Welfare Regimes and Social Inequalities in Health Dynamics: A Comparative Analysis of Panel Data from Britain, Denmark, Germany and the US

Objective: To describe average national trajectories of self-rated health over a 7-year period, identify social determinants of cross-sectional and longitudinal health; and compare cross-national patterns. Design: Prospective nationally representative household panel studies (the US Panel Study of Income Dynamics; British Household Panel Survey; the German Socio-Economic Panel Survey; the Danish panel from the European Community Household Panel Survey). Setting: The US, Britain, Germany and Denmark Participants: Household heads and their partners of working age throughout follow-up (US: 4855; Britain: 4365; Germany: 4694; Denmark: 3252). Main Outcome Measure: Repeated measures of self-rated health (1995 – 2001). Social indicators include education, occupational class, employment status, income, age, gender, minority status and marital status, all measured in 1994. Methods: Latent growth curve models describe average national trajectories of self-rated health and individual differences in these trajectories. Latent factors representing intercept and slope components are extracted from seven annual observations across time for self-rated health, and are conditioned on predictors measured one year prior to baseline. Aging-vector graphs are used to visualize trajectories of self-rated health. Results: The vector graphs for the US and Germany show that self-rated health remained relatively stable for young adults, declined as adults became middle aged and then became more stable again. The graphs for Britain and Denmark indicate a steady decline throughout working life. The Danish model indicates an unfavourable trend in self-rated health during a period that experienced a move to monetarism: ratings were lower for persons of a given age in 2001 than for persons of the same age in 1995. Social covariates predicted baseline health in all four countries, with the strength of association consistent with Esping-Andersen’s welfare regime type. The strongest social gradients were seen in the US, while the weakest were seen in Germany and Denmark. Britain occupied a position between these two extremes. Once inequalities in baseline health had been accounted for, there were few determinants of mean health decline. When these did occur, they were in countries classified as liberal welfare states. There was little difference in the aging trajectories for those with advantaged and average social profiles. By contrast, disadvantage has a strong effect on aging trajectories. Differences were already apparent at 25 years of age in the US and Britain and gaps widened with age in all four countries. Conclusion: National differences in self-rated health trajectories and their social correlates may be attributed, in part, to welfare policies. The paper is forthcoming in the Journal of Community Health and Epidemiology (JECH). Peggy McDonough is an Associate Professor in the Dalla Lana School of Public Health at the University of Toronto. Her research interests in social inequalities in health and women’s health have led her recently to incorporate a comparative welfare state dimension in her studies

Individualization, opportunity and jeopardy in American women's work and family lives: A multi-state sequence analysis

AbstractLife course sociologists are increasingly concerned with how the general character of biographies is transformed over historical time – and with what this means for individual life chances. The individualization thesis, which contends that contemporary biographies are less predictable, less orderly and less collectively determined than were those lived before the middle of the 20th century, suggests that life courses have become both more internally dynamic and more diverse across individuals. Whether these changes reflect expanding opportunities or increasing jeopardy is a matter of some debate. We examine these questions using data on the employment, marital and parental histories, over the ages of 25–49, for five birth cohorts of American women (N=7150). Our results show that biographical change has been characterized more by growing differences between women than by increasing complexity within individual women's lives. Whether the mounting diversity of work and family life paths reflects, on balance, expanding opportunities or increasing jeopardy depends very much on the social advantages and disadvantages women possessed as they entered their prime working and childrearing years

De-standardization and gender convergence in work–family life courses in Great Britain: A multi-channel sequence analysis

This study addresses the question of de-standardized life courses from a gender perspective. Multi-channel sequence analysis is used to characterise the domains of work, partnership and parenthood in combination across the adult life courses of three birth cohorts of British men and women between the ages of 16 and 42. Three research questions are addressed. First, we examine whether there is evidence of increasing between-person de-standardization (diversity) and within-person differentiation (complexity) in work and family life courses across cohorts during the main childrearing years. Second, we investigate whether men's and women's work–family life courses are converging over time. Finally, we assess the link between educational attainment and work–family life courses across cohorts. Data are from the MRC National Survey of Health and Development 1946 birth cohort (n = 3012), the National Child Development Study 1958 birth cohort (n = 9616), and the British Cohort Study 1970 birth cohort (n = 8158). We apply multi-channel sequence analysis to group individuals into twelve conceptually-based work–family life course types. We find evidence of growing between-person diversity, across cohorts, for both women and men. In addition, partnership trajectories are growing more complex for both genders, while parental biographies and women's work histories are becoming less so. Women's and men's work–family life courses are becoming increasingly similar as more women engage in continuous full-time employment; however, life courses involving part-time employment or a career break remain common for women in the most recent cohort. Continuous, full-time employment combined with minimal family ties up to age 42 emerged as the most common pattern for women and the second most common for men in the 1970 cohort

