Welfare state regimes and differences in self-perceived health in Europe: a multilevel analysis

The aim of this study was to determine the degree to which welfare state regime characteristics explained the proportional variation of self-perceived health between European countries, when individual and regional variation was accounted for, by undertaking a multilevel analysis of the European Social Survey (2002 and 2004). A total of 65,065 individuals, from 218 regions and 21 countries, aged 25 years and above were included in the analysis. The health outcomes related to people's own mental and physical health, in general. The study showed that almost 90% of the variation in health was attributable to the individual-level, while approximately 10% was associated with national welfare state characteristics. The variation across regions within countries was not significant. Type of welfare state regime appeared to account for approximately half of the national-level variation of health inequalities between European countries. People in countries with Scandinavian and Anglo-Saxon welfare regimes were observed to have better self-perceived general health in comparison to Southern and East European welfare regimes.     

The persistence of health inequalities in modern welfare states: the explanation of a paradox

The persistence of socioeconomic inequalities in health, even in the highly developed 'welfare states' of Western Europe, is one of the great disappointments of public health. Health inequalities have not only persisted while welfare states were being built up, but on some measures have even widened, and are not smaller in European countries with more generous welfare arrangements. This paper attempts to identify potential explanations for this paradox, by reviewing nine modern 'theories' of the explanation of health inequalities. The theories reviewed are: mathematical artifact, fundamental causes, life course perspective, social selection, personal characteristics, neo-materialism, psychosocial factors, diffusion of innovations, and cultural capital. Based on these theories it is hypothesized that three circumstances may help to explain the persistence of health inequalities despite attenuation of inequalities in material conditions by the welfare state: (1) inequalities in access to material and immaterial resources have not been eliminated by the welfare state, and are still substantial; (2) due to greater intergenerational mobility, the composition of lower socioeconomic groups has become more homogeneous with regard to personal characteristics associated with ill-health; and (3) due to a change in epidemiological regime, in which consumption behavior became the most important determinant of ill-health, the marginal benefits of the immaterial resources to which a higher social position gives access have increased. Further research is necessary to test these hypotheses. If they are correct, the persistence of health inequalities in modern European welfare states can partly be seen as a failure of these welfare states to implement more radical redistribution measures, and partly as a form of 'bad luck' related to concurrent developments that have changed the composition of socioeconomic groups and made health inequalities more sensitive to immaterial factors. It is argued that normative evaluations of health inequalities should take these explanations into account, and that a direct attack on the personal, psychosocial and cultural determinants of health inequalities may be necessary to achieve a substantial reduction of health inequalities.     

Flexible employment,flexible eating and health risks

Over the last 30 years, the risks to public health from working conditions have subtly shifted in line with new economic regimes, notably the shift towards contractualist, individualised market driven and ‘flexible’ regulation of employment associated with the neo-liberal project. Yet, the resulting transformation in temporal schedules has occurred without due consideration of potential health impacts. We contend that contemporary employment policies pose a threat to public health because of their impact on how time is valued, used and experienced. In particular, time matters for earning an income and for basic health behaviours, like healthy eating. The sociological theory of timescapes is used to interpret a qualitative study of food consumption and labour market engagement practices among three generations of Australians. We find that wide variability in individual employment schedules is accompanied by desynchronised social lives and less healthy eating practices. The research leads us to theorise that employment regimes that are flexible for employers require workers to live flexible or fluid cultural lives, disembedded from the temporal structure of previous social rituals, whether culinary, familial or friendship. The health consequences of this requirement remain unrecognised by policy-makers.     

Welfare reform, labor supply, and health insurance in the immigrant population

Although the 1996 welfare reform legislation limited the eligibility of immigrant households to receive assistance, many states chose to protect their immigrant populations by offering state-funded aid to these groups. I exploit these changes in eligibility rules to examine the link between the welfare cutbacks and health insurance coverage in the immigrant population. The data reveal that the cutbacks in the Medicaid program did not reduce health insurance coverage rates among targeted immigrants. The immigrants responded by increasing their labor supply, thereby raising the probability of being covered by employer-sponsored health insurance.     

