Stefanie Sperlich

Sozialepidemiologische Erklärungsansätze im Spannungsfeld zwischen Schicht-und Lebensstilkonzeptionen Plädoyer für eine integrative Betrachtung auf der Grundlage der Bourdieuschen Habitustheorie

ZusammenfassungDie Sozialstrukturforschung der 80er Jahre war gekennzeichnet durch eine zunehmende Infragestellung der klassischen Sozialstrukturmodelle in Gestalt von Klassen-und Schichtkonzeptionen. Mit dem Verweis auf die Erscheinungen des sozialen Wandels, wie Pluralisierung der Lebensformen und Diversifizierung von Lebensbedingungen, wurde die Erklärungskraft dieser Gesellschaftsmodelle zunehmend in Zweifel gezogen. In der Reaktion entstanden Neukonzeptionen in Form von Lebensstil-und Milieumodellen, die in Abkehr zu den klassischen Konzeptionen subjektive Sozialstrukturdimensionen, wie Lebensstile und Wertorientierungen, in den Mittelpunkt rückten. Diese Umorientierung hat auch die Sozialepidemiologie nicht unberührt gelassen. Obwohl nach wie vor Zusammenhänge zwischen der sozialen Lage und den Gesundheitschancen nachgewiesen wurden, stand auch hier die Frage zur Disposition, ob die konventionellen Schicht-und Klassenmodelle noch in der Lage sind, die heterogenen Gesundheitsdeterminanten zu erfassen oder ob dies nicht die alternativen Milieu-und Lebensstilkonzeptionen besser leisten können. Damit einhergehend stand auch der, verhältnisbezogene Erklärungsansatz ’für die Entstehung gesundheitlicher Ungleichheit zur Disposition. In den letzten Jahren mehrt sich nunmehr die Kritik an den Neukonzeptionen, die sich vor allem auf die Vereinseitigungen der Subjektdimension bezieht. Inzwischen ist der Höhepunkt in der Auseinandersetzung überschritten und die Diskussion hat insgesamt an Brisanz verloren. Trotzdem ist die Frage nach den sozialstrukturell relevanten Ungleichheitsdimensionen immer noch ungeklärt und die Unsicherheit bei der konzeptionellen Ausgestaltung einer Sozialstrukturanalyse entsprechend hoch. In diesem Beitrag wird für den Bereich der sozialepidemiologischen Forschung eine Weiterführung der Diskussion angeregt und für eine Integration sowohl, alter ’als auch, neuer ’ für die Sozialepidemiologie relevanten Sozialstrukturdimensionen im Rahmen eines Mehrebenenmodells plädiert. Gleichzeitig werden damit die beiden Haupterklärungsansätze der Verhältnis-und verhaltensbezogenen Verursachung sozial bedingter gesundheitlicher Ungleichheit in einen systematischen Zusammenhang gebracht. Dazu werden die Kernargumente der jüngsten Debatte in der Sozialstrukturforschung noch einmal aufgerollt und dabei die Unzulänglichkeiten einer einseitigen Betrachtung sowohl der alten als auch der neuen Modelle herausgestellt. Als Ausgangspunkt für ein integratives Mehrebenenmodell wird die Bourdieusche Habitustheorie vorgestellt, in der eine vermittelnde Perspektive zwischen den traditionellen und den neuen Konzeptionen angelegt ist. Auf dieser Konzeption aufbauend wird schließlich ein Mehrebenenmodell entwickelt, welches die gesundheitsrele-vanten Variablen der neuen und alten Sozialstrukturmodelle und damit die beiden zentralen sozialepidemiologischen Erklärungsansätze in einen integrativen und theoretisch fundierten Zusammenhang stellt.AbstractSince the 1980’s the sociological discussion on the social structure was characterised by questioning the old hierarchical model that distinguishes population groups by their education, occupation and/or income. Referring to the pluralisation of lifestyles and living conditions the old model was increasingly believed to be outdated. This is why new models based on lifestyles and value orientations were developed. This change of perspective did also have an effect on social epidemiology. Although the empirical studies still showed large health inequalities by education, occupation and income, an increasing number of researchers questioned if these classical dimensions of social inequality should be replaced by ‘new’ dimensions such as lifestyles and value orientations. The discussion entered a new phase now, as some sociologists and many social epidemiologists stress that the old dimensions are still important and that the new dimensions should not replace but supplement the old ones. Today the old and the new model of social structure seem to be rather unconnected, there is very little integration between these two concepts and the researchers seem to choose either one approach or the other. In this paper we are trying to promote the discussion from a social epidemiological perspective. In a first step the advantages and disadvantages of the previous discussion are summarised. In a second step we are proposing an integrated model based on Bourdieus habitus theory. Of course this is only a first step towards developing a more comprehensive explanatory model in social epidemiology, but we believe that this is the right direction.

