Improving the Health of Women in the United States Workshop Summary (2016) / Chapter Skim
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3 Socioeconomic and Behavioral Factors That Influence Differences in Morbidity and Mortality
3 Socioeconomic and Behavioral Factors That Influence Differences in Morbidity and Mortality
Pages 27-48
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From page 27... ...
GEOGRAPHY Jennifer Karas Montez (Syracuse University) introduced her presentation as the result of collaborative work with Mark Hayward and Anna Zajacova over the last several years with the aim of explaining the large inequalities in women's mortality in the United States and, specifically, the inequalities at the state level.
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From page 28... ...
The large inequalities have grown since the early 1980s during a time when federal aid to states declined, and states have been granted more discretion over policies and programs. Montez reported that it is now possible to test these hypotheses because, as of 2013, data from the National Longitudinal Mortality Study (NLMS)
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, at the county level, shows differences within states. Some potential explanatory factors are better con 1For information on the National Longitudinal Mortality Study, see https://www.census.
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, which contained estimates of remaining life expectancy at age 50 for men and women based on their quintiles of average Social Security earnings in their 40s. The report found that low-income adults in the United States are losing ground relative to their wealthier peers.
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For example, poor health in early life health could impair educational attainment, which could influence subsequent earnings and then subsequent health prospects. Both causal influences and health selection can be at work, and understanding them is very important for understanding SES gradients and health.
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women in terms of socioeconomic resources and achievements, along with changes in other areas of life. From the 1960s to the mid-1980s, women attended college in greater numbers than they had previously, and rates of labor force participation grew almost continuously, even among mothers of young children.
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From page 33... ...
In addition, although men and women both benefit from social welfare programs in the United States, in some cases the social welfare programs are tied to labor-force participation histories, and women, who tend to have shorter work histories due to child-rearing responsibilities, may not benefit as much as men from those benefits. Another dimension affecting the differential health experiences of men and women, even when they have the same level of SES, is patterns of time use.
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From page 34... ...
He emphasized that the relationship between education and health is dynamic and pervasive. For example, as discussed below, over the past two decades, women with less than a high school education experienced increased mortality but there were extremely rapid declines in mortality among women with a college education or more.
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From page 35... ...
A most important finding of several studies (Hayward et al., 2015; Montez et al., 2011, 2012; Olshansky et al., 2012: Sasson, 2014) is that, for non-Hispanic white women, the increasing gradient appears to be the consequence of two trends: increases in mortality for women with less than a high school education and extremely rapid declines in mortality among women with a college education or more.
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From page 36... ...
Women with less than a high school education lost life expectancy primarily in the age ranges below 60, although losses in life expectancy occurred above age 60 as well. Women with a high school education experienced some losses in life expectancy in the age groups to about age 55 or 60; at older ages, women experienced improvements in life expectancy.
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From page 37... ...
documented that the trend was accelerating, with advanced education being even more strongly associated with low-mortality risks among women. In summary, Hayward said, there is a growing literature that points to an increasingly stronger link between education and health in the United States over the past several decades.
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Another participant asked what the data suggest about the differential health trends for men and women. Hayward responded that males start out with more of a health disadvantage as measured in terms of life expectancy so that the improvement reflects their low starting point.
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reviewed the latest research on employment and women's health in the context of the changing economy and changing family lives of the 21st century. Historically, she said, the argument has been that higher education would damage women's health and that employment would interfere with women's roles as mothers and wives or lead to rising health risks as women become "like men" and therefore at risk for cardiovascular disease and other "men's diseases." She noted that the context of employment for women's health has changed dramatically: women are now almost as likely to be employed as are men and so equally vulnerable to the effects of poor working conditions.
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Trends in the economy -- including downsizing and outsourcing of core functions, increasing use of contingent labor, flatter management structures and lean production technologies -- have contributed to reduced job stability and increased workloads for many workers, and these factors give rise to high levels of job stress. Marshall pointed out that job stress has been found to be associated with cardiovascular disease and other illnesses, as well as psychological distress and depression, and that women are more likely to be employed in jobs with higher levels of stress ( ermeulen and Mustard, 2000)
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One study found that flexible work arrangements are particularly important to women with a lot of family responsibility and that flextime was more strongly linked to reducing work interference with family life than was flexplace (Shockley and Allen, 2007)
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. Women with school-age children have the highest labor-force participation rate of women across all of the life stages, Marshall noted.
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Grella (University of California, Los Angeles) focused on the behavioral health disorders -- specifically, substance use and mental health disorders -- and gender differences and their risk for morbidity and mortality among women.
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From page 44... ...
She noted that the very large gender differences, for instance, in the experiences of craving and withdrawal that are related to hormonal influences. These differences are seen in studies of nicotine addiction: women experience strong subjective reactions in terms of a craving response at different points in their menstrual cycles, which make it more difficult to treat tobacco dependence.
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From page 45... ...
However, women tend to have a higher rate of both mental health and substance abuse problems than do men, thus increasing the complexity of treating women's substance abuse. The life-span perspective is critically important in understanding the development of substance use and mental health disorders, Grella argued.
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From page 46... ...
Comorbidity is the crux of the issue of the greater severity among women when they initiate substance use and have comorbid mental health disorders, Grella stressed. Comorbidity is greater for women, even at lower levels of substance use.
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. Grella discussed another study of opioid users that looked at gender differences in patterns of comorbidity (Grella et al., 2009)
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From page 48... ...
. Using DALYs as the measure, the Global Burden of Disease study found that boys under the age of 10 have a bigger burden of disease due to mental health and substance abuse problems, primarily because of behavioral disorders, but that females over the age of 10 have a greater burden of disease at all age groups from the combined burden of substance use and mental health disorders (Whiteford et al., 2013)
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