Documents Marmot, Michael 28 results

"Objective The main aims of this longitudinal study were to (i) examine associations between changes in economic difficulties and health functioning among middle-aged employees and (ii) assess whether the associations remained after considering conventional domains of socioeconomic position. The associations were tested in two European welfare state occupational cohorts to strengthen the evidence base and improve generalizability. Methods Data came from two cohorts: the Finnish Helsinki Health Study (baseline 2000–2002, follow-up 2007, N=6328) and the British Whitehall II Study (baseline 1997–1999, follow-up 2003–2004, N=4350). Responses to the survey item “finding it hard to afford adequate food and clothes and pay bills” repeated at baseline and follow-up were used to examine persistent, increasing, and decreasing economic difficulties. Poor physical and mental health functioning were denoted as being in the lowest quartile of the Short Form 36 physical and mental component summary. Logistic regression analyses were adjusted for sex, age, childhood economic difficulties, household income at baseline and follow-up, employment status at follow-up, and baseline health functioning. Results We observed strong sex- and age-adjusted associations between increasing [odds ratio (OR) range 1.69–2.96] and persistent (OR range 2.54–3.21) economic difficulties and poorer physical and mental health functioning in both British and Finnish occupational cohorts. These associations remained after full adjustments. Those reporting decreasing difficulties over follow-up also had poorer functioning (OR range 1.30–1.61) compared to those who did not have difficulties at baseline, possibly reflecting residual effects of economic difficulties at baseline. Conclusion Changes in economic difficulties are associated with poorer physical and mental health functioning independent of income, employment status, and baseline health functioning.'

"Objectives The aim of this study was to examine the association of the discrepancy between externally and self-assessed measures of work environment with long- and short-term sickness absence.Methods The study population included 6997 middle-aged men and women from the Whitehall II cohort, whose work characteristics were examined at baseline (1985–1988) through both an external evaluation and self-report, with a follow-up of up to 13 years of sickness absence reporting from administrative records. The primary exposure of interest was the discrepancy between measures of work stress for fast job pace, conflicting demands, and decision latitude.Results In mutually adjusted models, external measures of job characteristics were more strongly associated with higher rates of sickness absence compared with self-assessed measures, for both lower frequency of fast work pace and lower conflicting demands (ie “passive” levels). Individuals who self-reported higher frequencies of fast work pace and conflicting demands than were reported through external assessment had higher rates of short-term sickness absence [incident rate ratios (IRR) of 1.13 (95% confidence interval [95% CI] 1.11–1.15) and IRR 1.14 (95% CI 1.11–1.16), respectively]. There was no difference in rates of sickness absence found for decision latitude [IRR 1.02 (95% CI 1.00–1.04)].Conclusions Our findings demonstrate that the discrepancy between externally and self-assessed job demand measures have additional predictive power beyond each individual measure of job structure, which may be related to the extent of cognitive and emotional processing of assessment questions as compared to decision latitude measures."

"Background The relationship of childhood socioeconomic position (SEP) to adult cancer has been inconsistent in the literature and there has been no review summarising the current evidence focused solely on cancer outcomes.Methods and resultsWe performed a rapid review of the literature, which identified 22 publications from 13 studies, primarily in the UK and northern European countries that specifically analysed individual measures of SEP in childhood and cancer outcomes in adulthood. Most of these studies adjusted for adult SEP as a critical mediator of the relationship of interest.Conclusions Results confirm that childhood socioeconomic circumstances have a strong influence on stomach cancer and are likely to contribute, along with adult circumstances, to lung cancer through cumulative exposure to smoking. There was also some evidence of increased risk of colorectal, liver, cervical and pancreatic cancers with lower childhood SEP in large studies, but small numbers of cancer deaths made these estimates imprecise. Gaps in knowledge and potential policy implications are presented."