Soziale Lebenssituation und Gesundheit von Müttern in Deutschland

ZusammenfassungIm Mittelpunkt der vorliegenden Studie steht die Frage, welche sozialen und familiären Lebensbedingungen mit erhöhten gesundheitlichen Beeinträchtigungen von Müttern verbunden sind. Anhand einer für die Merkmale Bundesland, Schulbildung, Erziehungsstatus, Alter der Mutter und Kinderzahl repräsentativen Bevölkerungsstichprobe (n=3129) wurden dazu körperliche und Allgemeinbeschwerden, Angst und Depressivität sowie die subjektive Gesundheit von Frauen mit minderjährigen Kindern untersucht. Die Analysen ergaben, dass 27% der Mütter Beeinträchtigungen im körperlichen und Allgemeinbefinden, 21% erhöhte Angst- und 22% erhöhte Depressivitätswerte aufwiesen. Gut 6% schätzten ihren Gesundheitszustand als (sehr) schlecht ein. Insbesondere Ein-Elternschaft, Arbeitslosigkeit, die alleinige Verantwortung für die Haus- und Familienarbeit sowie ein geringes Einkommen und geringe Schulbildung konnten als Risikofaktoren für die psychische und körperliche Gesundheit identifiziert werden. Die Befunde verdeutlichen, dass die Lebensphase der Familiengründung und Kindererziehung für spezifische Frauengruppen mit erhöhten Gesundheitsrisiken verbunden ist. Sie verweisen auf die Relevanz einer lebensphasensensiblen Analyse gesundheitlicher Ungleichheit unter Einbeziehung lebenslaufspezifischer Stressoren.AbstractThis paper reports findings from a population sample of mothers with underage children living in Germany (n=3,129). The objective of the study was to analyze whether social and familiar living conditions are associated with enhanced health risks for mothers. The sample is representative with respect to German federal states, school education, marital status, age of mothers, and number of children. Health problems were assessed in terms of physical disabilities and discomforts, anxiety and depression, and self-rated health. About 27% of mothers perceived physical disabilities and discomfort, 21% reported high levels of anxiety, and 22% high levels of depression. About 6% assessed their health as poor or very poor. Particularly single motherhood, unemployment, sole responsibility for household and family as well as low income and low school education increased the risk of poor health. The findings suggest that for specific subgroups of mothers parenting may be a vulnerable phase of life reflecting the need for a life stage orientation in health inequality research.

Kompression oder Expansion der Morbidität

BACKGROUND Within the context of demographic change, the development of morbidity among the older population has increasingly gained importance. In this respect, three different scenarios of the development of morbidity are discussed: the compression of morbidity, the dynamic equilibrium, and the expansion of morbidity. OBJECTIVES This paper investigates in which way subjective and functional health have developed among the older population between 1997 and 2010. MATERIALS AND METHODS Using German Socio-Economic Panel (GSOEP) data, the developments of subjective and functional health are examined in cross-sectional comparisons. The age groups between 65 and 89 are considered. Analyses are stratified according to gender and age. RESULTS In comparing different cohorts, men and women from younger cohorts report better subjective and functional health compared to people born before them. Concerning subjective health, this trend mostly affects younger people (65-74 years). Elderly subjects (aged 75-89 years) in the cohort comparison between 1997 and 2010 report no improvements in subjective health. In contrast, functional health between the cohorts affected all age groups in a similar manner. CONCLUSION Results for subjective and functional health are consistent with the compression of morbidity and the dynamic equilibrium and they do not point towards an expansion of morbidity.

[Social living conditions and health among mothers in Germany : findings from a population sample].

