Health-related social mobility: a comparison of currently employed men and women in Britain and Finland

Selective health-related social mobility has been suggested as one possible explanation for health inequalities. The aim of this paper is to examine the size and significance of the contribution which health-related social mobility makes to social class differences in health. We do this by examining the association between intergenerational social mobility and health among currently employed men and women in Britain and Finland. We used comparable nationally representative interview surveys from Britain and Finland. The British data is derived from the General Household Survey for 1988 and 1989, and the Finnish data from the 1986 Survey on Living Conditions. Health measures included limiting long-standing illness and self-assessed health as below good. Social mobility was measured comparing the respondent's class of origin (father's occupation) with his/her class of destination (own current occupation). Social structural changes and related social mobility have been more dramatic in Finland than in Britain during the last few decades. Downward mobility has been relatively rare, and mobility has taken place predominantly upwards. In Finland downward mobility from upper non-manual to manual worker was associated with a somewhat higher risk of limiting long-standing illness than expected among men as well as women. However, there was no statistically significant interaction effect on health between the respondent's father's occupational class and his/her own current class. In Britain, neither self-assessed health nor limiting long-standing illness were related to social mobility. Some weak evidence for health-related downward social mobility was found for currently employed Finnish men and women, but not for their British counterparts. Moreover, the evidence is weaker for self-assessed health than for limiting long-standing illness. Where social mobility may have been health-related, it concerns very rare and small groups; therefore health inequalities among the currently employed cannot be explained by intergenerational health-related social mobility.

Changes in the social patterning of health? The case of Finland 1986-1994

This paper analyses the social patterning and change of health status among the Finnish population from the mid-1980s until the mid-1990s. A broad structural transformation has been going on in Finland including demographic, social structural and, in the early 1990s, particularly sudden and deep labour market changes. We first examine the patterning of health status and its change among the Finnish adult population by age; secondly by regional structure; thirdly by socioeconomic status, that is educational level; and fourthly by employment status, that is between the employed and the unemployed. Analyses were made separately for men and women. The data derive from two pooled nationwide "Surveys on Living Conditions" which were conducted in 1986 (N = 12,057) and in 1994 (N = 8650). Health status was measured by limiting long-standing illness (LLI) and self-assessed health (SAH) as below good. The overall trend shows that health status has remained stable or improved slightly among the Finnish adult population from 1986 to 1994. Age differences show leveling off as particularly men above age 45 in 1994 reported better health status than eight years before; those below age 45 tend to report somewhat poorer health. Also regional differences have declined; health in the East/North regions is approaching the level of the rest of the country, except the Helsinki Metropolitan region. Educational differences in health status continue to be clear; however, for men, differences in LLI between the two lower educational groups have levelled off by 1994. Also for men, employment status differences in LLI have declined by 1994; no corresponding levelling off was apparent for women. The health status and its social patterning among the Finnish adult population have remained rather stable during the recession and related social structural changes in the early 1990s. Certain levelling off has taken place among men. As a result men's and women's health inequalities now resemble each other more than eight years before. Adverse health consequences of the recession are supposed to take a longer time to show up.

Health expectancy by level of education in Finland

Using the method first presented by Sullivan, the article presents results on health expectancy by level of education and gender in the late 1980s in Finland. The life tables by level of education cover the years 1986-90. Indicators of disability and poor health were based on three variables from the nationwide 1986 Survey on Living Conditions (N = 12,057): limiting long-standing illness, functional disability or poor self-perceived health. Two cutting points indicating different levels of severity of disability or poor health were used for each measure, giving six dichotomous indicators. Disability-free life expectancy and life expectancy with disability were found to depend strongly on the indicator of disability, but the patterns of differences both between genders and between educational categories were largely independent of the indicators used. Life expectancy as well as disability-free life expectancy showed a systematic relationship with level of education: the higher the level of education, the higher the life expectancy and disability-free life expectancy. The differences between educational categories in disability-free life expectancy were markedly larger than in total life expectancy. Life expectancy with disability was shortest among the more educated and longest among the less educated. Due to the higher life expectancy and the higher prevalence of disability among women, life expectancy with disability was longer among women than men according to all indicators.

