Is gender policy related to the gender gap in external cause and circulatory disease mortality? A mixed effects model of 22 OECD countries 1973-2008

Contributions of injury deaths to the changes in sex gaps in life expectancy and life disparity in the Nordic countries in the 21st century

OBJECTIVE

The objective of this study was to provide novel comparative insights on the contributions of injury deaths to the changes in sex gaps in life expectancy (SGLE) and sex gaps in life disparity (SGLD) across Nordic countries.

STUDY DESIGN

Retrospective demographic analysis of aggregated mortality data.

METHODS

To compute life expectancy (LE)/life disparity (LD), annual data on age- and sex-specific causes of death from the World Health Organization mortality database were used to construct abridged life tables for two periods: 2000-2002 and 2016-2018 (2014-2016 for Norway). The contributions of injury deaths to the changes in the SGLE and SGLD between these two periods were decomposed by age and cause using a continuous-change model.

RESULTS

Females' LE and LD advantages due to injury deaths narrowed by 0.16-0.44 (0.06-0.35) years for LE (LD) over time. While self-inflicted injuries consistently played a predominant role in contributing to the SGLE/SGLD in all countries in both periods, in all countries but Finland, transport accidents had the greatest contributions to the narrowing SGLE/SGLD. Widening SGLE due to self-inflicted injuries in Iceland and due to falls in Sweden were unique to these countries. Accounting for >20% of total contributions of injury deaths, the age group of 20-24 years had the greatest contributions to the narrowing SGLE/SGLD. Deaths due to falls in older ages and assault in younger ages generally contributed to the widening SGLE/SGLD.

CONCLUSIONS

Injury deaths, particularly transport accidents, contributed significantly to the narrowing SGLE and SGLD across Nordic countries, with cross-country variations in age- and cause-specific patterns. The results suggest the need for injury prevention policies targeting self-inflicted injuries in younger and falls in older males.

Have Policies Tackled Gender Inequalities in Health? A Scoping Review

Gender is recognized as one of the most relevant determinants of health inequalities. This scoping review sought to identify and analyse policies, either implemented or formulated as proposals, which aimed to reduce gender inequalities in health. We searched Medline, Web of Science, and Scielo. Of 2895 records, 91 full text articles were analysed, and 33 papers were included. Of these papers, 22 described the process of formulation, implementation, or evaluation of policies whose aim was to reduce gender inequalities in health; six focused on recommendations, and the remaining five dealt with both issues. Our review showed that the policies aimed at reducing gender inequalities in health, either implemented or formulated as proposals, are scarce. Moreover, despite some success, overall progress has been slow. The studies show failures in design and particularly in the implementation process. We found a lack of awareness and capacity in the policy-making progress, under-financing, bureaucratization, shortage of relevant data, and absence of women’s participation in decision-making. Therefore, an emphasis on the design and implementation of gender-sensitive policies seems essential to advance gender equality in health. This scoping review gathers evidence to support the design of such policies and recommendations that can facilitate their implementation.

Cancer Screening Participation and Gender Stratification in Europe

The current study examines whether the extent of macrolevel gender inequality affects the association between women's educational attainment and their participation in cervical and breast cancer screening and how this relationship is moderated by a country's cancer screening strategy (organized vs. opportunistic). A multilevel design with women (N_cervical = 99,794; N_breast = 55,021) nested in 30 European countries was used to analyze data from the European Health Interview Survey (2013-2015). Results of multilevel logistic regression models demonstrate that higher macrolevel gender inequality is associated with (a) a lower overall likelihood that women have had a mammography and Pap smear and (b) a larger gap in participation between women with low and high levels of education, regardless of a country's screening strategy (i.e., no moderation by a country's screening strategy was found). We conclude that macrolevel gender stratification should not be neglected when designing cancer screening policy.

Gender differences in common mental disorders: a comparison of social risk factors across four European welfare regimes

BACKGROUND

Decreasing gender differences in mental health are found largely in countries in which the roles of men and women have improved in terms of opportunities for employment, education, child care and other indicators of increasing gender equality. In this study, we examine how European welfare regimes influence this association between mental health and the social roles that men and women occupy.

METHODS

The EU-World Mental Health data are used, which covers the general population in 10 European countries (n = 37 289); Countries were grouped into four welfare regions: Liberal regime (Northern Ireland), Bismarckian regime (Belgium, Germany, the Netherlands and France), Southern regime (Spain, Italy, Portugal) and Central-Eastern regime (Romania and Bulgaria). The lifetime prevalence of mood, anxiety and alcohol disorders was determined by using the Composite International Diagnostic Interview 3.0. Overall prevalence rates along with odds ratios by means of bivariate logistic regression models are calculated to compare the presence of common mental disorders in women versus men per welfare regime.

RESULTS

Overall prevalence of common mental disorders is highest in the Liberal regime and lowest in the Central/Eastern regime. The gender gap in mental disorders is largest in the Southern regime and smallest in the Liberal regime. Marital status and certain employment positions help to explain variation in mental disorders across and within welfare regimes.

CONCLUSION

Most prominent pathways linking gender to mental ill-health being are related to marital status and certain employment positions. However, these pathways also show substantial variation across welfare regimes.

Who benefits from social investment? The gendered effects of family and employment policies on cardiovascular disease in Europe

BACKGROUND

In the context of fiscal austerity in many European welfare states, policy innovation often takes the form of 'social investment', a contested set of policies aimed at strengthening labour markets. Social investment policies include employment subsidies, skills training and job-finding services, early childhood education and childcare and parental leave. Given that such policies can influence gender equity in the labour market, we analysed the possible effects of such policies on gender health equity.

