Search

Background: The high and fluctuating mortality and rising health inequalities in post-Soviet countries have attracted considerable attention. However, there are very few individual-level data on distribution of health outcomes in Central Asian countries of the former Soviet Union. We analysed socioeconomic predictors of two self-rated health outcomes in a national survey in Kazakhstan., Methods: We used data from the 2012 Kazakhstan Household Health Survey on 12,560 respondents aged 15+. Self-rated health, self-reported worsening of health, and a range of socio-demographic variables were collected in an interview. The self-rated health outcomes were dichotomized and logistic regression was used to estimate their associations with education, income, ownership of a car, second house and computer, marital status, ethnicity and urban/rural residence., Results: The prevalence of poor/very poor self-rated health was 5.3%, and 11.0% of participants reported worse health compared to 1 year ago. After controlling for age, sex and region, all socio-demographic factors were related to self-rated health. After adjusting for all variables, education and car ownership showed the most consistent effects; the odds ratio of poor health and worsening of health were 0.43 (95% confidence interval 0.32-0.58) and 0.54 (0.44-0.68) for university vs. primary education, respectively, and 0.64 (0.51-0.82) and 0.68 (0.58-0.80) for car ownership, respectively. Unmarried persons, ethnic Russians and urban residents also had increased prevalence of poor health in multivariable models., Conclusions: Despite the limitations of using subjective health measures, these data suggest strong associations between two measures of self-rated health and a number of socioeconomic characteristics. Future studies and health policy initiatives in Kazakhstan and other Central Asian countries should take social determinants of health into account.

As coronavirus disease (COVID-19) continued to spread globally, studies of transmission mainly focused on clusters of [greater than or equal to] 2 epidemiologically linked cases. Some governments, including those of [...]

To achieve sustainable health equity, we need to address two intertwined challenges: social inequality and the climate crisis. They both create health inequalities within and between countries; when these health [...]

Background: Hong Kong has a relatively low incidence rate of COVID-19 across the globe. Nevertheless, ethnic minorities in Hong Kong, especially South Asians (SAs) and Southeast Asians (SEAs), face numerous physical, mental, social, economic, cultural and religious challenges during the pandemic. This study explores the experiences of SA and SEA women in a predominantly Chinese metropolitan city. Methods: Ten SA and SEA women were recruited and face-to-face interviews were conducted. Questions about participants' daily life experience, physical and mental health conditions, economic situation and social interaction amid COVID-19 pandemic were asked to assess the impact of COVID-19. Results: SAs and SEAs have a distinctive family culture, and women experienced significant physical and mental impact of COVID-19 due to their unique gender role in the family. In addition to taking care of their family in Hong Kong, SA and SEA women also had to mentally and financially support family members residing in their home countries. Access to COVID-related information was restricted due to language barrier. Public health measures including social distancing imposed extra burden on ethnic minorities with limited social and religious support. Conclusions: Even when COVID-19 incidence rate is relatively low in Hong Kong, the pandemic made life even more challenging for SAs and SEAs, which is a community already struggling with language barriers, financial woes, and discrimination. This in turn could have led to greater health inequalities. Government and civil organizations should take the social determinants of health inequalities into account when implementing COVID-19-related public health policies and strategies. [ABSTRACT FROM AUTHOR]

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.socscimed.2010.09.031 Byline: Michikazu Sekine (a), Tarani Chandola (b), Pekka Martikainen (b)(c), Michael Marmot (b), Sadanobu Kagamimori (a) Abstract: Poor physical and mental functioning are more common among women than men and those with disadvantaged work and family characteristics. This study aims to clarify whether sex differences in health functioning can be explained by sex differences in work and family characteristics. The subjects were 3787 civil servants (2525 men and 1262 women), aged 20-65, working in a local government on the west coast of Japan. A questionnaire survey was conducted in January 2003. Low employment grade, high demands, long work hours, shift work, being unmarried, having no young children, high family-to-work conflict and high work-to-family conflict were more common among women than men and were independently associated with poor physical and mental functioning. The age-adjusted odds ratios (ORs) of women for poor health functioning were 1.80 for poor physical functioning and 1.77 for poor mental functioning. When adjusted for employment grade and work characteristics (control, demand, support, work hours, and shift work), the sex differences in health functioning attenuated. When adjusted for family characteristics (family structure and work-family conflicts), the sex differences in health functioning further attenuated and were no longer statistically significant. Sex differences in family characteristics contributed more to sex difference in mental functioning than sex differences in work characteristics. Japan belongs to conservative welfare regimes. In such countries, men are able to concentrate on their work with relative freedom from their family tasks and responsibilities, whereas women feel difficulties in maintaining their work-life balances. Such sex differences in work- and family-related stresses may contribute to sex difference in health. Longitudinal research is necessary to clarify the causal nature of these associations. Author Affiliation: (a) Department of Welfare Promotion and Epidemiology, University of Toyama, 2630 Sugitani, Toyama 930-0194, Japan (b) Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London WC1E 6BT, United Kingdom (c) Department of Sociology, Population Research Unit, University of Helsinki, P.O. Box 18, FIN-00014, Finland