Precarious employment and migrant workers’ mental health: a systematic review of quantitative and qualitative studies

ObjectivesEvidence suggests that precarious employment can have detrimental effects on workers’ health, including mental health. Migrant workers are discussed to be especially vulnerable to such effects. Thus, we systematically reviewed existing research on the association between precarious employment and migrant workers’ mental health.MethodsThree electronic databases (Web of Science, PsycINFO and PubMed/Medline) were searched for original articles on quantitative and qualitative studies published from January 1970 to February 2022 in English, German, Turkish and Spanish. Multiple dimensions of precarious employment were considered as exposure, with mental health problems as outcomes. Narrative synthesis and thematic analyses were performed to summarize the findings of the included studies along with risk of bias and quality assessment.ResultsThe literature search resulted in 1557 original articles, 66 of which met the inclusion criteria – 43 were of high quality and 22 were of moderate quality. The most common exposure dimensions analyzed in the studies included temporariness, vulnerability, poor interpersonal relationships, disempowerment, lacking workers’ rights and low income. The outcome measures included stress, depression, anxiety and poor general mental health. The prevalence of these outcomes varied between 10–75% among the included quantitative studies. All qualitative studies reported one or more dimensions of precarious employment as an underlying factor of the development of mental health problems among migrants. Of 33 quantitative studies, 23 reported evidence for an association between dimensions of precarious employment and mental health.ConclusionThe results of this review support the hypothesis that precarious employment is associated with migrant workers’ mental health.     

Critical health literacy: a review and critical analysis

Though there has been a considerable expansion of interest in the health literacy concept worldwide, there has also been criticism that this concept has been poorly defined, that it stretches the idea of "literacy" to an indefensible extent and more specifically, that it adds little to the existing concerns and intervention approaches of the better established discipline of health promotion. This paper takes as a starting point the expanded model of health literacy advanced by Nutbeam (2000) and addresses these concerns by interrogating the concept of "critical health literacy" in order to draw conclusions about its utility for advancing the health of individuals and communities. The constituent domains of critical health literacy are identified; namely information appraisal, understanding the social determinants of health, and collective action, and as far as possible each are clearly delineated, with links to related concepts made explicit. The paper concludes that an appreciation of work undertaken in a range of different disciplines, such as media studies, medical sociology, and evidence-based medicine can enhance our understanding of the critical health literacy construct and help us understand its usefulness as a social asset which helps individuals towards a critical engagement with health information. There is some evidence that aspects of critical health literacy have indeed been found to be a resource for better health outcomes, but more research is needed in this area, both to develop quantitative and qualitative approaches to evaluating health literacy skills, and to offer convincing evidence that investment in programmes designed to enhance critical health literacy are worthwhile.     

Beyond welfare reform: reframing undocumented immigrants' entitlement to health care in the United States, a critical review

This article addresses the main scholarly frames that supported the deservingness of unauthorized immigrants to health benefits in the United States (U.S.) following the passage of the Personal Responsibility Work Opportunity Reconciliation Act (PRWORA), known as the Welfare Reform bill, in 1996. Based on a critical literature review, conducted between January 1997 and March 2011, this article begins with an analysis of the public health rhetorics that endorsed immigrants' inclusion into the U.S. health safety net. In this vein, the "cost-saving" and "the effortful immigrant" frames underscore immigrants' contributions to society vis-à-vis their low utilization of health services. These are complemented by a "surveillance" account that claims to protect the American public from communicable diseases. A "maternalistic" frame is also discussed as a tool to safeguard families, and particularly immigrant mothers, in their roles as bearers and caretakers of their American-born children. The analyses of the "chilling" and the "injustice" frames are then introduced to underscore major anthropological contributions to the formulation of counter-mainstream discourses on immigrants' selective inclusion into the U.S. health care system. First, the "chilling effect," defined as the voluntary withdrawal from health benefits, is examined in light of unauthorized immigrants' internalized feelings of undeservingness. Second, an "injustice" narrative highlights both the contributions and the limitations of a social justice paradigm, which advocated for the restoration of government benefits to elderly immigrants and refugees after the passage of PRWORA. By analyzing the contradictions among all these diverse frames, this paper finally reflects on the conceptual challenges faced by medical anthropology, and the social sciences at large, in advancing health equity and human rights paradigms.     

Is precarious employment damaging to self-rated health? Results of propensity score matching methods,using longitudinal data in South Korea

