1.
Novak, Masuma, 1969-
(författare)
Social inequity in health : Explanation from a life course and gender perspective
2010
Doktorsavhandling (övrigt vetenskapligt/konstnärligt) abstract
Background: A boy child born in a Gothenburg suburb has a life expectancy that is nine years shorter than that of another child just 23 km away, and among girls the difference is five years. There is no necessary biological reason to this observed difference. In fact, like life length, most diseases follow a social gradient, even in a country like Sweden where many believe there is no class inequity. This social inequity in health tells us that some of us are not achieving our potential in health or in life length compared to our more fortunate fellow citizens. Aim: This thesis attempts to explore the patterns of health inequities and the pathways by which health inequities develop from a life course and gender perspective. In particular focuses on the importance of material, behavioural, health related and psychosocial circumstances from adolescence to adulthood in explaining social inequity in musculoskeletal disorders (MSDs), obesity, smoking, and social mobility. Method: All four papers of this thesis were based on quantitative analyses of data from a 14-year follow-up study. The baseline survey was conducted in 1981 in Luleå, Sweden. The survey included all 16-year-old pupils born in 1965. A total of 1081 pupils (575 boys and 506 girls) were surveyed. They were followed up at ages 18, 21 and 30 years with comprehensive self-administered questionnaires. The response rate was 96.5% throughout the 14-year follow-up. In addition to the questionnaires data, school records, and interviews with nurse and teachers’ were used. Results: There were no class or gender differences in MSDs and in obesity during adolescence, but significantly more girls than boys were smokers. Class and gender differences had emerged when they reached adulthood with more women reporting to have MSDs but more men being overweight and obese. Women continued to be smokers at a higher rate than men through to adulthood. When an intersection between class and gender was considered, a more complex picture emerged. For example, not all women had higher prevalence of MSDs or smoked more than men, rather men with high socioeconomic position (SEP) had lower prevalences of MSDs and smoking than women with high SEP; and these high SEP women had lower prevalences than men with low SEP. The worst-off group was women with low SEP. The obesity pattern was quite the contrary, where women with high SEP had a lower prevalence of obesity than women with low SEP; and these low SEP women had a lower prevalence than men with high SEP. The worst-off group was men with low SEP. Regarding social mobility, health status (other than height in women) and ethnic background were not associated with mobility either for men or women. The results indicated that unequal distribution of material, psychosocial, health and health related behavioural factors during adolescence, young adulthood and adulthood accounted for the observed social gradients and social mobility. However, several factors from adolescence appeared to be more important for women while recent factors were more important for men. Important adolescent factors for social inequity and downward mobility were: unfavourable material circumstances defined as low SEP of parent, unemployed family member, and had no own room during upbringing; unfavourable psychosocial circumstances defined as parental divorce, poor contact with parents, being less liked in school, and low school control; and poor health related behaviour defined as smoking and physical inactivity. Among these factors, being less liked in school showed consistent association with all outcome measures of this thesis. Being less liked by the teachers and students was found to be more common among adolescents whose parents had low SEP. Men and women who were less liked in school during their adolescence were more likely as adults to be smokers, obese (only women), and downwardly mobile. The dominant adult life factor that contributed to class inequity in MSDs for men and women was physical heavy working conditions, which attributed to an estimated 46.9% (women) and 49.5% (men) of the increased risk in MSDs of the lower SEP group. High alcohol consumption among men with low SEP was an additional factor that contributed to class inequities in health and social mobility. Conclusion: Social patterning of health in this cohort was gendered and age specific depending on the outcome measures. Unfavourable school environment in early years had long lasting negative influence on later health, health behavior and SEP. The thesis supports the notion of accumulation of risk that social inequities in health occurs due to accumulation of multiple adverse circumstances among the lower SEP group throughout their life course. Schools should be used as a setting for interventions aimed at reducing socioeconomic inequities in health. The detailed policy implications for reduction of social inequities in health among men and women are discussed.
2.
Aronsson, Gunnar, et al.
(författare)
A systematic review including meta-analysis of work environment and burnout symptoms
2017
Ingår i: Bmc Public Health. - : Springer Science and Business Media LLC. - 1471-2458. ; 17:264
Forskningsöversikt (refereegranskat) abstract
Background: Practitioners and decision makers in the medical and insurance systems need knowledge on the relationship between work exposures and burnout. Many burnout studies -original as well as reviews-restricted their analyses to emotional exhaustion or did not report results on cynicism, personal accomplishment or global burnout. To meet this need we carried out this review and meta-analyses with the aim to provide systematically graded evidence for associations between working conditions and near-future development of burnout symptoms. Methods: A wide range of work exposure factors was screened. Inclusion criteria were: 1) Study performed in Europe, North America, Australia and New Zealand 1990-2013. 2) Prospective or comparable case control design. 3) Assessments of exposure (work) and outcome at baseline and at least once again during follow up 1-5 years later. Twenty-five articles met the predefined relevance and quality criteria. The GRADE-system with its 4-grade evidence scale was used. Results: Most of the 25 studies focused emotional exhaustion, fewer cynicism and still fewer personal accomplishment. Moderately strong evidence (grade 3) was concluded for the association between job control and reduced emotional exhaustion and between low workplace support and increased emotional exhaustion. Limited evidence (grade 2) was found for the associations between workplace justice, demands, high work load, low reward, low supervisor support, low co-worker support, job insecurity and change in emotional exhaustion. Cynicism was associated with most of these work factors. Reduced personal accomplishment was only associated with low reward. There were few prospective studies with sufficient quality on adverse chemical, biological and physical factors and burnout. Conclusion: While high levels of job support and workplace justice were protective for emotional exhaustion, high demands, low job control, high work load, low reward and job insecurity increased the risk for developing exhaustion. Our approach with a wide range of work exposure factors analysed in relation to the separate dimensions of burnout expanded the knowledge of associations, evidence as well as research needs. The potential of organizational interventions is illustrated by the findings that burnout symptoms are strongly influenced by structural factors such as job demands, support and the possibility to exert control.