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.socscimed.2009.08.022 Byline: Michikazu Sekine (a), Tarani Chandola (b), Pekka Martikainen (c), Michael Marmot (b), Sadanobu Kagamimori (a) Abstract: This study aims to evaluate whether the pattern of socioeconomic inequalities in physical and mental functioning as measured by the Short Form 36 (SF-36) differs among employees in Britain, Finland, and Japan and whether work characteristics contribute to some of the health inequalities. The participants were 7340 (5122 men and 2218 women) British employees, 2297 (1638 men and 659 women) Japanese employees, and 8164 (1649 men and 6515 women) Finnish employees. All the participants were civil servants aged 40-60 years. Both male and female low grade employees had poor physical functioning in all cohorts. British and Japanese male low grade employees tended to have poor mental functioning but the associations were significant only for Japanese men. No consistent employment-grade differences in mental functioning were observed among British and Japanese women. Among Finnish men and women, high grade employees had poor mental functioning. In all cohorts, high grade employees had high control, high demands and long work hours. The grade differences in poor physical functioning and disadvantaged work characteristics among non-manual workers were somewhat smaller in the Finnish cohort than in the British and Japanese cohorts. Low control, high demands, and both short and long work hours were associated with poor functioning. When work characteristics were adjusted for, the socioeconomic differences in poor functioning were mildly attenuated in men, but the differences increased slightly in women. This study reconfirms the generally observed pattern of socioeconomic inequalities in health for physical functioning but not for mental functioning. The role of work characteristics in the relationship between socioeconomic status and health differed between men and women but was modest overall. We suggest that these differences in the pattern and magnitude of grade differences in work characteristics and health among the 3 cohorts may be attributable to the different welfare regimes among the 3 countries. Author Affiliation: (a) University of Toyama, Graduate School of Medicine and Pharmaceutical Sciences, Department of Welfare Promotion and Epidemiology, 2630 Sugitani, Toyama 930-0194, Japan (b) Department of Epidemiology and Public Health, University College London, United Kingdom (c) Department of Sociology, Population Research Unit, University of Helsinki, Finland Article Note: (footnote) [star] We are indebted to all the civil servants for their participation in this study and the research teams in all collaborating centres. The British civil servants study (The Whitehall II study) has been supported by grants from the Medical Research Council; British Heart Foundation; Economic and Social Research Council; Health and Safety Executive; Department of Health; National Heart Lung and Blood Institute (HL36310), US, NIH; National Institute on Aging (AG13196), US, NIH; Agency for Health Care Policy Research (HS06516); and the MacArthur Foundation., The Japanese civil servant study has been supported by grants from the Ministry of Health, Labour and Welfare, the Japanese Society for the Promotion of Science, the Occupational Health Promotion Foundation, the Univers Foundation (98.04.017), the Daiwa Anglo-Japanese Foundation (03/2059), and the Great Britain Sasakawa Foundation (2551). The Finnish civil servants study (The Helsinki Health Study) is supported by grants from the Academy of Finland, Research Council for Health (48119, 48553 and 53245), and the Finnish Work Environment Fund (99090). MS is supported by a grant from the British Heart Foundation. PM is supported by a fellowship and a grant from the Academy of Finland (70631, 48600) and the Gyllenberg Foundation. MM is supported by a United Kingdom MRC Research Professorship. Funding organizations were not involved in the design, conduct, interpretation, and analysis of the study, or in the review or approval of the manuscript.