We aimed to evaluate the health effects of precarious employment based on a counterfactual framework, using the Korea Labor and Income Panel Survey data. At the 4th wave (2001), information was obtained on 1991 male and 1378 female waged workers. Precarious work was defined on the basis of workers employed on a temporary or daily basis, part-time, or in a contingent (fixed short-term) job. The outcome was self-rated health with five response categories. Confounding factors included age, marital status, education, industry and occupation of current employment, household income, residential area, and prior health status. Propensity scores for each individual to be a precarious worker were calculated from logistic models including those covariates, and based on them, precarious workers were matched to non-precarious workers. Then, we examined the effects of precarious employment on health and explored the potential intermediary variables, using ordered logistic Generalized Estimating Equations models. All analyses were performed separately by gender. Precarious workers were found to be in a lower socioeconomic position and to have worse health status. Univariate matched analyses showed that precarious employment was associated with worse health in both men and women. By further controlling for socio-demographic covariates, the odds ratios were attenuated but remained significant. Job satisfaction, especially as related to job insecurity, and monthly wage further attenuated the effects. This suggests that to improve health status of precarious workers in Korea, policy strategies need to tackle the channeling of the socially disadvantaged into precarious jobs. Also, regulations to eliminate discrimination against precarious workers in working conditions or material reward should be introduced and enforced. There is no doubt that job insecurity, which is pervasive among workers in Korea, should be minimized by suspending market-oriented labor policies which rely on quantitative flexibility.     

Working at night and work ability among nursing personnel: when precarious employment makes the difference

Purpose  To test the association between night work and work ability, and verify whether the type of contractual employment has any influence over this association. Methods  Permanent workers (N = 642) and workers with precarious jobs (temporary contract or outsourced; N = 552) were interviewed and filled out questionnaires concerning work hours and work ability index. They were classified into: never worked at night, ex-night workers, currently working up to five nights, and currently working at least six nights/2-week span. Results  After adjusting for socio-demography and work variables, current night work was significantly associated with inadequate WAI (vs. day work with no experience in night work) only for precarious workers (OR 2.00, CI 1.01–3.95 and OR 1.85, CI 1.09–3.13 for those working up to five nights and those working at least six nights in 2 weeks, respectively). Conclusions  Unequal opportunities at work and little experience in night work among precarious workers may explain their higher susceptibility to night work.     

Unemployment, job insecurity and life satisfaction: results of a study with young adults in the new German states

Zusammenfassung. Fragestellung: Ausgehend von den zahlreichen Forschungen zu psychosozialen Aspekten des Erlebens von Arbeitslosigkeit untersucht die Studie die Folgen von tats?chlicher Arbeitslosigkeit auf die Lebenszufriedenheit und die Auswirkungen von Bedrohung durch Arbeitslosigkeit und wahrgenommener Sicherheit des Arbeitsplatzes auf die Lebenszufriedenheit. Methoden: Im Rahmen der 17. Welle der S?chsischen L?ngsschnittstudie wurden 2003 N = 419 Personen (193 M?nner, 226 Frauen, Mittleres Alter 30.05 Jahre) mit dem Fragebogen zur Lebenszufriedenheit (FLZ M) untersucht. Der Bogen erlaubt die ?konomische Erfassung von acht spezifischen Bereichen der Lebenszufriedenheit (Freunde, Freizeit, Gesundheit, Einkommen, Beruf, Wohnen, Familie, Partnerschaft). Ergebnisse: Zwei Drittel der Studienteilnehmer hatten bereits Erfahrungen mit Arbeitslosigkeit. Personen, die mehrfach arbeitslos waren, waren signifikant unzufriedener mit ihrem Einkommen, ihrer Wohnsituation, ihrem Beruf und ihrer Gesundheit. Jedoch hatten auch die Sicherheit des derzeitigen Arbeits- oder Ausbildungsplatzes und die subjektiv erlebte Bedrohung durch Arbeitslosigkeit bei derzeit Nichtarbeitslosen deutlich negative Auswirkungen auf deren Lebenszufriedenheit. Dies zeigte sich auch in Bereichen, die nicht direkt mit Erwerbsarbeit in Zusammenhang stehen, wie Freunde/Bekannte oder Familienleben. Schlussfolgerung: Die Studie unterstreicht bekannte Befunde zum Zusammenhang von Arbeitslosigkeit und (negativer) Lebenszufriedenheit. Nachgewiesen wird, dass auch bereits der antizipierte Verlust des Arbeitsplatzes zu einer eindeutig schlechteren subjektiven Lebenszufriedenheit in vielen Bereichen führt.

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Summary. Unemployment, job insecurity and life satisfaction: results of a study with young adults in the new German states Objectives: Based on research about the psychosocial aspects of experiencing unemployment, the present study analyses the effects of actual unemployment and the impact of being at risk of becoming unemployed and the influence of perceived job insecurity on life satisfaction. Methods: In the 17^th wave of the Saxon Longitudinal Study (S?chsische L?ngsschnittstudie) in 2003, 419 people (193 male, 226 female, mean age 30.05 years) were examined with a life satisfaction questionnaire. This questionnaire addresses eight areas of life satisfaction: friends, leisure time, health, income, job, housing, family, partnership. Results: Two-thirds of the participants have had experiences with unemployment so far. People who had been unemployed several times were significantly more dissatisfied with their income, housing, profession and health. Still, considering people employed at the time of survey, the subjective job insecurity and the perceived risk of becoming unemployed had noticeably negative effects on life satisfaction. This could be also shown for areas which are not directly connected to occupation, such as friends and family life. Conclusions: The study emphasizes the known results regarding the connection between unemployment and (poor) life satisfaction. Evidence was provided that even the anticipated loss of the workplace causes a decrease in life satisfaction, affecting many areas of subjective evaluation.