"Background Relatively large socioeconomic inequalities in health and mortality have been observed in Central and Eastern Europe (CEE) and the former Soviet Union (FSU). Yet comparative data are sparse and virtually all studies include only education. The aim of this study is to quantify and compare socioeconomic inequalities in all-cause mortality during the 2000s in urban population samples from four CEE/FSU countries, by three different measures of socioeconomic position (SEP) (education, difficulty buying food and household amenities), reflecting different aspects of SEP. Methods Data from the prospective population-based HAPIEE (Health, Alcohol, and Psychosocial factors in Eastern Europe) study were used. The baseline survey (2002–2005) included 16?812 men and 19?180 women aged 45–69 years in Novosibirsk (Russia), Krakow (Poland), Kaunas (Lithuania) and seven Czech towns. Deaths in the cohorts were identified through mortality registers. Data were analysed by direct standardisation and Cox regression, quantifying absolute and relative SEP differences. Results Mortality inequalities by the three SEP indicators were observed in all samples. The magnitude of inequalities varied according to gender, country and SEP measure. As expected, given the high mortality rates in Russian men, largest absolute inequalities were found among Russian men (educational slope index of inequality was 19.4 per 1000 person-years). Largest relative inequalities were observed in Czech men and Lithuanian subjects. Disadvantage by all three SEP measures remained strongly associated with increased mortality after adjusting for the other SEP indicators. Conclusions The results emphasise the importance of all SEP measures for understanding mortality inequalities in CEE/FSU."

"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."

"Background Little is known about the role that work-related factors play in the decline of cognitive function. This study examined the association between perceived organisational justice and cognitive function among middle-aged men and women. Methods Perceived organisational justice was measured at phases 1 (1985–8) and 2 (1989–90) of the Whitehall II study when the participants were 35–55?years old. Assessment of cognitive function at the screening clinic at phases 5 (1997–9) and 7 (2003–4) included the following tests in the screening clinic: memory, inductive reasoning (Alice Heim 4), vocabulary (Mill Hill), and verbal fluency (phonemic and semantic). Mean exposure to lower organisational justice at phases 1 and 2 in relation to cognitive function at phases 5 and 7 were analysed using linear regression analyses. The final sample included 4531 men and women. Results Lower mean levels of justice at phases 1 and 2 were associated with worse cognitive function in terms of memory, inductive reasoning, vocabulary and verbal fluency at both phases 5 and 7. These associations were independent of covariates, such as age, occupational grade, behavioural risks, depression, hypertension and job strain. Conclusions This study suggests an association between perceived organisational justice and cognitive function. Further studies are needed to examine whether interventions designed to improve organisational justice would affect employees' cognition function favourably."

"Background Occupational work involves many factors capable of protecting cognition. The ‘disuse' hypothesis suggests that removal of such factors at retirement may increase the risk of cognitive decline.Objective To examine whether retirement is significantly associated with cognitive change after adjusting for preretirement cognitive function, personal, social, health and lifestyle factors, work characteristics and leisure activity.Methods Participants were from the Whitehall II study, a prospective study of London-based Civil Servants. Short-term memory, the AH4 Part 1 (a test of inductive reasoning), verbal fluency and the Mill Hill Vocabulary Scale were collected at ages 38–60?years, and again, on average 5?years later, at 42–67?years, providing pre- and postretirement cognitive functioning assessments for 2031 participants (470 retired and 1561 working). Linear regression was used to test the association between retirement and cognitive performance adjusted for preretirement cognition.Results Mean cognitive test scores increased between the two assessments. However, after adjusting for age, sex, education, occupational social class, Mill Hill score, work characteristics, leisure activities, and indicators of physical and mental health, those retired showed a trend towards smaller test score increases over 5?years than those still working, although this only reached 5% significance in one test (AH4; ?=?0.7, 95% CI ?1.2 to ?0.09) and did not show a dose–response effect with respect to length of time in retirement.Conclusions This trend is consistent with the disuse hypothesis but requires independent replication before it can be accepted as supportive in this respect."

"In November 2008, Professor Sir Michael Marmot was asked by the then Secretary of State for Health to chair an independent review to propose the most effective evidence-based strategies for reducing health inequalities in England from 2010.

The final report, 'Fair Society Healthy Lives', was published in February 2010, and concluded that reducing health inequalities would require action on six policy objectives:

1. Give every child the best start in life

2. Enable all children, young people and adults to maximise their capabilities and have control over their lives

3. Create fair employment and good work for all

4. Ensure healthy standard of living for all

5. Create and develop healthy and sustainable places and communities

6. Strengthen the role and impact of ill-health prevention."

"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."

"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."