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

Optimal indicators of socioeconomic status for health research

Objectives: This paper examines the relationship between various measures of SES and mortality for a representative sample of individuals. ; Methods: Data are from the Panel Study of Income Dynamics. Sample includes 3,734 individuals aged 45 and above who participated in the 1984 interview. Mortality was tracked between 1984 and 1994 and is related to SES indicators using Cox event-history regression models. ; Results: Wealth has the strongest associations with subsequent mortality, and these associations differ little by age and sex. Other economic measures, especially family-size-adjusted household income, have significant associations with mortality, particularly for nonelderly women. ; Conclusions: By and large, the economic components of SES have associations with mortality that are at least as strong as, and often stronger than, more conventional components (e.g., completed schooling, occupation).Income distribution

Poster Introductions I--Socioeconomic Inequalities in Health and the Welfare State: A Research Synthesis

Research on the social determinants of health and health inequalities has drawn increasingly from the comparative social policy literature. Much of this research relies on one welfare regime typology, but there is a need to systematically review the efficacy of this and alternative approaches if we are to advance research in this area and provide state-of-the-art information to policy makers. Our paper presents the findings of a critical review of the public health literature on socioeconomic inequalities in health and the welfare state. In addition to synthesizing existing research, we identify knowledge gaps, and address the research and policy implications of existing work. Sarah Brennenstuhl is a 2nd year Ph.D. student at the Dalla Lana School of Public Health, University of Toronto. Sarah\u27s general research interests are the structural determinants of women\u27s health. For her dissertation work, Sarah plans to looks at how the structural changes associated with the dominant political ideology of neo-liberalism have impacted uniquely on women\u27s health in Canada. 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. Amélie Quesnel-Vallée, PhD, is Assistant Professor at McGill University, where she holds an Arts and Medicine cross-faculty appointment in the Departments of Sociology and of Epidemiology. She also heads the International Research Infrastructure on Social inequalities in health (IRIS), funded by the Canada Foundation for Innovation Leaders Opportunity Fund. In 2005, she received the American Sociological Association Dissertation Award for her Fulbright-funded doctoral research. She currently studies the impact of public policies on health inequalities in 21 OECD countries. Her work recently appeared in a book she co-edited, Le privé dans la santé : Les discours et les faits (Presses de l’Université de Montréal, 2008

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

Abstracción, Transformación, e Inspiración. El arte como fuente de conocimiento y creatividad arquitectónica en el taller de diseño

Aunque se ha dicho mucho sobre la relación directa entre el arte y la arquitectura, poco se ha hecho sobre cómo las obras de arte históricamente significativas pueden ser utilizadas como fuentes de inspiración para la producción arquitectónica de hoy. Podemos citar varios análisis históricos y estéticos sobre tales obras de arte y su espíritu particular, pero ¿cómo podría una obra de arte de este tipo iluminar y extender el proceso arquitectónico, las teorías y las ideas actuales? En otras palabras, (1) ¿cómo el pasado (in) (de) (re) forma el presente? y (2) ¿cómo las percepciones de otra disciplina (in) (de) (re) forman el proceso de ideación de nuestra disciplina? Teniendo en cuenta estos pensamientos, se desarrolló una pedagogía para permitir que estudiantes en el comienzo de la carrera de arquitectura se den cuenta de que (1) la arquitectura trata temas e ideas que trascienden lo puramente programático (es decir, ‘funcional’) y lo estereotípicamente formal; (2) las nuevas ideas arquitectónicas pueden provenir de fuentes no arquitectónicas del pasado; (3) las ideas se descubren y evolucionan a través de un proceso crítico por etapas, en oposición a un acto singular de explicación; y (4) el papel del arquitecto/diseñador es interpretar, en lugar de imitar, el entorno, la cultura, la tradición, etc.Although much has been said about the direct relationship between art and architecture, little has been done regarding how historically significant works of art may be utilized as sources of inspiration for the architectural production of today. We may cite several historical and aesthetic analyses on such works of art and their particular zeitgeist, but how might such a work of art illuminate and extend today’s architectural process, theories and ideas? In other words, (1) how does the past (in)(de)(re)form the present? and (2) how do another discipline’s insights(in)(de)(re)form our discipline’s process of ideation? Having these thoughts in mind, a pedagogy was developed tomake students realize that (1) architecture deals with issues and ideas that transcend the purely programmatic (i.e.,’functional’) and the stereotypically formal; (2) new architectural ideas may come from old and non-architectural sources; (3) ideas are discovered and evolve through a staged critical process, as opposed to a singular act of explanation ; and (4) the role of the architect/designer is one of interpreter, as opposed to imitator, of one’s surroundings, culture, tradition, etc.Embora tenha sido dito muito sobre a relação direta entre arte e arquitetura, pouco foi feito sobre como as obras de arte historicamente significativas podem ser usadas como fontes de inspiração para a produção arquitetônica atual. Podemos citar várias análises históricas e estéticas de tais obras de arte e seu espírito particular, mas como essa obra de arte poderia iluminar e estender o processo arquitetônico, as teorias e idéias atuais? Em outras palavras, (1) como o passado (in) (de) (re) forma o presente? e (2) como as percepções de outra disciplina (in) (de) (re) formam o processo de ideação de nossa disciplina? Levando esses pensamentos em consideração, uma pedagogia foi desenvolvida para permitir que os alunos no início da carreira de arquitetura percebam que (1) a arquitetura aborda questões e idéias que transcendem o puramente programático (ou seja, ‘funcional’) e o estereotipicamente formal; (2) novas idéias arquitetônicas podem vir de fontes não arquitetônicas do passado; (3) idéias são descobertas e evoluídas através de um processo crítico em estágios, em oposição a um ato singular de explicação; e (4) o papel do arquiteto / designer é interpretar, ao invés de imitar, o ambiente, a cultura, a tradição et

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