Wir danken der Otto-Brenner-Stiftung (http://www.otto-brenner-stiftung.de) für die freundliche Unterstützung der S?chsischen L?ngsschnittstudie.     

Action oriented health education: a critical review of health campaigns in Denmark

This paper is a critical examination of and reflection about,the notion of action and its implications for modern healtheducation and its campaigns. Based on observations of Danishhealth campaigns, the paper aims to contribute to discussionsabout educational thinking and planning for health. In healtheducation it is important to examine whether contemporary healthcampaigns help or hinder progress towards the official goalfor Health Education in Danish schools, which is to developpupils' capability to act, to promote their own and others'health. In the Danish arena there is, however, much con fusion aboutthe concept of action. The lack of a viable, or generally accepteddefinition is mirrored both in health education in schools,and in nation-wide campaigns. The ward ‘action’isoften used in different ways, as a word meaning activity, abehaviour, habits or reasoned action. It is therefore a necessarypart of educational planning to consider the notion of actionand what it implies for the implementation of goals for healtheducation and health education campaigns.     

Making health services management research critical: a review and a suggestion

This piece reviews the qualitative research literature on NHS management published since 1990. It suggests that much of the established work in this field takes for granted managerial assumptions that are consequently not subjected to sustained critical examination. It is argued therefore that this research has tended to create a version of the world that supports elite interests whilst appearing to be disinterested. A framework for seeing management in a radically different manner is also proposed - Critical Management Studies. Its approaches to analysing management and organisation are offered in the belief that they articulate the kind of challenges to orthodox views that many with an interest in health care are likely to find attractive and perhaps emancipatory.     

奉贤区中心医院人才引进管理的实践与探索

就如何提高人才引进的成功与保证人才引进后能充分发挥其最大效应进行探索与研究,并提出建议,旨在进一步完善人才的引进、使用、管理与学科建设,促进医院的持续、快速、有序发展,为医院的升级奠定扎实基础。     

Temporary employment and health: a review

OBJECTIVES: We aimed to review evidence on the relationship between temporary employment and health, and to see whether the association is dependent on outcome measure, instability of employment, and contextual factors. METHOD: We systematically searched for studies of temporary employment and various health outcomes and critically appraised 27 studies. RESULTS: The review suggests higher psychological morbidity among temporary workers compared with permanent employees. According to some studies, temporary workers also have a higher risk of occupational injuries but their sickness absence is lower. Morbidity may be higher in temporary jobs with high employment instability and in countries with a lower number of temporary workers and unemployed workers. CONCLUSIONS: The evidence indicates an association between temporary employment and psychological morbidity. The health risk may depend on instability of temporary employment and the context. Confounding by occupation may have biased some of the studies. Additional research to clarify the role of employment instability, hazard accumulation, and selection is recommended.     

Job insecurity and health: A study of 16 European countries

Although the number of insecure jobs has increased considerably over the recent decades, relatively little is known about the health consequences of job insecurity, their international pattern, and factors that may modify them. In this paper, we investigated the association between job insecurity and self-rated health, and whether the relationship differs by country or individual-level characteristics. Cross-sectional data from 3 population-based studies on job insecurity, self-rated health, demographic, socioeconomic, work-related and behavioural factors and lifetime chronic diseases in 23,245 working subjects aged 45–70 years from 16 European countries were analysed using logistic regression and meta-analysis. In fully adjusted models, job insecurity was significantly associated with an increased risk of poor health in the Czech Republic, Denmark, Germany, Greece, Hungary, Israel, the Netherlands, Poland and Russia, with odds ratios ranging between 1.3 and 2.0. Similar, but not significant, associations were observed in Austria, France, Italy, Spain and Switzerland. We found no effect of job insecurity in Belgium and Sweden. In the pooled data, the odds ratio of poor health by job insecurity was 1.39. The association between job insecurity and health did not differ significantly by age, sex, education, and marital status. Persons with insecure jobs were at an increased risk of poor health in most of the countries included in the analysis. Given these results and trends towards increasing frequency of insecure jobs, attention needs to be paid to the public health consequences of job insecurity.     

