The Interrelationships between Morbidity, Functional Limitation and Self-Rated Health in Europe
Uppsala University, Sweden
In the medical sociology literature, most commonly used health proxies are self-rated health, morbidity and functional limitation. The interest in different aspects of health led to the investigation of the relationships between those, mostly, focusing on two aspects of health rather than three or more. There are only a few studies exploring relationships between three or more proxies of health that date back to 1980s and 1990s testing different models for the structure of health. Studies, unfortunately, have not been continued and, moreover, were performed mainly in the U.S. and limited to the elderly population. Thus, the main objective of the current research is to explore interrelationships between the three aspects of health: morbidity, functional limitation and self-rated health. The study proposes a modification of the previous models of health structure and tests it on the entire population (all ages) across 20 European countries.
The study utilizes the European Social Survey (ESS) from 2014 that provides the data on self-rated health, functional limitation and various health problems. Structural equation modeling is employed in order to estimate causal pathways for the morbidity, functional limitation and self-rated health as well as direct and indirect effects.
The preliminary results support the predictions from the proposed model. Specifically, morbidity and functional limitation all have direct effect on self-rated health. Furthermore, morbidity has indirect effect on self-rated health through functional limitation. Yet a few exceptions among European countries are revealed.
The results of this European cross-country comparative study allows us to increase the generalizability of the health structure. Furthermore, the study opens new research avenues in terms of adding socio-economic factors and health related behavior to the model.
Ideology and resistance in young people’s experiences of health under ‘the imperative of enjoyment’
Aalborg University, Copenhagen Denmarj, Denmark
This article explores upper secondary school students’ understandings and experiences of health in Denmark, where public health promotion makes appeals to pleasure. Health promotion hereby taps into capitalist society’s ‘imperative of enjoyment’ (cf. Žižek 1999; 2006; Declercq 2006; McGowan 2004), which reproduces ideological fantasies about the fulfilment of desires through consumption of health. Based on qualitative empirical material produced through participatory and visual methods during fieldwork in 2012, the analysis shows that relations between healthiness and pleasure are conflated and paradoxical: the students try to fit into society not only by being healthy, but also by enjoying it, but if they fail pleasure, they fail healthiness, and experience a loss of individual social value. However, the despite the ‘enjoyment society’ potentially produces marginalisation, individualisation, de-politicisation and fragmentation, the students of this study actively attempt to subvert its duble binds and become subjects not totally absorbed in ideology. Nevertheless, public health promotion that reproduces enjoyment as imperative even in pursuing health, risk reinforcing young people’s resistance towards ‘health’.
The education gradient in cancer prevention use, a consistent phenomenon across Europe?
University Ghent, Belgium
Objectives: To extend the literature on educational inequalities in cancer prevention use by (1) simultaneously studying different preventive cancer measures (e.g. cervical smear test (PAP), colorectal cancer test (FOBT), prostate-specific antigen test (PSA), and mammography screening) across different European countries, and (2) evaluating both absolute and relative inequalities. Diffusion of innovation theory and country differences in the organisation and financing of health services are considered as frameworks to guide interpretation of the findings.
Methods: Analyses are based on Eurobarometer data. Depending on the preventive outcome and the specific target population at risk, final sample sizes ranges from 4,511 (PSA) to 10,313 (FOBT) respondents. Overall and country-specific logistic regressions are applied
Results: Educational inequalities in cancer prevention use exist, but vary considerably between countries and preventive outcomes. Overall pro-high educational inequalities are only observed in PAP and PSA test use. In terms of both absolute and relative measures of inequality, the most problematic countries seem to be Denmark, Greece, Spain, and Austria for respectively cervical smear testing, mammography screening, PSA testing, and colorectal cancer testing.
Conclusion: Two explanations for this large variation in educational inequalities in cancer prevention use across and within countries popped out the results. (1) In line with DOI theory, colorectal cancer testing seems to be in an early stage of diffusion with low or non-existing inequalities, PSA and PAP smear testing in a further stage with emerging and high inequalities, and mammography screening in an advanced stage with decreasing or low inequalities. (2) Also differences in the organisation and financing of health services seem to matter, as in countries with universal coverage and/or publicly funded health services educational inequalities are absent.
The effect of intergenerational social mobility on psychological well-being: a cross-national comparison in Europe.
Ghent University, Belgium
In this paper I empirically investigate if and to what extent intergenerational social mobility affects individual psychological well-being across EU countries. By incorporating country level characteristics within the study of the psychological consequences of social mobility, I analyze how the impact of moving between different social classes on psychological well-being varies between welfare state regimes in EU countries. Using diagonal reference models on data from the fifth wave (2013) of the SHARE-data, I find that for the majority of the countries individual psychological well-being is chiefly a function of the social class someone has moved to, indicating processes of acculturation. However, in Switzerland and Belgium, social mobility has an asymmetric effect on well-being, with upward mobility positively and downward mobility negatively affecting psychological well-being. Although these preliminary results indicate cross-country variations of the psychological consequences of social mobility, they do not support the notion of mobility consequences that are dependent upon the welfare state regimes present in EU countries.
Material deprivation and health care services in Europe
Università di Milano-Bicocca, Italy
A large number of studies documenting an influence on access and utilization of health care of traditional social stratification variables. Socio-economic status (SES) is related to health because individuals deploy resources (such as knowledge, money, power) to avoid risks and to adopt protective strategies. Therefore, people with greater resources are better able to use health care services in order to improve their health than people with lower SES. In this perspective, a key dimension are economic resources that we know to be an excellent predictor of health conditions. An extensive literature defines relative and absolute poverty based on monetary income or consumption. However, income-based measures may be particularly poor proxies of material conditions among older people. Additionally, these measures are problematic in the context of international comparisons. For these reasons, in this work the economic situation of individuals can be approximate by material deprivation measure.
The aim of this study is to describe the relationship between material deprivation and health care system among individuals aged 50 and over in 14 European countries. Data derived from the wave 5 of SHARE (Survey of Health, Ageing and Retirement in Europe) project. In particular, we are interested to analyze the association between economic conditions and three health care outcomes: a) access and use of services; b) health care satisfaction; and c) out-of-pocket expenditure.
First results prove that for elderly people, who are becoming an increasingly important group in our societies, material deprivation may represent a serious problem with regards to health care access and use. This means that there is a large space for European social policies to remove obstacles for healthy aging and for increasing individual well-being.