Andrea E. Willson

Cumulative Advantage Processes as Mechanisms of Inequality in Life Course Health1

While there is consistent evidence that inequality in economic resources follows a process of cumulative advantage, the application of this framework to another aspect of life course inequality, health, has not produced consensus. This analysis uses longitudinal data from the Panel Study of Income Dynamics to examine the over‐time relationship between health and socioeconomic status, considering how multiple dimensions of socioeconomic resources and economic history are related to health disparities as people age. The authors find cautious support for path‐ and duration‐dependent processes of cumulative advantage in health. Results suggest that in studies of mechanisms of inequality over time, the cumulative advantage process may appear to be bounded by age because of the disproportionate attrition and mortality of those with low socioeconomic status.

Cumulative Disadvantage and Black-White Disparities in Life-Course Health Trajectories

In this study, the authors use longitudinal data from the Panel Study of Income Dynamics and growth curve models to examine the utility of the concept of cumulative disadvantage as an explanation for race differences in life-course health (self-rated) in the United States. The authors ask whether socioeconomic resources equally benefit the health of Blacks and Whites, or if Whites receive higher rates of return to resources across the life course. The authors find that the relationship differs depending on the indicator of socioeconomic status that is examined. Education does not offer the same advantages for the health of Blacks as it does for Whites, particularly at higher levels of education, and this is compounded with age. In contrast, returns to income and wealth are similar for Blacks and Whites, and these resources remain equally important to protecting the health of Blacks and Whites across the life course. Over time, Blacks are at an increasing health disadvantage relative to Whites, a result that is not attenuated by educational attainment.

Ambivalence in Mother-Adult Child Relations: A Dyadic Analysis.

The concept of ambivalence represents an interactional process in which individuals evaluate social relations as simultaneously positive and negative. This study investigates ambivalence in interpersonal relations through an empirical analysis of relationships between aging mothers and their adult children from their joint perspectives. Multilevel models examine the influence of dependence on levels of ambivalence in relationship dyads as well as differences in levels of ambivalence between mothers and their adult children. Results suggest that ambivalence increases under conditions of potential dependence, rather than through the help that is more routinely exchanged among family members. Within the relationship, mothers experienced less ambivalence than their sons and daughters; overall findings demonstrate the importance of analyzing multiple perspectives in social relationships.

Patterns of Cumulative Abuse Among Female Survivors of Intimate Partner Violence Links to Women’s Health and Socioeconomic Status

Drawing on the Women’s Health Effects Study, a community sample of women (N = 309) who recently left an abusive partner, this study examines patterns of cumulative abuse experiences over the life course, their socioeconomic correlates, and associations with a range of health outcomes. Latent class analysis identified four groups of women with differing cumulative abuse profiles: Intimate Partner Violence (IPV) Dominant, Child Abuse and IPV, All Forms, and All Forms Extreme. We find a relationship pattern between cumulative abuse and socioeconomic circumstances, and significantly worse health outcomes among women with the All Forms Extreme profile. Implications for research and practice are discussed.

Life Course Approaches to Health, Illness and Healing

The life course perspective provides a theoretical framework, concepts, and analytical tools for examining how individual lives unfold in historical and institutional contexts. Nearly a half century ago, C. Wright Mills described the task and promise of the sociological imagination as the ability to “grasp history and biography and the relations between the two” (Mills 1959: 6). In the intervening decades since Mills’ plea for the sociological imagination, life course scholars have illuminated both the challenge and promise of this endeavor, focusing on the importance of a dynamic view of individuals and their social contexts. The growth of a wide array of large, longitudinal data collections and the increasing availability of a wide range of statistical tools for longitudinal analysis have made attention to the dynamics of lives in context increasingly possible. In turn, interest in innovative methodologies and the availability of large, national data sets that focus on particular life stages, such as adolescence, midlife, or later life, have encouraged more scholars to incorporate elements of life course perspective in their research.