Past or present? Childhood living conditions and current socioeconomic status as determinants of adult health

The aim was to study the associations of childhood living conditions, together with past and present socioeconomic status, with adult health among Finnish men and women. The data were derived from a nationwide interview Survey on Living Conditions collected by Statistics Finland in 1986. The sample represents the non-institutional Finnish population aged 15 years or older. The number of respondents was 12,057 and the response rate 87%. In this study we analysed 30-year-old and older subjects. Two health indicators were analysed: first, limiting long-standing illness; and second, self-assessed health as "below good". Four different indicators of childhood living conditions were included: one concerning economic problems, and three concerning family related social problems during childhood. Additionally, the degree of urbanisation of the childhood living area was examined. Past and present socioeconomic status were measured by the status of origin, i.e. the respondent's father's and mother's education, and the status of destination, i.e. the respondent's own current education. Economic problems during childhood were associated with current health. The association of childhood social problems with health was somewhat weaker and less consistent than that of economic problems. A comparison of the mutual impacts of economic and social problems, respectively, shows that economic problems are stronger and more independent determinants of adult health than social problems. According to multivariate logistic regression analysis, past and, particularly, present socioeconomic status are both important determinants of adult health. Current socioeconomic status showed strongest associations with adult health, but living conditions during upbringing, particularly economic problems and status of origin, were also significant predictors.

Modern and healthy?: socioeconomic differences in the quality of diet

OBJECTIVE

The purpose of this study was to describe how nutrient intake and food consumption varied according to education and household income in men and women. The second aim was to find out to what extent the goals of the national dietary guidelines were met in different socioeconomic groups.

DESIGN

A random dietary survey using a 3 d estimated food record and a self-administered questionnaire.

SETTING

Individuals from four different regions in Finland in spring 1992.

SUBJECTS

870 men and 991 women aged 25-64 y.

MAIN OUTCOME MEASURES

Food group and nutrient consumption, two saturated fat indices, educational level and household income.

MAIN RESULTS

Men with a higher educational level had a lower energy intake and women with a higher income a lower intake of carbohydrates. The intake of vitamin C and carotenoids increased with increasing socioeconomic status. Otherwise, no socioeconomic differences in energy intake, densities of fat and saturated fat, macronutrient or fibre were found. Higher socioeconomic groups consumed more cheese, vegetables, fruit and berries and candies and less milk, butter and bread.

CONCLUSIONS

Higher socioeconomic groups did not follow current national dietary guidelines better than lower socioeconomic groups. Higher socioeconomic groups consumed more of the modern recommended foods, such as vegetables and fruit and berries, but less traditional recommended foods, such as bread and potatoes.

Health inequalities in early adulthood: a comparison of young men and women in Britain and Finland

Several studies have recently reported that social class differences in ill-health during adolescence are almost non-existent or invisible. The aims of this comparative study of two different welfare states are first, to compare whether the relationship between social class and health is similar among young men and women at different age groups in these two welfare states; second, to examine at what age social class differences in self-reported health and illness among young adults emerge in these two countries; and third, to find out whether class of origin (i.e. parental social class) or class of destination (i.e. individual's achieved social class) have greater explanatory power in studies of health among young adults. We used comparable nationally representative interview surveys from Britain and Finland. The British data is derived from the General Household Survey for 1988 and 1989, and the Finnish data from the 1986 Level of Living Survey. We analysed five year age groups between 16 and 39 years in Britain (N = 16,626) and 15 and 39 years in Finland (N = 5950). Two health indicators (limiting long-standing illness and self-assessed health), and several indicators for social class were compared. The best discriminator of differences in ill-health among young adults both in Finland and Britain was education. Social class differences by own occupation (achieved class) emerged soon after the age of 20 among men and women in both countries and strengthened with increasing age. There was a weaker but consistent association with class of origin in both countries. Housing tenure is strongly associated with young adults' health in Britain but not Finland.(ABSTRACT TRUNCATED AT 250 WORDS)

