Peggy McDonough

Optimal Indicators of Socioeconomic Status for Health Research

OBJECTIVES In this study we examined the relationship between indicators of socioeconomic status (SES) and mortality for a representative sample of individuals. METHODS The sample included 3734 individuals aged 45 and older interviewed in 1984 in the Panel Study of Income Dynamics. In the current study, mortality was tracked between 1984 and 1994 and is related to SES indicators of education, occupation, income, and wealth. RESULTS Wealth and recent family income were the indicators that were most strongly associated with subsequent mortality. These associations persisted after we controlled for the other SES indicators and were stronger for women than for men and for non-elderly than for elderly individuals. CONCLUSIONS We found that the economic indicators of SES were usually as strongly associated with mortality as, if not more strongly associated with mortality than, the more conventional indicators of completed schooling and occupation.

Relationship between all-cause mortality and cumulative working life course psychosocial and physical exposures in the United States labor market from 1968 to 1992.

Objective To examine the relationship between cumulative exposures to psychosocial and physical work conditions and mortality in a nationally representative sample. Methods A working cohort was created using the U.S. Panel Study of Income Dynamics. Information on psychosocial and physical work conditions were imputed using the Job Characteristics Scoring System exposure matrix for the period 1968 through 1991 to construct working life courses. Deaths were ascertained from 1970 through 1992. Results Working in low-control jobs for a working life was associated with a 43% increase in the chance of death (OR, 1.43, 1.13–1.81) assuming a 10-year time lag. No significant effect was found for high-strain work (ie, high psychosocial job demands and low job control), but a relationship was found between passive work (ie, low psychosocial job demands and low job control) and mortality (OR, 1.35, 1.06–1.72). No significant risk of death was found for psychosocial or physical job demands, job security, or work-related social support. Retirement (OR, 2.85, 1.59–5.11) and unemployment (OR, 2.26, 1.65–3.10) transitions and baseline disability (OR, 1.38, 1.06–1.79) predicted mortality. Conclusions The results support the importance of job control to health. The passive work effect suggests that job content may be important in shaping a worker’s health over the life course. Future research should focus on modeling stressors over the life course to capture the dynamic interplay of life transitions, stressor intensity and duration and the role of health in the interplay.

Job insecurity and health.

As employers respond to new competitive pressures of global capitalism through layoffs and the casualization of labor, job insecurity affects a growing number of workers. It appears to harm mental health, but less is known about its effects on physical health and health behaviors and the mechanisms through which it may act. The prevailing individual-centered conceptualization of job insecurity as the perception of a threat to job continuity precludes systematic investigation of the social patterning of its health effects. Analysis of data from a 1994 Canadian national probability sample of adults determined that high levels of job insecurity lowered self-rated health and increased distress and the use of medications, but had no impact on heavy drinking. The findings support one possible mechanism of action whereby job insecurity reduces feelings of control over ones environment and opportunities for positive self-evaluation; these psychological experiences, in turn, have deleterious health consequences. There is little evidence of social patterning of this relationship by gender, education, household income, age, marital status, and social support at work.

Welfare regimes, population health and health inequalities: a research synthesis

Background Research on the social determinants of health is increasingly using welfare regime theory. Although a key argument is that population health will be better and health inequalities lower in social democratic regimes than in others, this research has not been subjected to a systematic review. This paper identifies and assesses empirical studies that explicitly use a welfare regime typology in comparative health research. Methods 15 electronic databases and relevant bibliographies were searched to identify empirical studies published in English-language journals from January 1970 to February 2011. Thirty-three studies appearing in 14 peer-reviewed journals between 1994 and 2011 met the inclusion criteria. Results Three welfare regime typologies and their variants dominated existing work, which consisted of two broad study types: One compared population health and health inequalities across welfare regimes; the other considered relationships between health and the political determinants and policies of welfare regimes. Studies were further distinguished by the presence or absence of statistical significance testing of relationships of interest. Just under one half of studies comparing outcomes by regime found at least some evidence that health inequalities were lowest or population health was the best in social democratic countries. Studies analysing the relationship between health (mortality) and the political determinants or policies of welfare states were more likely to report results consistent with welfare regime theory. Conclusions Health differences by regime were not always consistent with welfare regime theory. Measurement of policy instruments or outcomes of welfare regimes may be more promising for public health research than the use of typologies alone.

Population Health in Canada: A Brief Critique

An internationally influential model of population health was developed in Canada in the 1990s, shifting the research agenda beyond health care to the social and economic determinants of health. While agreeing that health has important social determinants, the authors believe that this model has serious shortcomings; they critique the model by focusing on its hidden assumptions. Assumptions about how knowledge is produced and an implicit interest group perspective exclude the sociopolitical and class contexts that shape interest group power and citizen health. Overly rationalist assumptions about change understate the role of agency. The authors review the policy and practice implications of the Canadian population health model and point to alternative ways of viewing the determinants of health.

