Sara Arber

Gender differences in health in later life: the new paradox?

This paper examines gender differences in health, based on data from over 14,000 men and women aged 60 and above from 3 years of the British General Household Survey, 1992-1994. There is little difference between the sexes in the reporting of self-assessed health and limiting longstanding illness, but older women are substantially more likely to experience functional impairment in mobility and personal self-care than men of the same age. These findings persist after controlling for the differential social position of men and women according to their marital status, social class, income and housing tenure. The results reveal a paradox in health reporting among older people; for a given level of disability, women are less likely to assess their health as being poor than men of the same age after accounting for structural factors. Older womens much higher level of functional impairment co-exists with a lack of gender difference in self-assessed health.

Class, paid employment and family roles: Making sense of structural disadvantage, gender and health status☆

The British tradition of analysing differences in health has been dominated by class, with women belatedly entering this debate. The American tradition has been dominated by role analysis, with womens health considered primarily in terms of their marital, parental and employment roles, with recent research coming to contradictory conclusions. Research in both traditions has reached an impasse. This paper uses a sample of over 25,000 men and women from the 1985 and 1986 British General Household Survey to show how both traditions need to be reformulated and integrated. The ways in which family roles are associated with womens health status is determined by material circumstances, but the material circumstances cannot be captured by occupational class alone. Participation in the labour market and consumption divisions, in the form of housing tenure, are crucial additional indicators of structural disadvantage. Standardised limiting long-standing illness ratios and multivariate logit analysis confirm that occupational class and paid employment are the most important attributes associated with health status for women and men. Family roles are important for women; women without children and previously married women have particularly poor health status especially those not in paid employment and living in local authority housing.

Comparing inequalities in women's and men's health: Britain in the 1990s

Data on over 20,000 women and men aged 20-59 are analysed from the British General Household Survey for 1991 and 1992, showing the importance of separately analysing educational qualifications, occupational class and employment status for both women and men. Own occupational class and employment status are the key structural factors associated with limiting long-standing illness, but educational qualifications are particularly good predictors of womens self-assessed health. Class inequalities in health are less pronounced among women who are not in paid work. Womens limiting long-standing illness relates solely to their own labour market characteristics, whereas self-assessed health relates to wider aspects of womens everyday lives, including their household material conditions, and for married women, their partners occupational class and employment status. Mens unemployment has adverse consequences for the health of their wives, which occurs through the mechanism of the family living in disadvantaged material circumstances. Womens labour market position and role in the family have undergone substantial changes since the 1970s. Approaches to measuring inequalities in womens health need to reflect changes in womens employment participation and changes in marital status and living arrangements.

MULTIPLE ROLES AND HEALTH AMONG BRITISH AND FINNISH WOMEN: THE INFLUENCE OF SOCIOECONOMIC CIRCUMSTANCES *

Two contrasting hypotheses have been presented to predict womens health variations. The Multiple burden hypothesis predicts that combining a paid job, being married, and having children is likely to be detrimental to womens health. The multiple attachment hypothesis predicts that multiple roles provide attachment to the community, which is likely to be beneficial to womens health. These hypotheses are examined in Britain and Finland, which have different patterns of womens employment participation. Lone mothers form a critical case, since they have fewer attachments and greater burdens, and therefore are expected to have poorer health. The socioeconomic position of lone mothers differs in Britain and Finland, but in both societies they are likely to have fewer attachments. We assess the extent to which health variations between women with different family and parental role combinations are because of the differences in their socioeconomic status and material circumstances. Comparable surveys from Britain and Finland from 1994 were used. Perceived general health and limiting long-standing illness were analysed for working age women (20-49 years) by family type and employment status. as well as other socioeconomic variables. In both countries, women living in two parent families and having children had better health than women living in other family types or on their own. Lone mothers form a disadvantaged group and showed overall worse health in both countries. Adjusting for employment status. education and household income weakened the association between family type and poor health. The findings are broadly in accordance with the multiple attachment hypothesis. Despite the more generous welfare state and high full-time employment among Finnish women, single lone mothers report poorer health than other women in Finland as well as in Britain. However, in Britain the disadvantaged social position of lone mothers accounts for a greater proportion of their poor health than in Finland.

Gender and socio-economic patterning of self-reported sleep problems in Britain.

Sleep is fundamental to health and well-being, yet relatively little research attention has been paid to sleep quality. This paper addresses how socio-economic circumstances and gender are associated with sleep problems. We examine (i) socio-economic status (SES) patterning of reported sleep problems, (ii) whether SES differences in sleep problems can be explained by socio-demographic characteristics, smoking, worries, health and depression, and (iii) gender differences in sleep problems, addressing the relative contribution of SES, smoking, worries, health and depression in explaining these differences. Logistic regression is used to analyse the British Psychiatric Morbidity Survey 2000, which interviewed 8578 men and women aged 16-74. Strong independent associations are found between sleep problems and four measures of SES: household income, educational qualifications, living in rented housing and not being in paid employment. Income differences in sleep problems were no longer significant when health and other characteristics were adjusted. The higher odds of sleep problems among the unemployed and adults with low education remained significant following adjustment. Women reported significantly more sleep problems than men, as did the divorced and widowed compared with married respondents. Gender differences in sleep problems were halved following adjustment for socio-economic characteristics, suggesting that SES inequalities play a major part in accounting for gender differences in sleep problems. Our study casts doubt on the primacy of physiological explanations underlying these gender differences. Since disadvantaged socio-economic characteristics are strongly associated with sleep problems, we conclude that disrupted sleep may be a mechanism through which low SES is linked to poor health.