Is being in paid work beyond state pension age beneficial for health? Evidence from England using a life-course approach

BACKGROUND Given the current policy emphasis in many Western societies on extending working lives, we investigated the health effects of being in paid work beyond state pension age (SPA). Until now, work has largely focused on the health of those who exit the labour force early. METHODS Our data come from waves 2–4 of the English Longitudinal Study of Ageing, including the life history interview at wave 3. Using logistic and linear regression models, we assessed the longitudinal associations between being in paid work beyond SPA and 3 measures of health (depression, a latent measure of somatic health and sleep disturbance) among men aged 65–74 and women aged 60–69. Our analyses controlled for baseline health and socioeconomic characteristics, as well as for work histories and health in adulthood and childhood. RESULTS Approximately a quarter of women and 15% of men were in paid work beyond SPA. Descriptive bivariate analyses suggested that men and women in paid work were more likely to report better health at follow-up. However, once baseline socioeconomic characteristics as well as adulthood and baseline health and labour market histories were accounted for, the health benefits of working beyond SPA were no longer significant. CONCLUSIONS Potential health benefits of working beyond SPA need to be considered in the light of the fact that those who report good health and are more socioeconomically advantaged are more likely to be working beyond SPA to begin with

Do work and family care histories predict health in older women?

Background Social and policy changes in the last several decades have increased women’s options for combining paid work with family care. We explored whether specific combinations of work and family care over the lifecourse are associated with variations in women’s later life health. Methods We used sequence analysis to group women in the English Longitudinal Study of Ageing according to their work histories and fertility. Using logistic regression, we tested for group differences in later life disability, depressive symptomology and mortality, while controlling for childhood health and socioeconomic position and a range of adult socio-economic circumstances and health behaviours. Results Women who transitioned from family care to either part-time work after a short break from the labour force, or to full-time work, reported lower odds of having a disability compared with the reference group of women with children who were mostly employed full-time throughout. Women who shifted from family care to part-time work after a long career break had lower odds of mortality than the reference group. Depressive symptoms were not associated with women’s work and family care histories. Conclusion Women’s work histories are predictive of their later life disability and mortality. This relationship may be useful in targeting interventions aimed at improving later life health. Further research is necessary to explore the mechanisms linking certain work histories to poorer later life health and to design interventions for those affected

Work-family life courses and metabolic markers in mid-life: evidence from the British National Child Development Study

Background Previous studies have found generally better health among those who combine employment and family responsibilities; however, most research excludes men, and relies on subjective measures of health and information on work and family activities from only 1 or 2 time points in the life course. This study investigated associations between work-family life course types (LCTs) and markers of metabolic risk in a British birth cohort study. Methods Multichannel sequence analysis was used to generate work-family LCTs, combining annual information on work, partnership and parenthood between 16 and 42 years for men and women in the British National Child Development Study (NCDS, followed since their birth in 1958). Associations between work-family LCTs and metabolic risk factors in mid-life (age 44-45) were tested using multivariate linear regression in multiply imputed data. Results Life courses characterised by earlier transitions into parenthood were associated with significantly increased metabolic risk, regardless of attachment to paid work or marital stability over the life course. These associations were only partially attenuated by educational qualifications, early life circumstances and adult mediators. The positive association between weak labour markets ties and metabolic risk was weaker than might be expected from previous studies. Associations between work-family LCTs and metabolic risk factors did not differ significantly by gender. Conclusions Earlier transitions to parenthood are linked to metabolic risk in mid-life

Work-family life courses and markers of stress and inflammation in mid-life: evidence from the National Child Development Study.