Background. We investigated social inequalities in walking speed in early old age. Methods. Walking speed was measured by timed 8-ft (2.44 m) test in 6,345 individuals, with mean age of 61.1 (SD 6.0) years. Current or last known civil service employment grade defined socioeconomic position. Results. Mean walking speed was 1.36 (SD 0.29) m/s in men and 1.21 (SD 0.30) in women. Average age- and ethnicity-adjusted walking speed was approximately 13% higher in the highest employment grade compared with the lowest. Based on the relative index of inequality (RII), the difference in walking speed across the social hierarchy was 0.15 m/s (95% confidence interval [CI] 0.12-0.18) in men and 0.17 m/s (0.12-0.22) in women, corresponding to an age-related difference of 18.7 (13.6-23.8) years in men and 14.9 (9.9-19.9) years in women. The RII for slow walking speed (logistic model for lowest sex-specific quartile vs others) adjusted for age, sex. and ethnicity was 3.40 (2.64-4.36). Explanatory factors for the social gradient in walking speed included Short-Form 36 physical functioning, labor market status, financial insecurity, height, and body mass index. Demographic. psychosocial, behavioral, biologic, and health factors in combination accounted for 40% of social inequality in walking speed. Conclusion. Social inequality in walking speed is substantial in early old age and reflects many factors beyond the direct effects of physical health. Key Words: Socioeconomic position--Physical functioning--Epidemiology--Humans.

Studies have suggested that subjective social status (SSS) is an important predictor of health. This study examined the link between SSS and health in old age and investigated whether SSS mediated the associations between objective indicators of socioeconomic status and health. It used cross-sectional data from the second wave (2004-2005) of the English Longitudinal Study of Ageing, which were collected through personal interviews and nurse visits. The study population consisted of 3368 men and 4065 women aged 52 years or older. The outcome measures included: self-rated health, long-standing illness, depression, hypertension, diabetes, central obesity, high-density lipoprotein cholesterol, triglycerides, fibrinogen, and C-reactive protein. The main independent variable was SSS measured using a scale representing a 10-rung ladder. Wealth, education, and occupational class were employed as covariates along with age and marital status and also, in additional analyses, as the main independent variables. Gender-specific logistic and linear regression analyses were performed, In age-adjusted analyses SSS was related positively to almost all health outcomes. Many of these relationships remained significant after adjustment for covariates. In men, SSS was significantly (p < 0.05) related to self-rated health, depression, and long-standing illness after adjustment for all covariates, while its association with fibrinogen became non-significant. In women, after adjusting for all covariates, SSS was significantly associated with self-rated health, depression, long-standing illness, diabetes, and high-density lipoprotein cholesterol, but its associations with central obesity and C-reactive protein became non-significant. Further analysis suggested that SSS mediated fully or partially the associations between education, occupational class and self-reported and clinical health measures. On the contrary, SSS did not mediate wealth's associations with the outcome measures, except those with self-reported health measures. Our results suggest that SSS is an important correlate of health in old age, possibly because of its ability to epitomize life-time achievement and socioeconomic status. Keywords: Subjective social status Health inequalities Education Wealth UK Occupational class Old age

Adverse health behaviors and obesity are key determinants of major chronic diseases. Evidence on work-related determinants of these behavioral risk factors is inconclusive, and comparative studies are especially lacking. We aimed to examine the associations between job strain, working overtime, adverse health behaviors, and obesity among 45-60-year-old white-collar employees of the Whitehall II Study from London (n = 3397), Helsinki Health Study (n = 6070), and the Japanese Civil Servants Study (n = 2213). Comparable data from all three cohorts were pooled, and logistic regression analysis was used, stratified by cohort and sex. Models were adjusted for age, occupational class, and marital status. Outcomes were unhealthy food habits, physical inactivity, heavy drinking, smoking, and obesity. In London, men reporting passive work were more likely to be physically inactive. A similar association was repeated among women in Helsinki. Additionally, high job strain was associated with physical inactivity among men in London and women in Helsinki. In London, women reporting passive work were less likely to be heavy drinkers and smokers. In Japan, men working overtime reported less smoking, whereas those with high job strain were more likely to smoke. Among men in Helsinki the association between working overtime and non-smoking was also suggested, but it reached statistical significance in the age-adjusted model only. Obesity was associated with working overtime among women in London. in conclusion, job strain and working overtime had some, albeit mostly weak and inconsistent, associations with adverse health behaviors and obesity in these middle-aged white-collar employee cohorts from Britain, Finland, and Japan. Keywords: Psychosocial; Unhealthy food habits; Physical inactivity; Heavy drinking; Current smoking; International comparisons; UK; Finland; Japan; Work