Family structure and mothers’ mental health: A life course perspective on stability and change☆

Abstract We describe how a life course perspective can be used to examine the intersection of various patterns of stability or change in family structure over the life course with womens trajectories of psychological distress. Our approach in this chapter addresses both conceptual issues and methodological developments that we believe can advance our understanding of the intricate interplay between social structure and mental health over the life course. With information derived from life history calendars and a 14-year longitudinal study of a large sample of single and married mothers, we demonstrate how latent class cluster analysis can be used to construct trajectories of both family structure and psychological distress. We contend that such trajectories capture the dynamics of change over the life course. We conclude with a discussion of the ways in which four kinds of experiences may assist us in explaining variations in these trajectories. We argue that adversities in childhood and adolescence, precocious role transitions, early onset of depression, and the operant burden of stress each play important roles in influencing trajectories of family structure and psychological distress.

Economic hardship in childhood and adult health trajectories: An alternative approach to investigating life-course processes.

In this study, we advance existing research on health as a life course process by conceptualizing and measuring both childhood disadvantage and health as dynamic processes in order to investigate the relationship between trajectories of early life socioeconomic conditions and trajectories of health in midlife. We utilize a trajectory-based analysis that takes a disaggregated, person-centered approach to understand dynamic trajectories of health as latent variables that reflect the timing, duration and change in health conditions experienced by respondents over a period of 10 years in midlife as a function of stability and change in exposure to economic hardship in early life. Results from repeated-measures latent class analysis of longitudinal data from the Panel Study of Income Dynamics indicate that economic hardship in childhood has long-term, negative consequences for health both among individuals beginning life and remaining in poverty as well as those moving into poverty. In contrast, adults with more advantaged early life experiences, or who moved out of poverty during the period of observation, were at a lower risk of experiencing health trajectories characterized by the early onset or increasing risk of disease. We argue that a person-centered, disaggregated approach to the study of the relationship between socioeconomic status and health across the life course holds potential for the study of health inequality and that a greater focus on trajectory-based analysis is needed.

Life Course Pathways of Economic Hardship and Mobility and Midlife Trajectories of Health.

We utilize over 40 years of prospective data from the Panel Study of Income Dynamics (N = 1,229) and repeated-measures latent class analysis to examine how long-term patterns of stability and change in economic hardship from childhood to adulthood are related to subsequent trajectories of midlife health. We review conceptual and methodological approaches to examining health inequality across the life course and highlight the contribution of a person-centered, disaggregated approach to modeling health and its association with long-term pathways of economic resources, including changing resources associated with mobility. Findings suggest those who experienced early mobility out of economic hardship were less likely than those in persistent economic hardship to experience a high-risk health trajectory, while experiencing later mobility did not lessen this risk. We conclude with a call for further investigation into the role of social mobility and the timing, degree, and direction of change in investigations of health inequality.

Health Inequalities Among Older Adults In Developed Countries: Reconciling Theories and Policy Approaches

The extension in high-income countries of systems of income support and access to health care for large, if not all, segments of the elderly population undoubtedly counts as one of major successes of public policy over the past century. It is perhaps not surprising then to note that today’s elderly find themselves in much better health than their parents and grandparents did in their older age. Indeed, relative to the past, older populations in developed countries have improved functioning and are afflicted with less disability on average; however, these improvements may not have been equally gained across the elderly population. Indeed, the body of literature regarding health inequalities among the elderly is growing as the assumption that the older population is a rather homogeneous group in this regard is increasingly discarded.

A Longitudinal Analysis of the Intergenerational Transmission of Health Inequality

Objectives Empirical investigations of cumulative dis/advantage typically treat health inequality as an intraindividual process rooted in early-life conditions and operating within the span of the individual life course, while literature on processes of intergenerational transmission has historically focused on socioeconomic mobility, largely overlooking health. The current study examines the persistence of work disability across generations and multiple explanations for this relationship, including the role of early-life disadvantage, childhood health, educational attainment, and social mobility. Methods We model latent classes of midlife work disability characterized by timing and stability using longitudinal data from the intergenerational component of the U.S. Panel Study of Income Dynamics (N = 3,328). Latent class analysis captures the initial risk of experiencing a work disability and how this risk changes across mid-life as a function of early-life conditions, childhood health, educational attainment, mobility, and parents work disability. Results Early disadvantage, childhood health, and educational attainment were associated with patterns of midlife work disability, and although upward mobility provided some protection, intergenerational continuity in health remained net of all of these factors. Discussion Findings support the importance of looking beyond the individual life course to the transmission of health inequality across generations within families.