Social influences on trajectories of self-rated health: evidence from Britain, Germany, Denmark and the USA

Background This study investigates social inequalities in self-rated health dynamics for working-aged adults in four nations, representing distinct welfare regime types. The aims are 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. Methods Data are from national household panel surveys in Britain, Germany, Denmark and the USA. The self-rated health of working-age respondents is measured for the years 1995–2001. Social indicators include education, occupational class, employment status, income, age, gender, minority status and marital status. Latent growth curve models are used to estimate both individual change and average national trajectories of self-rated health, conditioned on the social indicators. Results Ageing-vector graphs reveal general declines in health as people age. They also show differential patterns of change for specific national cohorts. Older cohorts in Denmark had poorer health and young cohorts in the USA had better health in 2001 than 1995. Social covariates predicted baseline health in all four countries, in ways that were consistent with welfare regime theories. Once inequalities in baseline health were accounted for, the few determinants of mean health decline occurred mainly in the USA, again in line with theoretical expectations. Finally, trajectories of health for those in average and advantaged social circumstances were similar, but disadvantaged individuals had much poorer health trajectories than ‘average’ individuals. The differences were greatest in the countries with lower levels of public transfers. Conclusion National differences in self-rated health trajectories and their social correlates may be attributed partly to welfare policies.

Self-Rated Health Trajectories in the United States and the United Kingdom: A Comparative Study

OBJECTIVES We reviewed literature on comparative social policy and life course research and compared associations between health and socioeconomic circumstances during an 11-year period in the United States and the United Kingdom. METHODS We obtained data from the US Panel Study of Income Dynamics and the British Household Panel Survey (1990-2002). We used latent transition analysis to examine change in self-rated health from one discrete state to another; these health trajectories were then associated with socioeconomic measures at the beginning and at the end of the study period. RESULTS We identified good and poor latent health states, which remained relatively stable over time. When change occurred, decline rather than improvement was more likely. UK populations were in better health compared with US populations and were more likely to improve over time. Labor market participation was more strongly associated with good health in the United Kingdom than in the United States. CONCLUSIONS National policies and practices may be keeping more US workers than UK workers who are in poor health employed, but British policies may give UK workers the chance to return to better health and to the labor force.

Healthcare use before and after a workplace injury in British Columbia, Canada

Objectives: There is growing evidence that occupational injuries influence workers’ emotional and physical wellbeing, extending healthcare use beyond what is covered by the Workers’ Compensation Board (WCB). Methods: The authors used an administrative database that links individual publicly funded healthcare and WCB data for the population of British Columbia (BC), Canada. They examined change in service use, relative to one year before the injury, for workers who required time off for their injuries (lost time = LT) and compared them to other injured workers (no lost time = NLT) and individuals in the population who were not injured (non-injured = NI). Results: LT workers increased physician visits (22%), hospital days (50%), and mental healthcare use (43% physician visits; and 70% hospital days) five years after the injury, relative to the year before the injury, at a higher rate than the NI group. For the NLT workers, the level of increased use following the injury was between that of these two groups. These patterns persisted when adjusting for registration in the BC Medical Service Plan (MSP) and several workplace characteristics. Conclusions: Although the WCB system is the primary mechanism for processing claims and providing information about workplace injury, it is clear that the consequences of workplace injury extend beyond what is covered by the WCB into the publicly funded healthcare system.

Age and the gender gap in distress.

ABSTRACT Women report more psychological distress than men and recent evidence suggests that this gap increases with age. It has been argued that the widening differential in distress reflects the progressive and cumulative nature of womens disadvantaged work and family roles. Drawing on the cumulative disadvantage hypothesis and social stress theory, we test: (1) whether exposure to chronic stress accounts for an increasingly larger proportion of the gender effect on distress with age; and (2) whether women are increasingly more vulnerable to the effects of chronic stress on distress with age. Data are from the 1994 wave of the Canadian National Population Health Survey, a national probability sample of women and men aged 20 and older (N = 13,798). Exposure to long-term stress helps us understand gender differences in distress for those in their pre-retirement years. However, contrary to the cumulative disadvantage hypothesis, the model became increasingly less likely to explain such differences with age. Gendered vulnerability to long-term stress was not evident in the sample. The implications of these findings are discussed with particular reference to our ongoing efforts to understand health in the context of social structure and subjectivity.

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

Life 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 womens 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.