3.
Linander, Ida, et al.
(författare)
Negotiating the (bio)medical gaze - Experiences of trans-specific healthcare in Sweden
2017
Ingår i: Social Science & Medicine. - : Elsevier BV. - 0277-9536 .- 1873-5347. ; 174, s. 9-16
Tidskriftsartikel (refereegranskat) abstract
In Sweden as well as in other western countries persons with trans experiences have to go through a clinical evaluation in order to get access to gender-confirming medical procedures. The aim of this study is to analyse care-users' experiences of navigating and negotiating access to gender-confirming medical procedures in Sweden. Biomedicalisation is used as a theoretical framework in order to analyse how technoscientific and neoliberal developments are parts of constructing specific experiences within trans specific care. Constructivist grounded theory was used to analyse 14 interviews with persons having experiences of, or considering seeking, trans-specific healthcare. The participants experienced trans-specific healthcare as difficult to navigate because of waiting times, lack of support, provider ignorance and relationships of dependency between healthcare-users and providers. These barriers pushed the users to take responsibility for the care process themselves, through ordering hormones from abroad, acquiring medical knowledge and finding alternative support. Based on the participants' experiences, it can be argued that the shift of responsibility from care-providers to users is connected to a lack of resources within trans-specific care, to neoliberal developments within the Swedish healthcare system, but also to discourses that frame taking charge of the care process as an indicator that a person is in need of or ready for care. Thus, access to gender-confirming medical procedures is stratified, based on the ability and opportunity to adopt a charge-taking role and on economic and geographic conditions. Based on the results and discussion, we conclude that trans-specific care ought to focus on supporting the care-seekers throughout the medical process, instead of the current focus on verifying the need for care. There is also a need for increased knowledge and financial resources. A separation between legal and medical gender reassignment could contribute to a better relationship between care-providers and care-users and increase the quality of care. (C) 2016 Elsevier Ltd. All rights reserved.
4.
Brydsten, Anna, et al.
(författare)
Health inequalities between employed and unemployed in northern Sweden : a decomposition analysis of social determinants for mental health
2018
Ingår i: International Journal for Equity in Health. - London : BMC. - 1475-9276. ; 17:59
Tidskriftsartikel (refereegranskat) abstract
Background: Even though population health is strongly influenced by employment and working conditions, public health research has to a lesser extent explored the social determinants of health inequalities between people in different positions on the labour market, and whether these social determinants vary across the life course. This study analyses mental health inequalities between unemployed and employed in three age groups (youth, adulthood and mid-life), and identifies the extent to which social determinants explain the mental health gap between employed and unemployed in northern Sweden.Methods: The Health on Equal Terms survey of 2014 was used, with self-reported employment (unemployed or employed) as exposure and the General Health Questionnaire (GHQ-12) as mental health outcome. The social determinants of health inequalities were grouped into four dimensions: socioeconomic status, economic resources, social network and trust in institutional systems. The non-linear Oaxaca decomposition analysis was applied, stratified by gender and age groups.Results: Mental health inequality was found in all age groups among women and men (difference in GHQ varying between 0.12 and 0.20). The decomposition analysis showed 43–51% of the total inequality among youths, 42–98% among adults and 60–65% among middle-aged. The main contributing factors were shown to vary between age groups: cash margin (among youths and middle-aged men), financial strain (among adults and middle-aged women), income (among men in adulthood), along with trust in others (all age groups), practical support (young women) and social support (middle-aged men); stressing how the social determinants of health inequalities vary across the life course.Conclusions: The health gap between employments was explained by the difference in access to economic and social resources, and to a smaller extent in the trust in the institutional systems. Findings from this study corroborate that much of the mental health inequality in the Swedish labour market is socially and politically produced and potentially avoidable. Greater attention from researchers, policy makers on unemployment and public health should be devoted to the social and economic deprivation of unemployment from a life course perspective to prevent mental health inequality.
5.
