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BEDREHELSE-Bedre helse og livskvalitet

Explaining health inequalities in an ageing population: Social pathways and linked lives

Alternative title: null

Awarded: NOK 5.3 mill.

Sustaining a growing ageing population requires an increased focus on prolonging good health and wellbeing throughout the life course, also in later life. The increase in life expectancy and healthy life-years have predominantly occurred among higher socioeconomic status groups in Norway. This has led to an increased gap in health by socioeconomic position (SEP) over time and to new patterns of social health inequalities in later life. Reducing social health inequalities is high on the political agenda in Norway, and a specific and long-term objective of Norwegian public health policy. Social health inequalities can be found in all life phases, but tend to peak at midlife (age span 45-65), indicating a phase where the accumulated advantages and disadvantages tend to show their most pronounced impact. Despite a vast literature on social health inequalities in general, the focus on health inequalities in later life has been limited, especially in Norway. One possible explanation is lack of large-scale survey data including persons 67 years and older. The empirical basis of the current project is NorLAG - the Norwegian study on Life course, Ageing and Generation, and the international Generations and Gender study (GGS). The aim of the project is to increase new knowledge on the complex pathways from SEP to health in later life. The project is based on a life course perspective that emphasises ways in which risks and resources accumulate and interact over time to produce socioeconomic differences in late life health. A specific focus on the impact of events and conditions in later life can provide increased knowledge on pathways to stratification and inequality in Norway. Pathways highlighted in by the results in this project emphasize the impact of work and retirement, social relations and welfare state context. The paper "Social pathways to health: On the mediating role of the social network in the relation between socio-economic position and health", investigates which aspects of the social network explain the association between SEP and health in later life. The results indicate that people with higher SEP have social networks that better protect against loneliness, which in turn is associated with better health outcomes. A main finding is that the function of the network, rather than the structure, is important for health in later life. High SEP persons seem to be better able to make use of their network at an age where loss of friends and loved ones becomes more frequent. It is partly through this mechanism that SEP affects health outcomes in later life. Our paper on the "Health effects of Retirement. Evidence from Survey and Register Data", assesses the effects of retirement, as a trigger event in later life, on social health inequalities. Analyses from NorLAG and data from the public registers show that among people with low SEP, retirement leads to better physical health outcomes and fewer hospitalisations. Pension reforms aimed at prolonging working lives and delaying work exit may have socially distorting consequences as the health effects of retirement differ across SEP. The importance of different welfare state contexts in explaining social health inequalities in later life is highlighted in our papers on cross-national comparisons of late-life depression and loneliness in Europe. Analyses with GGS data underline considerable between-country differences in late-life depression as well as loneliness. Low levels of education are associated with higher prevalence of depression in all countries, but educational differences are substantially smaller in North-western countries compared to countries from Central- and Eastern Europe. Findings indicate a triple risk related to being woman, low education and living in Eastern Europe. The relatively smaller social inequalities in the Nordic countries indicate the importance of welfare arrangements for patterns of social inequalities in later life. Analyses of social inequalities in loneliness across different countries show similar results. Weaker welfare states have a higher prevalence of mental health problems, in particular in lower SEP groups. Two additional scientific papers are in progress, which are part of the final thesis to be submitted by the end of 2018. All results have been presented at national and international seminars and conferences and at advisory board meetings. The PhD student is linked to the Department of Economics at the University in Bergen and has during 2015-2016 had a research stay at Columbia University in New York. The project has also led to participation in the Nordforsk funded project on Social Inequalities in Ageing (SiA).

Improvements in life-expectancy and healthy life-years have predominantly occurred among higher socioeconomic status groups in Norway, thereby contributing to an increased gap in health by socioeconomic position over time and to the emergence of new patte rns of social health inequalities in later life. Compositional changes, notably an increase in educational attainment, strengthen these developments. Few studies explore the complex pathways between socioeconomic position and health and wellbeing in late r life, especially in a Norwegian setting. As health and welfare systems vary cross-culturally, Norwegian policy makers will need more knowledge on how one may intervene to slow down further accumulation of inequalities and postpone or compress the onset of health-compromising morbidity in later life. It may also help in the design of interventions aimed to enhance quality of life and wellbeing in later life. The project has a life course perspective and uses large-scale longitudinal survey data from two waves of the NorLAG survey and the nationally representative LOGG survey, which is also included in the international Generations and Gender Survey (GGS). Two key aspects of the life-course perspective are emphasized: social pathways and linked lives. T he novel contribution of this project lies in the availability of relatively large and comparative samples of older men and women with retrospective as well as prospective survey and register data. This enables studying multiple social pathways including how socioeconomic status predictors at different time points, work and family histories, health behaviours and psychosocial factors may relate to health and wellbeing in late life. Also the influence of family constellations and community characteristics on social health inequalities will be explored. Results from the project will be published in a doctoral thesis, international journals and on the website of the NorLAG study.

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BEDREHELSE-Bedre helse og livskvalitet