Socioeconomic status (SES) is related to health in every industrialized society where it has been studied. Indicators include educational attainment, occupational status, and income. Subjective social status (SSS), a summative judgment of one's socioeconomic position across these dimensions, also appears to be associated with health status. The current study examines whether SSS has similar associations with SES indicators and with health outcomes among British civil servants (participants in the Whitehall-II study), and U.S. whites and blacks (participants in the CARDIA study). The comparisons shed light on social status in the U.S. and England and on the applicability of findings from Whitehall-II to both whites and blacks in the U.S. Parallel analyses in each group examined (1) the extent to which income, education, and occupational status determine SSS ratings, (2) the association of SSS with hypertension, depression, and global health, and (3) the extent to which adjustment for education, occupation and income individually and collectively reduce the association of SSS and health outcomes. As predicted, occupation is a more important determinant of SSS in Whitehall-II than in CARDIA; adjustment for occupation reduces the association between SSS and health outcomes more for the Whitehall-II participants--especially males--than for CARDIA participants. Among the latter, education and income play relatively greater roles. Socioeconomic factors do not predict SSS scores for blacks as well as they do for the other two groups. SSS is significantly related to global health and depression in all groups and to hypertension in all groups except black males. Overall, relationships of SSS and health were stronger for Whitehall-II and white CARDIA participants than for blacks in CARDIA. Keywords: Subjective social status; Socioeconomic status (SES); Whitehall-II; CARDIA; Occupation; Race/ethnicity; UK; USA

Poor physical and mental functioning is more common among people of low socioeconomic status (SES) and those with disadvantaged work and family characteristics. This study aims to clarify whether the SES inequalities in functioning can be explained by the SES differences in work and family characteristics. The subjects were 3787 male and female civil servants, aged 20-65, working in a local government on the west coast of Japan. Logistic regression analysis was performed to examine (1) whether there were employment-grade (SES) differences in poor physical and mental functioning as measured by the Short Form 36 (SF-36) and (2) whether these SES differences were explained by work and family characteristics. In general, low control at work, high demands, low social support, short and long work hours, shift work, being unmarried, high family-to-work conflict and high work-to-family conflict were independently associated with poor physical and mental functioning in both men and women. In men, the age-adjusted odds ratio (OR) of low-grade employees for poor physical functioning was 1.93 (95% confidence interval: 1.38-2.69) in comparison to high-grade employees. The grade difference was mildly attenuated, when adjusted for work and family characteristics (OR = 1.72)(1.20-2.47). The age-adjusted OR of the low-grade employees for poor mental functioning was 1.88 (1.29-2.74). The grade difference was attenuated and no longer significant when adjusted for work and family characteristics (OR = 1.51)(0.99-2.31). Among women, there were no significant grade-differences in poor physical and mental functioning. Although longitudinal research is necessary to clarify the causal nature of these associations, improvements in SES differences in work and family characteristics may be important for reducing SES inequalities in physical and mental functioning among Japanese men. The different patterns of SES inequalities in health between men and women deserve further research. Keywords: Short form 36 (SF-36); Psychosocial factors; Socioeconomic status (SES); The whitehall II study; The British civil servants study; The JACS study; Japan; Gender

Socio-economic differentials in health in Russia are not well understood and the life course approach has been relatively neglected. This paper examines the influence of socio-economic risk factors over the life course on the self-rated health of older Russian men and women. A random sample (response rate 61%) of the general population of the Russian Federation in 2002 included 1004 men and 1930 women aged 50 years and over in a cross-sectional study. They provided information concerning their childhood circumstances, including going to bed hungry; education; current social conditions, including per capita household income; health behaviours and self-rated health. There was considerable tracking of adverse social conditions across the life course with men and women who reported hunger in childhood having lower educational achievements, and current household income was strongly influenced by educational attainment. The effect of these socio-economic risk factors on health accumulated with an odds ratio of poor health of 1.87 [1.07-3.28] for men with one risk factor, 3.64 [2.13-6.22] for two risk factors and 4.51 [2.57-7.91] for all three compared to men with no risk factors. For women, the odds ratios were 1.44 [1.05-2.01], 2.88 [2.10-3.93] and 4.27 [3.03-6.00] for one, two and three risk factors, respectively. Current income was the strongest individual predictor for men, and education for women. Adjustment for health behaviours reduced the odds ratios only marginally. The results suggest that self-rated health in older Russians reflects social exposures accumulated over the life course, with the differentials observed only partially explained by current social conditions. Health behaviours were not involved in mediating social differences in self-rated health. Our results indicate that a life course approach may contribute to the understanding of health in Russia. Keywords: Russia; Life course; Self-rated health; Socio-economic differentials

