Inequalities in Health among Older Adults in Western Industrialised Countries : Explanations from Gender, Socioeconomic and Time Use Perspectives

Abstract

Gender and socioeconomic inequalities in health persist in high-income countries, even at old age; yet, there is still no consensus about the best indicators of socioeconomic status to be used in health inequalities research among older adults, especially after retirement. Complementary social indicators that have been suggested to assess gender and socioeconomic inequalities in health outcomes at old age are social roles and time use activities. This thesis explores the social and economic inequalities in self-reported health among elderly men and women, using a combined framework of time use activities, socioeconomic status (SES) and family characteristics. It further explains gender and cross-national inequalities in health in some Western industrialised countries. The thesis is centered around three empirical studies focusing on different dimensions of social inequalities in health among elderly men and women. The studies are based on data from the Multinational Time Use Study (MTUS) on older men and women aged 65 years and above. It also consists of a framework paper with an introductory chapter and a discussion of methodological as well as content issues around the topic. Study I examined how time use activities, socioeconomic status and family characteristics impact the health of older adults, and the extent to which the associations varied by gender and across countries. It further examined the extent to which various social factors explain the gender inequalities in health at old age. Significant gender differences in self-reported health were found in Germany, Italy and Spain, but not in the United Kingdom and the United States. Further decomposition analysis showed that differences in time allocated to leisure activities and level of educational attainment accounted for the largest health gap between elderly men and women. The results also showed that whereas time devoted to paid work, housework and active leisure activities were positively associated with health, time allocated to passive leisure and personal activities were negatively related to health in both men and women. The magnitude of the associations however varied by gender and country. Study II investigated the extent to which the association between housework activities and health may be moderated by sleep duration among elderly men and women. The result showed that both short ( 7 hours) and long ( 8 hours) sleep duration were negatively associated with health for both genders. However, the interactive associations between total productive housework, sleep duration and health status varied considerably between men and women. Among women, long hours of housework combined with either short or long sleep was negatively associated with health. Study III examined whether stress defined in terms of time pressure plays a mediating role in the relationship between work-related activities (paid work and unpaid work) and health among elderly men and women. The results showed that socioeconomic status, demographic factors, stress and work-related time use activities after retirement had a significant direct influence on health among the elderly. The findings further revealed that although stress has a strong direct negative effect on the health of both genders, it does not indirectly influence the positive effects of work-related time use activities on health among older adults. The overall conclusion in this thesis is that social patterning of health inequalities persist at older ages in high-income countries. However, the magnitude of these inequalities differ across countries and are shaped by unequal distribution of social and time use resources. The results of this thesis thus demonstrate the need of using an integrated framework of social factors when analysing gender and cross-national inequalities in health among the elderly population.