Documents Martikainen, Pekka 11 results

"Health policies are specified in documents that contain values, objectives, strategies, and interventions to be implemented. The objective of our study was to analyse health policy documents of six European cities and one county council published around 2010 to determine (i) how cities conceptualize health inequalities, and (ii) what strategies are proposed to reduce them. We performed a qualitative document analysis. We selected Health or Health Inequalities policy documents and analysed the following aspects: general characteristics of the document, inclusion and definition of health inequalities, promotion of good governance and participation, number of objectives, and evaluation. We also described specific objectives. Rotterdam, London, and Stockholm use a conceptual framework. Two of them define health inequalities as a social gradient. Intersectoral action, participation, and evaluation are included in most documents. Interventions focus mainly on the socioeconomic context."

"OBJECTIVES:
The aim of this study was to examine whether differences in male and female occupations and workplaces explain gender differences in self-certified (1-3 days) and medically confirmed sickness absence episodes of various lengths (> or = 4 days, >2 weeks, >60 days). Analyses in the main ICD-10 diagnostic groups were conducted for absence episodes of >2 weeks. Furthermore, we examined whether the contribution of occupation is related to different distributions of female and male jobs across the social class hierarchy.
METHODS:
All municipal employees of the City of Helsinki at the beginning of 2004 (N=36 395) were followed-up until the end of 2007. Conditional fixed-effects Poisson regression was used to control for differences between occupations and workplaces.
RESULTS:
Controlling for occupation accounted for half of the female excess in self-certified and medically confirmed episodes lasting >60 days. In the intermediate categories, this explained about one third of the female excess. The effect of workplace was similar but weaker. Occupational and workplace differences explained the female excess in sickness absence due to mental and behavioral disorders, musculoskeletal diseases, and respiratory diseases. The effect of occupation was clearly stronger than that of social class in self-certified absence episodes, whereas in medically confirmed sickness absence episodes gender differences were to a large extent related to social class differences between occupations.
CONCLUSIONS:
Differences between occupations held by women and men explain a substantial part of the female excess in sickness absence. Mental and behavioral disorders and musculoskeletal diseases substantially contribute to this explanation."

"Background Socioeconomic mortality differences have increased in many high-income countries in recent decades mainly because of slower mortality decline among the lower social groups. The aim of this study was to investigate whether the changing socio-demographic composition explains the increasing disparity in mortality by income and the stagnation of mortality in the lowest income group. Methods The register data comprised a nationally representative 11% sample of individuals aged 35–64?years residing in Finland in 1988–2007, linked with mortality records. Household taxable income was used as the income measure. Poisson regression models were used to assess the changes in mortality disparity among the income quintiles between periods 1988–1991, 1996–1999 and 2004–2007. The measures of socio-demographic composition included educational level, social class, employment status and living alone. Results The mortality rate ratio (with the highest quintile as the reference category) of the lowest quintile increased from 2.80 to 5.16 among the men and from 2.17 to 4.23 among the women between 1988–1991 and 2004–2007. Controlling for other socio-demographic variables strongly attenuated the differences, but the rate ratio of the lowest quintile still increased from 1.32 to 1.73 among the men and from 1.13 to 1.66 among the women. There was no decline in the fully adjusted mortality of the lowest quintiles between second and third study periods. Conclusions Socio-demographic characteristics explained much of the mortality disparity between income quintiles within each study period. However, these characteristics do not explain the increasing disparity between the periods and stagnating mortality in the lowest quintile."

"Background Less attention has been paid to mortality trends across income groups than those measured by other socioeconomic indicators. This study assessed the change in life expectancy by income over 20?years in the Finnish general population. Methods Life expectancy among 35-year-olds by household income quintiles was studied. Change in life expectancy from 1988–92 to 2003–7 was decomposed by age and cause of death. The dataset contained 754?087 deaths by oversample of 80% of all deaths during the period. Results The gap in life expectancy between the highest and the lowest income quintiles widened during the study period by 5.1?years among men and 2.9?years among women, and in 2007 it stood at 12.5?years and 6.8?years, respectively. Stagnation in the lowest income group was the main reason for the increased disparity for both sexes. Increasing mortality attributable to alcohol-related diseases and increasing or stagnating mortality for many cancers, as well as a slower decline in mortality due to ischaemic heart disease among men in the lowest income quintile, were the most significant factors increasing the gap. Conclusions The increasing gap in life expectancy was mostly due to the stagnation of mortality in the lowest income quintile and especially because of the increasing mortality in alcohol-related diseases. The increase in disparity may be more extreme when using income instead of occupational class or education, possibly because income identifies a lower and economically more deprived segment on a social hierarchy more clearly. The results identify a clear need to tackle the specific health problems of the poorest."

