisesta jalanjäljestä laskettiin kullekin maalle ajanjaksolta vuosikeskiarvo. Kansanterveyden osoittimista analysoitiin muutosta vuosien 1960 ja 2015 välillä. Koska kansanterveyden lähtötaso ja siten kehityspotentiaali oli maissa erilainen, suhteutettiin absoluuttinen kehitys teoreettiseen maksimikehitykseen. Maakohtaisten analyysien jälkeen maat ryhmiteltiin suurempiin alueisiin tarkempaa ajallista analyysia varten. Tulokset esitetään hajontakuvioina. Löysimme kestävän ja suhteellisen pienen ekologisen jalanjäljen maita, joissa kansanterveys on kehittynyt suhteellisesti enemmän, ja vastaavasti suuren ekologisen jalanjäljen maita, joissa kehitys on ollut vähäistä. Tulokset antavat viitteitä siitä, että hyvä kansanterveyden taso voidaan säilyttää ja terveyttä edistää myös niukemman kulutuksen oloissa. Niin hyvinvointivaltioissa kuin alemman tulotason maissa on potentiaalia ympäristövaltioiksi, joissa huolehditaan sekä ympäristöstä että väestön terveydestä

“First, Do No Harm”: Have the Health Impacts of Government Bills on Tax Legislation Been Assessed in Finland?

Abstract As taxation is one of the key public policy domains influencing population health, and as there is a legal, strategic, and programmatic basis for health impact assessment (HIA) in Finland, we analyzed all 235 government bills on tax legislation over the years 2007–2014 to see whether the health impacts of the tax bills had been assessed. We found that health impacts had been assessed for 13 bills, bills dealing with tobacco, alcohol, confectionery, and energy legislation and that four of these impact assessments included impacts on health inequalities between social classes. Based on our theoretical classification, the health impacts of 40 other tax bills should have been evaluated