Use of health services by children and young people according to ethnicity and social class: secondary analysis of a national survey

Abstract Objective To assess whether equity is achieved in use of general practitioner, outpatient, and inpatient services by children and young people according to their ethnic group and socioeconomic background. Design Secondary analysis of the British general household survey, 1991-94. Subjects 20 473 children and young people aged between 0 and 19 years. Main outcome measures Consultations with a general practitioner within a two week period, outpatient attendances within a three month period, and inpatient stays during the past year. Results There were no significant class differences in the use of health services by children and young people, and there was little evidence of variation in use of health services according to housing tenure and parental work status. South Asian children and young people used general practitioner services more than any other ethnic group after controlling for socioeconomic background and perceived health status, but the use of hospital outpatient and inpatient services was significantly lower for children and young people from all minority ethnic groups compared with the white population. Conclusions Our results differ from previous studies, which have reported significant class differences in use of health services for other age groups. We found no evidence that children and young peoples use of health services varied according to their socioeconomic status, suggesting that equity has been achieved. A child or young persons ethnic origin, however, was clearly associated with use of general practitioner and hospital services, which could imply that children and young people from minority ethnic groups receive a poorer quality of health care than other children and young people.

Sleepers Wake! The Gendered Nature of Sleep Disruption among Mid-life Women

This article provides a window onto the gendered nature of our lives through the study of sleep. Drawing on empirical data from focus groups and audio sleep diaries, the article explores sleep from the perspective of mid-life women. It shows that sleep is a socially patterned phenomenon which reflects the gendered nature of women’s multiple roles and responsibilities. For many women in mid-life, the reality of sleep is one of disruption, with the bedroom becoming an ‘invisible workplace’ in which women’s sleep needs are compromised by the unpaid physical and emotional labour necessary for the well-being and maintenance of their family.The article suggests that the sleep context may represent a further arena in which gender inequalities are manifest, both in relation to the patterns of women’s sleep and in women’s responses to sleep disruption.

Understanding income inequalities in health among men and women in Britain and Finland.

The aims of this study were to investigate whether the relationship between income and self-perceived health is similar for men and women in two contrasting welfare states, Britain and Finland; whether the relationship between income and health is accounted for by employment status, education, and occupational social class; and whether the association differs when using alternative ways of measuring income: gross individual and net household equivalent income. Among British and Finnish men, low household and low individual income were related to poor health, even after adjusting for employment status, education, and social class. The adjusted relationship between individual income and health was stronger for British than Finnish men. Among British and Finnish women, net household equivalent income was strongly related to health, but after adjusting for employment status, education, and social class this relationship became weaker for British women and practically disappeared for Finnish women. For British women the association between income and health differed strongly depending on the income measure used; gross individual income had almost no effect on health. These results indicate that the association between health and income has no threshold in the sense that only people in poverty have poorer health than others. In further studies of income and health, household equivalent income should be used as the principal measure of income with adjustments for employment status, and men and women should be studied separately.

The Meaning of Informal Care: Gender and the Contribution of Elderly People

‘Caring’ and ‘carers’ are words in frequent use in social policy, but their meaning is often vague and undefined, encompassing a wide range of activities and relationships. This paper discusses the meaning of caring and focuses particular attention on older carers. Secondary analysis of the 1985 Office of Population, Censuses and Surveys (OPCS) Informal Carers Survey data shows that of the estimated six million informal carers in Britain, the largest contribution is made by women in their early 60s, and that elderly men are more likely than younger men to be carers. The bulk of informal caring work, in terms of total time spent, is provided by co-resident carers, most of whom are a spouse or parent of the dependant. However, the largest number of those receiving help live in separate households, and these are mainly parents or parents-in-law of their carers. The emphasis on elderly people as a ‘social burden’ neglects their contribution as providers of informal care. Over a third of informal care to people over 65 is provided by elderly people. Elderly men and women provide equal amounts of co-resident care, reflecting gender equality in the care of elderly spouses. But among younger people marked gender differences are apparent in co-resident care, and in the provision of informal care to elderly people living in separate households.

Sleep complaints in middle-aged women and men: the contribution of working conditions and work-family conflicts.

This study aimed to examine how physical working conditions, psychosocial working conditions and work–family conflicts are associated with sleep complaints, and whether health behaviours explain these associations. We used pooled postal questionnaire surveys collected in 2001–2002 among 40–60‐year‐old employees of the City of Helsinki (n = 5819, response rate 66%). Participants were classified as having sleep complaints if they reported sleep complaints at least once a week on average (24% of women and 20% of men). Independent variables included environmental work exposures, physical workload, computer work, Karasek’s job strain and work–family conflicts. Age, marital status, occupational class, work arrangements, health behaviours and obesity were adjusted for. Most working conditions were associated strongly with sleep complaints after adjustment for age only. After adjustment for work–family conflicts, the associations somewhat attenuated. Work–family conflicts were also associated strongly with women’s [odds ratio (OR) 5.90; confidence interval (CI) 4.16–8.38] and men’s sleep (OR 2.56; CI 1.34–4.87). The associations remained robust even after controlling for unhealthy behaviours, obesity, health status, depression and medications. Physically strenuous working conditions, psychosocial job strain and work–family conflicts may increase sleep complaints. Efforts to support employees to cope with psychosocial stress and reach a better balance between paid work and family life might reduce sleep complaints. Sleep complaints need to be taken into account in worksite health promotion and occupational health care in order to reduce the burden of poor sleep.