"BACKGROUND: Suicide mortality is high among the unemployed, but the role of causation and selection models in producing employment status differences remains to be understood. This study analyses the association between unemployment and suicide during different levels of national unemployment adjusting for several factors that might explain or mediate the relationship.METHODS: The data comprised annual population-register and death-register information on 25-64-year-old Finns at the beginning of each year in the period 1988-2003; thus, forming 16 separate follow-up cohorts. Experience of unemployment was measured at baseline and during the previous year for each cohort. Suicide was followed for 12 months after each baseline giving a total of 7388 suicides.RESULTS: Overall, age-adjusted suicide mortality was two to three times higher among the unstably employed and almost fourfold among the long-term unemployed. Adjustment for social class and living arrangements had small effect on the HRs, but adjustment for household income per consumption unit decreased the differences by 13% and 31% among the long-term unemployed women and men, respectively. When the national unemployment level was high, excess suicide mortality among the unstably employed was lower than during low unemployment when those becoming unemployed might be more selected. No such differences were found among the long-term unemployed.CONCLUSION: Long-term unemployment seems to have causal effects on suicide, which may be partly mediated by low income. As the effect of unstable employment is lower during the recessionary stage of the economic cycle some part of the excess suicide among the unstably employed is likely to be attributable to selection into unemployment."

"Circumstances over the life-course may contribute to adult social class differences in mortality. However, it is only rarely that the life-course approach has been applied to mortality studies among young adults. The aim of this study is to determine to what extent social class differences in mortality among young Finnish men are explained by living conditions in the parental home and life paths related to transitions in youth. The data for males born in 1956-60 based on the 1990 census records are linked with death records (3184 deaths) by cause of death for 1991-98, and with information on life-course circumstances from the 1970, 1975, 1980, and 1985 censuses. Controlling for living conditions in the parental home-social class, family type, number of siblings, language and region of residence-reduced the high excess mortality of the lower non-manual (RR 1.51, 95% CI: 1.28-1.79), skilled manual (RR 2.94, 2.54-3.40), and unskilled manual class (RR 4.08, 3.51-4.73) by 10% in all-cause mortality. The equivalent reduction for cardiovascular disease was 28% and for alcohol-related causes 16%. The effect of parental home on mortality differences was mainly mediated through its effect on youth paths (pathway model). Educational, marital, and employment paths had a substantial effect-independent of parental home-on social class differences from various causes of death. When all these variables were controlled for adult social class differences in cause specific mortality were reduced by 75-86%. Most of this reduction in mortality differences can be attributed to educational path. However, marital and employment paths had their independent effects, particularly on the excess mortality of unskilled manual workers with disproportionately common exposure to long-term unemployment and living without a partner. In summary, social class differences in total mortality among men in their middle adulthood were only partly determined by parental home but they were mainly attributable to educational, marital, and employment paths in youth."

"In most countries health inequality in women appears to be greater when their socio-economic position is measured according to the occupation of male partners or spouses than the women's own occupations. Very few studies show social gradients in men's health according to the occupation of their female partners. This paper aims to explore the reasons for the differences in social inequality in cardiovascular disease between men and women by analysing the associations between own or spouses (or partners) socio-economic position and a set of risk factors for prevalent chronic diseases.
Study participants were married or cohabiting London based civil servants included in the Whitehall II study. Socioeconomic position of study participants was measured according to civil service grade; socio-economic position of the spouses and partners according to the Registrar General's social class schema. Risk factors were smoking, diet, exercise, alcohol consumption, and measures of social support. In no case was risk factor exposure more affected by the socioeconomic position of a female partner than that of a male study participant. Wives' social class membership made no difference at all to the likelihood that male Whitehall participants were smokers, or took little exercise. Female participants' exercise and particularly smoking habit was, in contrast, related to their spouse's social class independently of their own grade of employment. Diet quality was affected equally by the socio-economic position of both male and female partners. Unlike the behavioural risk factors, the degree of social support reported by women participants was in general not strongly negatively affected by their husband or partner being in a less advantaged social class. However, non-employment in the husband or partner was associated with relatively lower levels of positive, and higher negative social support, while men with non-working wives or partners were unaffected.
Studying gender differences in health inequality highlights some of the problems in health inequality research more broadly. We are brought face to face with the fact that the development of conceptual models that can be applied consistently to aetiology in both men and women are still at an early stage of development. Closer attention is needed to the different processes behind material power and ‘emotional power' within the household when investigating gender differences in health and risk factors."