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.socscimed.2004.08.070 Byline: Archana Singh-Manoux, Michael Marmot Keywords: Health inequalities; Habitus; Socialization; Socio-economic position; Life course Abstract: This paper argues that social selection, materialist/structural and cultural/behavioural explanations for social inequalities in health are related to each other through the mechanism of socialization, seen here as a process through which societies shape patterns of behaviour and being that then affect health. Socialization involves the inter- and intragenerational transfer of attitudes, beliefs and behaviours. Parallels between socialization theory and Bourdieu's concept of habitus are also drawn, and the implications for social epidemiology are discussed. Four key areas that would benefit from research within the socialization framework are identified: health behaviours, psychological vulnerability, social skills and future time perspective. Author Affiliation: Department of Epidemiology and Public Health, International Centre for Health and Society, University College London, 1-19 Torrington Place, London WC1E 6BT, UK

This paper examines the potential of demographic, personal, material and behavioural characteristics, other psychosocial features of the work environment and job satisfaction to explain associations between self-reported job insecurity and health in a longitudinal study of British white-collar civil servants. Strong associations were found between self-reported job insecurity and both poor self-rated health and minor psychiatric morbidity. After adjustment for age, employment grade and health during a prior phase of secure employment, pessimism, heightened vigilance, primary deprivation, financial security, social support and job satisfaction explained 68% of the association between job insecurity and self-rated health in women, and 36% in men. With the addition of job control, these factors explained 60% of the association between job insecurity and minor psychiatric morbidity, and just over 80% of the association with depression in both sexes. Keywords: Job insecurity; Health; Whitehall II study; UK

We compared the pattern of socioeconomic inequalities in physical functioning and perceived health among male and female employees in Britain, Finland and Japan. Participants were male and female public sector employees in Britain, Finland and Japan, who were economically active and 40-60 year-olds at the time of data collection. We measured perceived health and physical functioning (SF-36 physical component summary) with standardized health questionnaires. The results obtained here reconfirm the similarity of the patterns of ill-health of those with lower socioeconomic status among non-manual men and women in Britain and Finland. These data also provide good evidence for a socioeconomic gradient in ill-health among Japanese non-manual men, although this gradient was less systematic. For Japanese men poorer health of manual workers as compared to non-manual workers was well demonstrated. However, among Japanese women socioeconomic differences in health were small and inconsistent. In conclusion, Britain, Finland and Japan--representing 'liberal', 'Nordic' and 'conservative' welfare state regimes--produce broadly similar patterns of socioeconomic differences in health among men. However, different patterns of labour force participation and welfare provision in different welfare regimes may bring about different patterns of socioeconomic differences in health for working women. This is exemplified by the lack of health inequalities among employed Japanese women.

Using comparative data from five countries, this study investigates the psychometric properties of the effort-reward imbalance (ERI) at work model. In this model, chronic work-related stress is identified as non-reciprocity or imbalance between high efforts spent and low rewards received. Health-adverse effects of this imbalance were documented in several prospective and cross-sectional investigations. The internal consistency, discriminant validity and factorial structure of 'effort', 'reward', and 'overcommitment' scales are evaluated, using confirmatory factor analysis. Moreover, content (or external) validity is explored with respect to a measure of self-reported health. Data for the analysis is derived from epidemiologic studies conducted in five European countries: the Somstress Study (Belgium; n = 3796), the GAZEL-Cohort Study (France; n = 10, 174), the WOLF-Norrland Study (Sweden; n = 960), the Whitehall II Study (UK; n = 3697) and the Public Transport Employees Study (Germany; n = 316). Internal consistency of the scales was satisfactory in all samples, and the factorial structure of the scales was consistently confirmed (all goodness of fit measure were > 0.92) Moreover, in 12 of 14 analyses, significantly elevated odds ratios In conclusion, a psychometrically well-justified measure of work-related stress (ERI) grounded in sociological theory is available for comparative socioepidemiologic investigations. In the light of the importance of work for adult health such investigations are crucial in advanced societies within and beyond Europe. Keywords: Effort-reward imbalance; Self-rated health; Work stress questionnaire; Europe

Psychosocial factors at work have been found to predict a range of health outcomes but their effect on mental health outcomes has not been extensively studied. This paper explores the relationship between psychosocial factors at work and depression in three countries of Central and Eastern Europe. The data come from a cross-sectional study of working men (n = 645) and women (n = 523) aged 45-64 years, randomly selected from population registers in Novosibirsk (Russia), Krakow (Poland) and Karvina-Havirov (Czech Republic). The questionnaire included questions on the effort and reward at work, job control, the full CES-D scale of depression, and a range of other characteristics. Linear regression was used to estimate the association between depression score and work characteristics: the logarithm of the effort reward ratio, and continuous job control score. The means of the depression score were 10.5 for men and 14.2 for women. After controlling for age, sex and country, effort-reward ratio (logarithmically transformed) was strongly related to depression score; a 1 SD increase in the log transformed effort-reward ratio was associated with an increase in the depression of 2.0 points (95% CI 1.5; 2.4), and further adjustment did not materially change the effect Job control was inversely associated with depression score in Poland and the Czech Republic (not in Russia) but the association was largely eliminated by controlling for socioeconomic characteristics. This study suggests that the effort--reward imbalance at work is related to prevalence of depression in these central and eastern European populations. Keywords: Depression; Job stress; Effort--reward model; Job control; Psychosocial factors; Eastern Europe