Job insecurity,fear of litigation,and mental health among expatriate nurses

Abstract

The objective was to assess whether job insecurity and fear of litigation were correlates of depression, anxiety, and stress among expatriate nurses in Saudi Arabia. The participants included 977 expatriate nurses working in Al-Qassim, Saudi Arabia who completed an online survey that assessed depression, anxiety, and stress (using DASS-21) as well as demography, lifestyle, and job characteristics. Mean age was 32?years and 60% of nurses were from India/Pakistan. Twenty-four percent of nurses reported job insecurity, and 18% reported a fear of litigation. Severe depression, anxiety, and stress were significantly higher among nurses who always felt insecure about their job (compared to never) and among those who always feared litigation (compared to never). We concluded that job insecurity and fear of litigation were significant correlates of severe depression, anxiety, and stress among expatriate nurses.     

A life-span perspective on women's careers, health, and well-being

The purpose of this study was to investigate if and how health and well-being in mid-life are influenced by the ways in which individuals have combined educational, occupational, and family involvement throughout their adult lives. Life-career patterns (LC) and occupational career patterns (OC) were retrieved from a longitudinal cohort of Swedish women born in the 1950s. Retrospective occupational biographies retrieved at age 43 generated nine LC and 10 OC patterns which served as the basis for the present study. LC patterns combined timing, ordering, duration, and content of activities (e.g., education, work, and parenthood), while OC patterns considered occupational level and its stability over time. Data on life and job satisfaction, psychological well-being, work-family conflict, optimism, and mental distress were collected at age 49. For a sub-sample of the women who took part in a medical examination, seven biomarkers were combined into a measure of allostatic load (AL). The results showed that LC pattern-groups differed significantly but modestly in four aspects of health and well-being whereas OC pattern-groups displayed significant between-group differences in all outcome variables except life satisfaction. The results are interpreted in terms of a social-health gradient effect and a supportive societal context of the Swedish welfare state, which offered a considerable amount of free choice to the women in the cohort.     

Measuring and valuing productivity loss due to poor health: A critical review

The use of contracts is vital to market transactions. The introduction of market reforms in health care in the U.K. and other developed countries twenty years ago meant greater use of contracts. In the U.K., health care contracting was widely researched in the 1990s. Yet, despite the changing policy context, the subject has attracted less interest in recent years. This paper seeks to fill a gap by reporting findings from a study of contracting in the English National Health Service (NHS) after the introduction of the national standard contract in 2007. By using economic and socio-legal theories and two case studies we examine the way in which the new contract was implemented in practice and the extent to which implementation conformed to policy intentions and to our theoretical predictions. Data were collected using non-participant observation of 36 contracting meetings, 24 semi-structured interviews, and analysis of documents. We found that despite efforts to introduce a more detailed ('complete') contract, in practice, purchasers and providers often reverted to a more relational style of contracting. Frequently reliance on the NHS hierarchy proved to be indispensable; in particular, formal dispute resolution was avoided and financial risk was re-allocated in compromises that sometimes ignored contractual provisions. Serious data deficiencies and shortages of skilled personnel still caused major difficulties. We conclude that contracting for health care continues to raise serious problems, which may be exacerbated by the impending transfer of responsibility to groups of general practitioners (GPs) who generally lack experience and expertise in large-scale, secondary care contracting.     

Maternal employment, breastfeeding, and health: evidence from maternity leave mandates

Public health agencies around the world have renewed efforts to increase the incidence and duration of breastfeeding. Maternity leave mandates present an economic policy that could help achieve these goals. We study their efficacy, focusing on a significant increase in maternity leave mandates in Canada. We find very large increases in mothers' time away from work post-birth and in the attainment of critical breastfeeding duration thresholds. We also look for impacts of the reform on self-reported indicators of maternal and child health captured in our data. For most indicators we find no effect.     

Social inequalities in 'sickness': European welfare states and non-employment among the chronically ill

The aim of this paper is to examine educational inequalities in the risk of non-employment among people with illnesses and how they vary between European countries with different welfare state characteristics. In doing so, the paper adds to the growing literature on welfare states and social inequalities in health by studying the often overlooked 'sickness'-dimension of health, namely employment behaviour among people with illnesses. We use European Union Statistics on Income and Living Conditions (EU-SILC) data from 2005 covering 26 European countries linked to country characteristics derived from Eurostat and OECD that include spending on active labour market policies, benefit generosity, income inequality, and employment protection. Using multilevel techniques we find that comprehensive welfare states have lower absolute and relative social inequalities in sickness, as well as more favourable general rates of non-employment. Hence, regarding sickness, welfare resources appear to trump welfare disincentives.