METHODS

Using age-stratified and sex-stratified data from the Global Burden of Disease Study on cardiovascular disease (CVD) morbidity and mortality between 2005 and 2010, we estimated linear regression models of policy indicators on employment supports, childcare and parental leave with country fixed effects.

FINDINGS

We found mixed effects of social investment for men versus women. Whereas government spending on early childhood education and childcare was associated with lower CVD mortality rates for both men and women equally, government spending on paid parental leave was more strongly associated with lower CVD mortality rates for women. Additionally, government spending on public employment services was associated with lower CVD mortality rates for men but was not significant for women, while government spending on employment training was associated with lower CVD mortality rates for women but was not significant for men.

CONCLUSIONS

Social investment policies were negatively associated with CVD mortality, but the ameliorative effects of specific policies were gendered. We discuss the implications of these results for the European social investment policy turn and for future research on gender health equity.

Does gender inequity increase men's mortality risk in the United States? A multilevel analysis of data from the National Longitudinal Mortality Study

A number of theoretical approaches suggest that gender inequity may give rise to health risks for men. This study undertook a multilevel analysis to ascertain if state-level measures of gender inequity are predictors of men's mortality in the United States. Data for the analysis were taken primarily from the National Longitudinal Mortality Study, which is based on a random sample of the non-institutionalised population. The full data set included 174,703 individuals nested within 50 states and had a six-year follow-up for mortality. Gender inequity was measured by nine variables: higher education, reproductive rights, abortion provider access, elected office, management, business ownership, labour force participation, earnings and relative poverty. Covariates at the individual level were age, income, education, race/ethnicity, marital status and employment status. Covariates at the state level were income inequality and per capita gross domestic product. The results of logistic multilevel modelling showed a number of measures of state-level gender inequity were significantly associated with men's mortality. In all of these cases greater gender inequity was associated with an increased mortality risk. In fully adjusted models for all-age adult men the elected office (OR 1.05 95% CI 1.01–1.09), business ownership (OR 1.04 95% CI 1.01–1.08), earnings (OR 1.04 95% CI 1.01–1.08) and relative poverty (OR 1.07 95% CI 1.03–1.10) measures all showed statistically significant effects for each 1 standard deviation increase in the gender inequity z-score. Similar effects were seen for working-age men. In older men (65+ years) only the earnings and relative poverty measures were statistically significant. This study provides evidence that gender inequity may increase men's health risks. The effect sizes while small are large enough across the range of gender inequity identified to have important population health implications.

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Theoretical approaches link gender inequity to increased health risks for men.

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Multilevel analysis allows investigation of a contextual effect of gender inequity.

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The study modelled the effect of state-level gender inequity on men's mortality.

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Aspects of gender inequity predicted an increased mortality risk for men.

Exploring models for the roles of health systems' responsiveness and social determinants in explaining universal health coverage and health outcomes

BACKGROUND

Intersectoral perspectives of health are present in the rhetoric of the sustainable development goals. Yet its descriptions of systematic approaches for an intersectoral monitoring vision, joining determinants of health, and barriers or facilitators to accessing healthcare services are lacking.

OBJECTIVE

To explore models of associations between health outcomes and health service coverage, and health determinants and health systems responsiveness, and thereby to contribute to monitoring, analysis, and assessment approaches informed by an intersectoral vision of health.

DESIGN

The study is designed as a series of ecological, cross-country regression analyses, covering between 23 and 57 countries with dependent health variables concentrated on the years 2002-2003. Countries cover a range of development contexts. Health outcome and health service coverage dependent variables were derived from World Health Organization (WHO) information sources. Predictor variables representing determinants are derived from the WHO and World Bank databases; variables used for health systems' responsiveness are derived from the WHO World Health Survey. Responsiveness is a measure of acceptability of health services to the population, complementing financial health protection.

RESULTS

Health determinants' indicators - access to improved drinking sources, accountability, and average years of schooling - were statistically significant in particular health outcome regressions. Statistically significant coefficients were more common for mortality rate regressions than for coverage rate regressions. Responsiveness was systematically associated with poorer health and health service coverage. With respect to levels of inequality in health, the indicator of responsiveness problems experienced by the unhealthy poor groups in the population was statistically significant for regressions on measles vaccination inequalities between rich and poor. For the broader determinants, the Gini mattered most for inequalities in child mortality; education mattered more for inequalities in births attended by skilled personnel.

CONCLUSIONS

This paper adds to the literature on comparative health systems research. National and international health monitoring frameworks need to incorporate indicators on trends in and impacts of other policy sectors on health. This will empower the health sector to carry out public health practices that promote health and health equity.

Cross-national differences in the gender gap in subjective health in Europe: does country-level gender equality matter?

Multiple studies have found that women report being in worse health despite living longer. Gender gaps vary cross-nationally, but relatively little is known about the causes of comparative differences. Existing literature is inconclusive as to whether gender gaps in health are smaller in more gender equal societies. We analyze gender gaps in self-rated health (SRH) and limiting longstanding illness (LLI) with five waves of European Social Survey data for 191,104 respondents from 28 countries. We use means, odds ratios, logistic regressions, and multilevel random slopes logistic regressions. Gender gaps in subjective health vary visibly across Europe. In many countries (especially in Eastern and Southern Europe), women report distinctly worse health, while in others (such as Estonia, Finland, and Great Britain) there are small or no differences. Logistic regressions ran separately for each country revealed that individual-level socioeconomic and demographic variables explain a majority of these gaps in some countries, but contribute little to their understanding in most countries. In yet other countries, men had worse health when these variables were controlled for. Cross-national variation in the gender gaps exists after accounting for individual-level factors. Against expectations, the remaining gaps are not systematically related to societal-level gender inequality in the multilevel analyses. Our findings stress persistent cross-national variability in gender gaps in health and call for further analysis.