Although there has been considerable research on psychosocial working conditions and their effect on physical and mental health, there has been little research into the effects of psychosocial domestic conditions on health. The association between psychosocial working conditions (and control at work in particular) and coronary heart disease (CHD) is not as strong for women compared to men. Other research suggests that household and domestic factors may have an important effect on women's health. Some studies have shown that low control at home affects psychological well being. However, there has been little research into its effects on physical health. Furthermore, similar to results analysing low control at work, low control at home may form part of the pathways underlying social inequalities in health. The study investigates the meaning of control at home, the effect of control at home on incident CHD events and whether this explains some of the social inequalities in CHD events in men and women. Data from phases 3-5 of the Whitehall II study, London, UK, were analysed (N = 7470). The results indicate that low control at home predicts CHD among women but not among men. Furthermore, low control at home may explain part of the association between household social position and CHD among women. There is some evidence suggesting that low control at home among women results from a lack of material and psychological resources to cope with excessive household and family demands. Psychosocial domestic conditions may have a greater effect on the health of women compared with men. Keywords: Inequalities in health; Psychosocial effects; Coronary heart disease; Control at home; Whitehall II study; UK

As social inequalities in health continue to be a key public health problem, scientific advances in explaining these inequalities are needed. It is unlikely that there will be a single explanation of social inequalities in health. This introductory paper sets out one explanatory framework, exposure to adverse psychosocial environments during midlife, and particularly at work. We argue that exposure to an adverse psychosocial environment, in terms of job tasks, defined by high demands and low control and/or by effort reward imbalance, elicits sustained stress reactions with negative long-term consequences for health. These exposures may be implicated in the association of socioeconomic status with health in two ways. First, these exposures are likely to be experienced more frequently among lower socioeconomic groups. Second, the size of the effects on health produced by adverse working conditions may be higher in lower status groups, due to their increased vulnerability. In this special issue, these arguments are illustrated by a collection of original contributions from collaborative research across Europe. The papers, in our view, advance the case for the robust associations between measures of adverse psychosocial environment and ill health, as they are based on comparative studies across several European countries and as they combine different types of study designs. This collaboration was enabled and supported by a European Science Foundation scientific programme on 'Social Variations in Health Expectancy in Europe'. Keywords: Social inequalities and health; Europe; Psychosocial environment; Stressful works Job strain; Effort reward imbalance

Over the past 20 years, socioeconomic inequalities in mortality have widened, while job security and financial security have decreased. This paper examines the Whitehall II study, a longitudinal study of white-collar British civil servants. In the Whitehall II cohort socioeconomic gradients in morbidity and cardiovascular risk factors at Phase 5 (1997-99) were generally steeper than at Phase 1 (1985-88). We examine the contribution of job and financial insecurity to these at Phase 5 in 6770 women and men, all of whom were white-collar civil servants at Phase 1. Steep, inverse employment grade gradients were observed for all health measures at Phase 5, except cholesterol and systolic blood pressure in women. Gradients in the sub-population of non-employed participants tended to be steeper than gradients for participants in employment, although, with the exception of self-rated health and General Health Questionnaire (GHQ) score in men, differences were non-significant. Steep gradients in job insecurity were observed among employed participants (p [less than or equal to] .01), and in financial insecurity among both employed and non-employed participants (p [less than or equal to] 0.001), particularly non-employed men. With the exception of depression, adjustment for job insecurity had little effect on the employment grade gradients in morbidity. However, financial insecurity contributed substantially to gradients in self-rated health, longstanding illness, and depression in both employed and non-employed men, and additionally to GHQ score and diastolic blood pressure in the latter. Adjustment for financial insecurity in non-employed women substantially attenuated gradients in self-rated health, GHQ score and depression. These findings imply that the specific effects of job insecurity in this cohort may be less important than the more general effects of financial insecurity in determining inequalities in health. Keywords: Job insecurity; Financial insecurity; Health inequalities; Employment status; Cross-sectional; White-collar; UK