Drinking and unemployment: contrasting patterns among men and women

Research on unemployment has paid only little attention to drinking and drinking problems. From the 1970s onwards the association of drinking and unemployment has come under systematic study. Contrasting tendencies emerge from this research. This paper distinguishes three instances of drinking and drinking problems and examines their association with employment status, i.e., (i) frequency of drinking, (ii) frequency of intoxication, and (iii) frequency of health problems due to drinking. A panel survey was conducted in 1983-1984, consisting of a sample of Finnish men and women, originally jobseekers in industry. Prevalence data and results of logistic regression analyses on the association of the three instances of drinking and drinking problems with employment status are presented. The frequency of drinking was unassociated with employment status for men and women at either of the two measurement points. Neither did the frequency of intoxication show any clear association with employment status. In contrast, the frequency of health problems due to drinking was associated in a statistically significant way with unemployment among men. Among women the association was rather the opposite, but it was not statistically significant. The paper concludes that it is important to distinguish between overall drinking and drinking problems, and between the determinants of male and female drinking problems. It is likely that selective processes at the labour market as well as social causation during unemployment lie behind the observed association of male unemployment and drinking problems.

Comparisons of inequalities in health: evidence from national surveys in Finland, Norway and Sweden

Nationwide surveys from Finland, Norway and Sweden were analysed to examine socioeconomic inequalities in illness. This article first describes differentials in self-reported limiting long-standing illness and its distribution according to educational level. Age-standardized prevalence rates according to education are examined, and top and bottom prevalence ratios are compared between countries and genders. Secondly, the article attempts to assess the 'global' extent of inequalities in illness. This is made by calculating concentration indices for each country and gender. The description shows large illness differentials according to educational level in each country. A similar socio-economic pattern emerges from all three countries and both genders; i.e. lower socio-economic positions are associated with higher illness levels. This pattern is more distinct for men than for women. The gap in illness between top and bottom educational groups is widest for Norwegian men and smallest for Finnish women. However, top and bottom comparisons overlook other than the extreme groups, and give no information on the sizes of the groups. To avoid these problems concentration indices were calculated to assess the extent of inequalities in illness. According to these indices Norwegian men also show the highest extent of inequality, but differences to Swedish and Finnish men are small. The extent of inequality among women is smaller than among men; among Finnish and Norwegian women it is smaller than among their Swedish counterparts. Measures of inequalities such as the concentration index are useful tools, although complex inequalities cannot be captured by single measures. In the assessment of health inequalities not only relative but also absolute differentials need to be considered.(ABSTRACT TRUNCATED AT 250 WORDS)

Inequalities in women's and men's ill-health: Britain and Finland compared

This paper examines inequalities in ill-health among men and women in Britain and Finland, using national survey data from the mid-1980s. Age-standardised illness ratios are compared followed by multivariate logistic regression analyses. The degree of social inequality in ill-health for women and men is greater in Finland than in Britain. British employed women in each class report less limiting long-standing illness than their Finnish counterparts. A major difference between the two countries is the poor health of British housewives. We relate these differences to societal variations in the participation of women in paid employment. In Finland women participate fully in paid work, whereas in Britain women are more likely to be full-time housewives or part-time employees. Unlike Finland, state provisions do not support the economic independence of British women. Structural variables, encapsulated by occupational class and employment status' are the primary factors associated with men's ill-health in Britain and Finland and also with Finnish women's ill-health. The difference between British and Finnish women is striking: class is associated with ill-health amongst women in both countries, but housing tenure and family roles are additional factors only among British women. In Britain, previously married women have particularly poor health. Our findings suggest that in a society such as Britain where paid employment is not universal for women, women's family roles and housing quality are associated with ill-health, but this is not the case in Finland, where women's participation in the labour market is near universal.