ZusammenfassungIm Mittelpunkt der vorliegenden Studie steht die Frage, welche sozialen und familiären Lebensbedingungen mit erhöhten gesundheitlichen Beeinträchtigungen von Müttern verbunden sind. Anhand einer für die Merkmale Bundesland, Schulbildung, Erziehungsstatus, Alter der Mutter und Kinderzahl repräsentativen Bevölkerungsstichprobe (n=3129) wurden dazu körperliche und Allgemeinbeschwerden, Angst und Depressivität sowie die subjektive Gesundheit von Frauen mit minderjährigen Kindern untersucht. Die Analysen ergaben, dass 27% der Mütter Beeinträchtigungen im körperlichen und Allgemeinbefinden, 21% erhöhte Angst- und 22% erhöhte Depressivitätswerte aufwiesen. Gut 6% schätzten ihren Gesundheitszustand als (sehr) schlecht ein. Insbesondere Ein-Elternschaft, Arbeitslosigkeit, die alleinige Verantwortung für die Haus- und Familienarbeit sowie ein geringes Einkommen und geringe Schulbildung konnten als Risikofaktoren für die psychische und körperliche Gesundheit identifiziert werden. Die Befunde verdeutlichen, dass die Lebensphase der Familiengründung und Kindererziehung für spezifische Frauengruppen mit erhöhten Gesundheitsrisiken verbunden ist. Sie verweisen auf die Relevanz einer lebensphasensensiblen Analyse gesundheitlicher Ungleichheit unter Einbeziehung lebenslaufspezifischer Stressoren.AbstractThis paper reports findings from a population sample of mothers with underage children living in Germany (n=3,129). The objective of the study was to analyze whether social and familiar living conditions are associated with enhanced health risks for mothers. The sample is representative with respect to German federal states, school education, marital status, age of mothers, and number of children. Health problems were assessed in terms of physical disabilities and discomforts, anxiety and depression, and self-rated health. About 27% of mothers perceived physical disabilities and discomfort, 21% reported high levels of anxiety, and 22% high levels of depression. About 6% assessed their health as poor or very poor. Particularly single motherhood, unemployment, sole responsibility for household and family as well as low income and low school education increased the risk of poor health. The findings suggest that for specific subgroups of mothers parenting may be a vulnerable phase of life reflecting the need for a life stage orientation in health inequality research.

Gratifikationskrisen in der Haus- und Familienarbeit – Teststatistische Prüfung des Fragebogens an Vätern mit minderjährigen Kindern

Recently, the concept of effort-reward imbalance (ERI) developed by Siegrist had been applied to unpaid household and family work (ERI-HF). Evidence suggests that the imbalance between effort spent and reward received in family and domestic labor is associated with poor mental and physical health. However, so far, the adopted questionnaire ERI-HF was exclusively used among women in childcare responsibility. This paper reports on the application of the model to men in childcare responsibility using data from a clinical sample of fathers in rehabilitation clinics (N=415). Analogous to the original version, ERI-HF is divided into 2 components: (i) dysbalance of effort and reward, and (ii) overcommitment. For both components, confirmatory factor analyses revealed good to satisfactory properties. Overall, 13.4% of men in childcare responsibility showed a dysbalance between high effort and low reward of household and family work. High levels of effort were more frequently reported than high levels of low reward. With percentages ranging between 24.3 and 59.6%, a significant proportion of fathers reported difficulties to withdraw from household and family work obligations. Analyses of construct validity revealed significant associations between ERI and socio-demographic factors (number of children, employment status, single fatherhood, work-family-conflict) as well as subjective health. Taken together, our findings suggest that the instrument is applicable to men in childcare responsibility.

Household and Family Work and Health

This chapter provides the first comprehensive review of findings from studies using the recently developed questionnaire measuring effort-reward imbalance (ERI) in unpaid household and family work. First, we outline the relevance of stress related to household and family work for public health, and we describe the development of the modified questionnaire. Using data of a population-based study with 3129 women of underage children we subsequently report psychometric properties of our adopted ERI-instrument, including a short scale measuring over-commitment in domestic work. Then, we will consider whether effort-reward imbalance in domestic work is associated with impaired health among mothers. Based on the assumption that women’s intensity of stress experience in the homemaking role varies according to structural conditions, we explore the impact of distinct socio-economic and family conditions on ERI in household and family work. Finally, we discuss whether and to what extent the relationship between education and health is mediated by ERI in household and family work, thus contributing to the explanation of health inequalities in women. The chapter ends with a set of policy-directed recommendations on how to reduce the burden of domestic work and with some suggestions for further research.