There has been considerable debate over the importance of the health selection hypothesis for explaining social gradients in health. Although studies have argued that it may not be an important explanation of social gradients in health, previous analyses have not estimated, simultaneously, the relative effect of health on changes in social position and of social position on changes in health (social causation). Cross-lagged longitudinal analyses using structural equation models enable the estimation of the relative size of these pathways which would be useful in determining the relative importance of the health selection hypothesis over the social causation hypothesis. Data from four phases of the Whitehall II study (initially consisting of 10,308 men and women aged 35-55 in the British civil service) were collected over a 10 year period. There was no evidence for an effect of mental (GHQ-30 and SF36) or physical health (SF-36) on changes in employment grade. When financial deprivation was used as a measure of social position, there was a significant effect of mental health on changes in social position among men although this health selection effect was over two and a half times smaller than the effect of social position on changes in health. The results suggest that the development of social gradients in health in the Whitehall II study may not be primarily explained in terms of a health selection effect. Keywords: Health selection; Social causation; Health inequalities; United Kingdom

The aim of the study is to (i) identify common dietary patterns, (ii) study socioeconomic differences in these dietary patterns, and (iii) assess whether they contribute to socioeconomic differences in biological risk factors. The data come from the Whitehall II study of London civil servants, who participated in the third phase (1991-1993) and were 39-63-years old (N = 8004). Food frequency questionnaire and socioeconomic background information was from a questionnaire, and biological risk factors from a medical screening. Six dietary patterns were identified. In reference to high employment grade men, the odds ratios of low grade men consuming the `unhealthy' or the `very unhealthy' diet were 1.26 and 3.34, respectively, while the odds for the `French' diet was 0.13. Among women the corresponding odds were 2.98, 6.19 and 0.25. Adjusting for spouse's socioeconomic status and to a lesser extent smoking and exercise as well as job control attenuate these grade differences somewhat. Among men and women adjusting for dietary patterns accounted for about 25-50 per cent of grade differences in HDL and serum triglyceride levels. Keywords: Socioeconomic status; Dietary patterns; Biological risk factors; UK

The purpose of this study was twofold--(1) investigate the role of subjective social status as a predictor of ill-health, with a further exploration of the extent to which this relationship could be accounted for by conventional measures of socioeconomic position; (2) examine the determinants of a relatively new measure of subjective social status used in this study. A 10 rung self-anchoring scale was used to measure subjective social status in the Whitehall II study, a prospective cohort study of London-based civil service employees. Results indicate that subjective status is a strong predictor of ill-health, and that education, occupation and income do not explain this relationship fully for all the health measures examined. The results provide further support for the multidimensional nature of both social inequality and health. Multiple regression shows subjective status to be determined by occupational position, education, household income, satisfaction with standard of living, and feeling of financial security regarding the future. The results suggest that subjective social status reflects the cognitive averaging of standard markers of socioeconomic situation and is free of psychological biases. Keywords: Subjective status; Inequalities in health; Whitehall; Occupation; Income; Education, UK

In this study we consider both a gender model, a model that focuses on the stress associated with social roles and conditions in the home environment, and a job model, which addresses the stressful characteristics of the work environment, to investigate patterns of women's and men's psychological morbidity across different social positions. Using data from the Whitehall II Study, a longitudinal study of British civil servants, we hypothesise that a lack of control in the home and work environments affects depression and anxiety differently for women and men and across three social class groups. Both women and men with low control either at work or at home had an increased risk of developing depression and anxiety. We did not find an interaction between low control at home and work. We did, however, find that the risks associated with low control either at home or work were not evenly distributed across different social positions, measured by employment grade. Women in the lowest or middle employment grades who also reported low control at work or home were at most risk for depression and anxiety. Men in the middle grade with low work control were at risk for depression while those in the lowest grade were at risk for anxiety. Men in the middle and highest grades, however, were at greatest risk for both outcomes if they reported low control at home. We conclude that, in addition to social roles and characteristics of the work environment, future investigations of gender inequalities in health incorporate variables associated with control at home and social position. Keywords: Depression; Anxiety; health inequalities; Gender inequalities; control; Work; home