Unemployment and mental well-being: elaboration of the relationship

The relationship between unemployment and mental well-being was studied in 703 Finnish women and men who were originally employed in industry (manufacturing). A population survey with a follow-up measurement was carried out in 1983 and 1984. Mental well-being was measured by a 12-item version of the General Health Questionnaire. The association between unemployment and mental ill-health proved to be a strong one. Cross-sectional analyses and analyses on the improvement of mental well-being were made. The impact of employment status on mental ill-health, as well as its improvement, was controlled for by means of logistic regression analysis (GLIM). Several variables included in the design did not alter the main result, apart from the fact that the impact of unemployment was stronger among men than among women. The impact of unemployment proved to be independent and direct. The author compares these results with other studies that have used a similar approach, and discusses the significance of paid work in developed capitalist societies in an understanding of the adverse impacts of unemployment.

Gender, social class and illness among young people

Gender and social class differences in illness among young people have been a neglected area in research on social inequities in health. It has been assumed that the illness differentials among adults persist throughout their lives. Only recently have social class health differentials among young people become a topic for research. The aim of this study is, first, to examine gender and social class differences in self-reported illness among young Finns; secondly, to determine whether the relationship between social class and limiting long-standing illness is similar among young men and women. In addition to the two main aims, we also examined whether several background variables have any impact on the relationship between class and illness or, directly, on illness. The data were derived from a nationwide Finnish 'Level of Living Survey', which was carried out by the Central Statistical Office of Finland in 1986. This interview material represents the noninstitutional Finnish population aged 15 years old or older. The number of respondents were 12,057, and the response rate was 87%. In the present study we only examined those who were 15-24-year-olds (N = 2238); i.e. 1101 men and 1137 women; the response rates were 91% and 92% respectively. Young women reported a limiting long-standing illness more often than young men. The prevalence of limiting long-standing illness increased with age. Cross-tabulation analyses showed virtually no relationship between social class and limiting long-standing illness. This held true irrespective of the various measures of social class that were used. Controlling the impact of several background variables in the logistic regression analyses did not alter this general result.

Health and social inequities in Finland and elsewhere

This review summarizes results of a number of studies on health and social inequities in Finland in comparison with other countries. Comparisons over time have been made when possible. Inequities in mortality in Finland can be compared with data from Denmark, Norway and Sweden as well as England and Wales plus Hungary. All countries show a similar relationship between mortality and level of education. No major changes in this relationship can be observed during the 1970s. Data on morbidity and perceived health complete the picture obtained on the basis of mortality data. Inequities concern various dimensions of health. Taken as a whole, the data suggest that the pattern of health inequities is more accentuated in Finland than in other Nordic countries.

The development of medical sociology in Finland

This paper reviews the development and major directions of medical sociology in Finland. An interest in the social aspects of health can be traced to 19th-century social medicine. A general interest in medical sociology emerged in the 1950s but the research was mainly focused on the work setting and behavior of various health professionals. In the 1960s, the regional differences in morbidity and accessibility to health care were the focus of the research sponsored by the government, and many studies examined the health behavior and health status of selected groups. In the 1980s, the research has covered the most topical areas in the field. Although there are a large number of active researchers, the field is characterized by a weak institutionalization.

Does unemployment challenge public health?

We have asked Lahelma to start a discussion on unemployment and ill health and scientists working with this problem are herewith invited to contribute. Unemployment should not be medicalized, he argues, but it has a public health dimension irrespective of the causal relation between unemployment and disease. He wants to put greater emphasis on the effects of unemployment on family and society at large.

Early rehabilitation and its implementation at the work place

During the last few decades a change has taken place in the morbidity pattern of industrialized societies. The proportion of chronic illness and disability has increased in middle-aged and elderly populations. Much of this disability appears as a result of gradual degenerative processes proceeding slowly towards severe disability. The practice of rehabilitation has not, however, been able to adapt flexibly to the new situation. The need for changing the emphasis of rehabilitation from mere restoration towards preventive aims is discussed in this paper. The branch of rehabilitation which has preventive aims is called early rehabilitation. Possibilities of implementing early rehabilitation activity at the work place are surveyed and a model, which was developed at two authorities of the City of Helsinki, is presented. In conclusion, some general problems concerning early rehabilitation are discussed.