"Background: In addition to conventional indicators of socioeconomic position, material conditions such as economic difficulties are associated with mental health. However, there has been little investigation of these associations. This study aims to examine the association of current economic difficulties with common mental disorders (CMD) and the contribution of social and behavioural factors to this association in two cohorts of Finnish and British white-collar employees. Methods: Comparable survey data from the Finnish Helsinki Health Study and the British Whitehall II Study were used. CMD were measured with the GHQ-12. Inequality indices from logistic regression analysis were used to examine the association between current economic difficulties and CMD, and the contribution of other past and present socioeconomic circumstances, health behaviours, living arrangements and work-family conflicts to this association. Inequality indices show the average change in ill health for each step up in the level of economic difficulties. Analyses were conducted separately for men and women.Results: Clear associations between current economic difficulties and CMD were found. Adjusting for work-family conflicts attenuated the associations. Adjusting for indicators of past and present socioeconomic circumstances, health behaviours and living arrangements had generally negligible effects. The results were very similar among both sexes in the two cohorts. Conclusions: Conflicts between work and family contribute to the association between economic difficulties and CMD in both Finland and Britain. Supporting people to cope not only with everyday economic difficulties but also with work-family conflicts may be important for reducing inequalities in mental health."

"BACKGROUND: The magnitude of educational inequalities in mortality avoidable by medical care in 16 European populations was compared, and the contribution of inequalities in avoidable mortality to educational inequalities in life expectancy in Europe was determined.METHODS: Mortality data were obtained for people aged 30-64 years. For each country, the association between level of education and avoidable mortality was measured with the use of regression-based inequality indexes. Life table analysis was used to calculate the contribution of avoidable causes of death to inequalities in life expectancy between lower and higher educated groups.RESULTS: Educational inequalities in avoidable mortality were present in all countries of Europe and in all types of avoidable causes of death. Especially large educational inequalities were found for infectious diseases and conditions that require acute care in all countries of Europe. Inequalities were larger in Central Eastern European (CEE) and Baltic countries, followed by Northern and Western European countries, and smallest in the Southern European regions. This geographic pattern was present in almost all types of avoidable causes of death. Avoidable mortality contributed between 11 and 24% to the inequalities in Partial Life Expectancy between higher and lower educated groups. Infectious diseases and cardiorespiratory conditions were the main contributors to this difference.CONCLUSIONS: Inequalities in avoidable mortality were present in all European countries, but were especially pronounced in CEE and Baltic countries. These educational inequalities point to an important role for healthcare services in reducing inequalities in health."

"OBJECTIVES: Low socioeconomic position is consistently associated with higher rates of sickness absence. We aimed to examine whether working conditions, health-related behaviours and family-related factors explain occupational class differences in medically certified sickness absence.METHODS: The study included 5470 women and 1464 men employees of the City of Helsinki, surveyed in 2000-2002. These data were prospectively linked to sickness absence records until the end of 2005, providing a mean follow-up time of 3.9 years. Poisson regression was used to examine the occurrence of medically certified sickness absence episodes lasting 4 days or more.RESULTS: Medically certified sickness absence was roughly three times more common among manual workers than among managers and professionals in both women and men. Physical working conditions were the strongest explanatory factors for occupational class differences in sickness absence, followed by smoking and relative weight. Work arrangements and family-related factors had very small effects only. The effects of psychosocial working conditions were heterogeneous: job control narrowed occupational class differences in sickness absence while mental strain and job demands tended to widened them. Overall, the findings were quite similar in women and men.CONCLUSIONS: Physical working conditions provided strongest explanations for occupational class differences in sickness absence. Smoking and relative weight, which are well-known determinants of health, also explained part of the excess sickness absence in lower occupational classes. Applying tailored work arrangements to employees on sick leave, reducing physically heavy working conditions and promoting healthy behaviours provide potential routes to narrow occupational class differences in sickness absence."