This study examined the association between perceived control and several socioeconomic variables and self-rated health in seven post-communist countries (Russia, Estonia, Lithuania, Latvia, Hungary, Poland, Czech Republic). Questionnaire interviews were used to collect data on self-rated health in the last 12 months, education, marital status, perceived control based on nine questions, and material deprivation based on availability of food, clothing and heating. For each population, two ecological measures of material inequalities were available: an inequality score estimated from the survey data as the distance between the 90th and 10th percentiles of material deprivation, and Gini coefficient from published sources. Data on 5330 men and women aged 20-60 were analysed. Prevalence of poor health (worse than average) varied between 8% in Czechs and 19% in Hungarians. The age-sex-adjusted odds ratio for university vs primary education was 0.36 (0.26-0.49); odds ratios per 1 standard deviation increase in perceived control and in material deprivation were 0.58 (95% CI 0.48-0.69) and 1.51 (1.40-1.63), respectively. The odds ratio for an increase in inequality equivalent to the difference between the most and the least unequal populations was 1.49 (0.88-2.52) using the material inequality score and 1.41 (0.91-2.20) using the Gini coefficient. No indication of an effect of either inequality measure was seen after adjustment for individuals' deprivation or perceived control. The results suggest that, as in western populations, education and material deprivation are strongly related to self-rated health. Perceived control appeared statistically to mediate some of the effects of material deprivation. The non-significant effects of both ecological measures of inequality were eliminated by controlling for individuals' characteristics. Keywords: Eastern Europe; Self-rated health; Socioeconomic factors; Psychosocial factors; Perceived control; Inequality

Continuous decline in functioning is not an inevitable consequence of ageing, as some individuals maintain high levels of functioning to old age. The origins of functional problems in old age are not only related to current circumstances, but may be traced back to earlier life-experiences. Previous analyses show that change in functioning is related to socioeconomic status, but it is uncertain to what extent these differences can be accounted for by the same health behaviours and material and psychosocial factors that are related to socioeconomic differences in morbidity and mortality. This paper investigates socioeconomic differences in change in mental and physical functioning in a relatively young and healthy population over a three year follow-up period. The data come from the Whitehall II Study of London based civil servants aged 39-63 in 1991-93. We measured functioning with the Short Form 36 (SF-36) General Health Survey and socioeconomic status by civil service employment grade. Among lower employment grade men the odds ratio of being in the quartile of rapid decline in mental and physical functioning was 1.79 and 1.56 respectively. For women the odds ratio for physical functioning was 1.34, but employment grade differences in mental functioning were inconsistent. Among men health behaviours were the most important determinants of employment grade differences in physical functioning change. In addition, material problems and job decision latitude accounted for employment grade differences in physical as well as mental functioning change. However, among women employment grade differences in change in physical functioning can not be accounted for with these risk factors. Analyses of change in determinants may provide further insight into the underlying pathways. Early detection of functional decline and intervention may be a key to better functioning in ageing populations. Keywords: Mental functioning; Physical functioning; SF-36; Socioeconomic status

The National Survey of Mid-life Developments in the United States (MIDUS) is one of several studies that demonstrate socioeconomic gradients in mortality during midlife. When MIDUS findings on self-reported health, waist to hip ratio, and psychological well-being were analyzed for their possible roles in generating socioeconomic differences in health, they revealed clear educational gradients for women and men (i.e., higher education predicted better health). Certain potential mediating variables, like household income, parents' education, smoking behavior, and social relations, contributed to an explanation of the socioeconomic gradient. In addition, two census-based measures, combined into an area poverty index, independently predicted ill health. The results suggest that a set of both early and current life circumstances cumulatively contribute toward explaining why people of lower socioeconomic status have worse health and lower psychological well-being.

Since August 1988 an increasing proportion of the executive functions of government in the United Kingdom have been devolved to executive agencies. Transfer to an executive agency involves a period of uncertainty during which the options of elimination or transfer to the private sector are considered, followed by a marked change in management style and further periods of uncertainty when the agency's function is reconsidered for transfer to the private sector. This paper examines the effects of this major organisational change and consequent job insecurity on the health status of a cohort of 7419 white-collar civil servants by comparing groups either exposed to or anticipating exposure to this stressor, with controls experiencing no change. Compared with controls, men both already working in and anticipating transfer to an executive agency experienced significant increases in health self-rated as 'average or worse', longstanding illness, adverse sleep patterns, mean number of symptoms in the fortnight before questionnaire completion, and minor psychiatric morbidity. Significant relative increases in body mass index were seen in both exposure groups while exposure to agency status was also associated with significant relative increases in blood pressure. Health-related behaviours, where they differed between exposure and control groups, tended to favour those in the exposure groups. Compared with controls, women in both exposure groups reported small increases in most self-reported morbidity measures and most clinical measurements, accompanied by slight beneficial changes in some health-related behaviours and small adverse changes in others. Significant relative increases were seen in mean number of symptoms, and ischaemia among women anticipating exposure and in body mass index among those exposed to agency status. Policy makers should be aware of the wider consequences of job insecurity when considering the efficiency of changes in employment policy. Key words - job insecurity, health, white-collar, longitudinal