Background This study investigated associations between work-family life courses and biomarkers of inflammation and stress in mid-life among British men and women. Gender differences in these associations were also explored. Methods A novel statistical method-multi-channel sequence analysis-defined work-family life courses between the ages of 16 and 42 years, combining annual information on work, partnership and parenthood. Associations between work-family life courses and inflammation [C-reactive protein (CRP), fibrinogen and von Willebrand factor] and cortisol at age 44/45 years were tested using multivariate linear regression using multiply-imputed data on almost 6500 participants from the National Child Development Study 1958 British birth cohort. Results Compared with those who combined strong ties to paid work with later transitions to stable family lives ('Work, later family' group), 'Teen parents' had higher CRP [40.6% higher, 95% confidence interval (CI): 5.6, 87.0] and fibrinogen (7.8% higher, 95% CI: 2.3, 13.5) levels, and homemakers ('No paid work, early family') had raised fibrinogen levels (4.7% higher, 95% CI: 0.7, 9.0), independent of childhood health and socioeconomic position, adult socioeconomic position, health behaviours and body mass index (BMI). Those who combined later transitions to stable family ties with a career break for childrearing had higher post-waking cortisol than the 'Work, later family' group; however, no associations were seen for other work-family types, therefore suggesting a null finding with cortisol. No statistically significant gender interactions in associations between work-family types and inflammatory or cortisol outcomes were found. Conclusions Work-family life courses characterised by early parenthood or weak work ties were associated with a raised risk profile in relation to chronic inflammation

Cumulative disadvantage, employment–marriage, and health inequalities among American and British mothers

This paper illuminates processes of cumulative disadvantage and the generation of health inequalities among mothers. It asks whether adverse circumstances early in the life course cumulate as health-harming biographical patterns across the prime working and family caregiving years. It also explores whether broader institutional contexts may moderate the cumulative effects of micro-level processes. An analysis of data from the British National Child Development Study and the US National Longitudinal Survey of Youth reveals several expected social inequalities in health. In addition, the study uncovers new evidence of cumulative disadvantage: Adversities in early life selected women into long-term employment and marriage biographies that then intensified existing health disparities in mid-life. The analysis also shows that this accumulation of disadvantage was more prominent in the US than in Britain

Socioeconomic inequalities in health dynamics: A comparison of Britain and the United States

Drawing on theory and research on the fundamental causes of health, the life course, and the welfare state, we investigate social inequalities in dynamic self-rated health for working-aged Britons and Americans. We use data from the British Household Panel Survey and Panel Study of Income Dynamics (1990-2004) and a mixture latent Markov model to test a theoretical model of health as a discrete state that may remain stable or change over time. Our contributions are threefold. First, our finding of three distinctive types of health processes (stable good health, stable poor health, and a "mover" health trajectory) represents a more differentiated profile of long-term health than previously shown. Second, we characterize health trajectories in structural terms by suggesting who was more likely to experience what type of health trajectory. Third, our more differentiated picture of dynamic health leads to a more nuanced understanding of comparative health: Although the health advantage of Britons was confirmed, our results also indicate that they were more likely to experience health change. Moreover, the socioeconomic gradient in long-term health was steeper in the US, raising provocative questions about how state policies and practices may affect population health.UK USA Health inequalities Mixture latent Markov models Socioeconomic inequalities Health change Self-rated health (SRH)

Returns to work after retirement:a prospective study of unretirement in the United Kingdom

ABSTRACTDespite the complexity of the retirement process, most research treats it as an abrupt and one-way transition. Our study takes a different approach by examining retirement reversals (unretirement) and their predictors. Using the British Household Panel Survey (1991–2008), and following participants into Understanding Society (2010–2015), we undertake a survival analysis to investigate retirement reversals among Britons aged 50–69 years who were born in 1920–1959 (N = 2,046). Unretirement was defined as: (a) reporting being retired and subsequently recommencing paid employment, or (b) beginning full-time work following partial retirement (the latter defined here as reporting being retired and working fewer than 30 hours per week). A cumulative proportion of around 25 per cent of participants experienced a retirement reversal after reporting being retired; about half of these reversals occurred within the first five years of retirement. Unretirement was more common for participants who were male, more educated, in better health, owned a house with a mortgage (compared to owning it outright) and whose partner was in paid work. However, unretirement rates were not higher for participants in greater financial need, whether measured as subjective assessment of finances or household income quintiles. These results suggest that unretirement is a strategy more often used by those who are already advantaged and that it has the potential to exacerbate income inequalities in later life.</jats:p