[Compression or expansion of morbidity? Development of health among the older population].

BACKGROUND Within the context of demographic change, the development of morbidity among the older population has increasingly gained importance. In this respect, three different scenarios of the development of morbidity are discussed: the compression of morbidity, the dynamic equilibrium, and the expansion of morbidity. OBJECTIVES This paper investigates in which way subjective and functional health have developed among the older population between 1997 and 2010. MATERIALS AND METHODS Using German Socio-Economic Panel (GSOEP) data, the developments of subjective and functional health are examined in cross-sectional comparisons. The age groups between 65 and 89 are considered. Analyses are stratified according to gender and age. RESULTS In comparing different cohorts, men and women from younger cohorts report better subjective and functional health compared to people born before them. Concerning subjective health, this trend mostly affects younger people (65-74 years). Elderly subjects (aged 75-89 years) in the cohort comparison between 1997 and 2010 report no improvements in subjective health. In contrast, functional health between the cohorts affected all age groups in a similar manner. CONCLUSION Results for subjective and functional health are consistent with the compression of morbidity and the dynamic equilibrium and they do not point towards an expansion of morbidity.

Widening inequalities in multimorbidity? Time trends among the working population between 2005 and 2015 based on German health insurance data

BackgroundPrevious research has produced evidence for social inequalities in multimorbidity, but little is known on how these disparities change over time. Our study investigates the development of social inequalities in multimorbidity among the middle-aged and older working population. Special attention is paid to whether differing time trends between socio-economic status (SES) groups have taken place, increasing or decreasing inequalities in multimorbidity.MethodsThe analyses are based on claims data of a German statutory health insurance company covering an observation period from 2005 to 2015. Multimorbidity prevalence risks are estimated using logistic generalized estimation equations (GEE) models. Predicted probabilities of multimorbidity prevalence are used to assess time trends in absolute social inequalities in terms of educational level, income, and occupational group.ResultsThe prevalence risks of multimorbidity rose among all SES groups and social gradients persist throughout the observation period, indicating significantly higher multimorbidity prevalence risks for individuals with lower SES. Widening absolute inequalities are found among men in terms of educational level and among women in terms of occupational groups.ConclusionsThe increases in multimorbidity prevalence among the working population are accompanied by widening social inequalities, pointing towards a growing disadvantage for men and women in lower SES groups. The rising burden and the increasing inequalities among the working population stress the importance of multimorbidity as a major public health concern.

Handlungsorientierte Perspektiven auf Gesundheit und Krankheit

Was sind soziologische Handlungstheorien und welchen Beitrag leisten sie zur Erklarung von gesundheitsrelevantem Verhalten? Wie konnen Agency und Struktur in der soziologischen Gesundheitsforschung verknupft werden? Wie entwickelt sich Agency im Lebenslauf?

Kompression oder Expansion der Morbidität?@@@Compression or expansion of morbidity?: Entwicklung der Gesundheit in der älteren Bevölkerung@@@Development of health among the older population

BACKGROUND Within the context of demographic change, the development of morbidity among the older population has increasingly gained importance. In this respect, three different scenarios of the development of morbidity are discussed: the compression of morbidity, the dynamic equilibrium, and the expansion of morbidity. OBJECTIVES This paper investigates in which way subjective and functional health have developed among the older population between 1997 and 2010. MATERIALS AND METHODS Using German Socio-Economic Panel (GSOEP) data, the developments of subjective and functional health are examined in cross-sectional comparisons. The age groups between 65 and 89 are considered. Analyses are stratified according to gender and age. RESULTS In comparing different cohorts, men and women from younger cohorts report better subjective and functional health compared to people born before them. Concerning subjective health, this trend mostly affects younger people (65-74 years). Elderly subjects (aged 75-89 years) in the cohort comparison between 1997 and 2010 report no improvements in subjective health. In contrast, functional health between the cohorts affected all age groups in a similar manner. CONCLUSION Results for subjective and functional health are consistent with the compression of morbidity and the dynamic equilibrium and they do not point towards an expansion of morbidity.