Brydsten, Anna, 1984-
(författare)
Yesterday once more? Unemployment and health inequalities across the life course in northern Sweden
2017
Doktorsavhandling (övrigt vetenskapligt/konstnärligt) abstract
AbstractBackground. It is relatively well established in previous research that unemployment has direct health consequences in terms of mental and physical ill health. Recently, knowledge has emerged indicating that unemployment can lead to economic consequences that remain long after re-establishment in the labour market. However, few empirical studies have been able to apply a life course perspective asking whether there are also long-term health consequences of unemployment, and, when and in which context unemployment may affect the individual health status across the life course. The aim of this thesis was to analyse the relationship between unemployment and illness across the life course, and how it relates to individual and structural factors in the geographical setting of northern Sweden. In particular, three main areas have been explored: youth unemployment and illness in adulthood (Paper I and Paper II), contextual unemployment of national unemployment rate and neighbourhood unemployment (Paper II and Paper III) and lastly, social determinants of health inequality between employment statuses (Paper IV).Methods. This thesis is positioned in Sweden between the early 1980s and the mid-2010s, following two comparable cohorts sampled from northern Sweden (26 and 19 years follow-up time respectively from youth to midlife) and a cross-sectional sample from 2014 of the four northernmost counties in Sweden. The two longitudinal cohorts comprised the Northern Swedish Cohort and the Younger Northern Swedish Cohort, consisting of all pupils in the 9th grade of compulsory school in Luleå municipality in 1981 and 1989. The participants responded to an extensive questionnaire on socioeconomic factors, work and health, in 5 and 2 waves respectively of data collections. Neighbourhood register data from Statistics Sweden was also collected for all participants in the Northern Sweden Cohort. At the latest data collection, 94.3% (n=1010) participated in the Northern Sweden Cohort and 85.6% (n=686) in the Younger Northern Sweden Cohort. The cross-sectional study Health on Equal Terms is a national study, administered by the Public Health Agency together with Statistics Sweden and county councils with the aim of mapping public health and living conditions in the country over time. In this thesis, material from 2014 has been used for northern Sweden with a response rate of around 50% (effective sample n=12769). The statistical analyses used were linear regression, multilevel analysis and difference-in-difference analysis to estimate the concurrent and long-term health consequences of unemployment, and a decomposition analysis to disentangle the inequality in health between different labour market positions. The health outcomes in focus were functional somatic symptoms (the occurrence of relatively common physical illnesses such as head, muscle and stomach ache, insomnia and palpitation) and psychological distress.Results. Among men only, as little as one month of youth unemployment was related to increased levels of functional somatic symptoms in midlife, regardless of previous ill health or unemployment later in life, although only during relatively low national unemployment (pre-recession) when comparing with youth unemployment during high national unemployment (recession). This was explained by the health promoting effect of more time spent in higher education during the recession period. Furthermore, the health impact of neighbourhood unemployment highlights the importance of the contextual setting for individuals’ health both across the life course and at specific periods of life. Lastly, employment-related mental health inequalities exist for both men and women in all life phases (youth, adulthood and midlife). Economic and social deprivation related to unemployment and illness varied across different phases in life and across genders.Conclusion. The key findings of this thesis paint a rather pessimistic vision of the future: one’s own and others’ unemployment may cause not only ill health today but also ill health later in life. Importantly, the responsibility of unemployment and the associated ill health should not be placed on the already marginalised individuals and communities. Instead, the responsibility should be directed towards the structural aspects of society and the political choices that shape these. In other words, health inequality manifested by the position in the labour market is socially produced, unfair and changeable through political decisions. The results of this study therefore cannot contribute to any simple or concrete solutions to the concurrent or long-term health consequences of individual or contextual unemployment, as the solution is beyond the areas of responsibility and abilities of research. However, if there are long-term health consequences of one’s own and other people’s unemployment, labour market and public health policies should be initiated from a young age and continue throughout the life course to reduce individual suffering and future costs of social insurance, sick-leave and unemployment benefits.
6.
Wiklund, Maria, et al.
(författare)
Constructing respectability from disfavoured social positions : exploring young femininities and health as shaped by marginalisation and social context. A qualitative study in Northern Sweden
2018
Ingår i: Global Health Action. - : Taylor & Francis Group. - 1654-9716 .- 1654-9880. ; 11:sup3
Tidskriftsartikel (refereegranskat) abstract
Background: Gender, class and living conditions shape health and illness. However, few studies have investigated constructs of femininity in relation to health and living conditions among young women who are unemployed and marginalised at an early age.Objective: The aim of this research was to elucidate constructs of femininities in relation to structuring living conditions and expressions of health in Northern Swedish women. The time period of interest was the transition from unemployed teenagers to young adults in a social context of high unemployment and societal change across the critical ‘school-to-work-transition’ period of the life course.Methods: Qualitative content analysis was used to analyse data from repeated interviews with unemployed young women, aged 16–33 years, during the 1980s and 1990s. These longitudinal interviews were part of a cohort study in a ‘remote’ municipality in Northern Sweden that began in 1981. All girls who were not in education, employment, or training were selected for interview. An inductive analysis phase was followed by a theoretically informed phase. The contextual frame is the Nordic welfare-state model and the ‘caring state’ with its particular focus on basic and secondary education, and women’s participation in the labour market. This focus paralleled high rates of youth unemployment in northern Sweden during the study period.Results: The results are presented as the theme of ‘constructing respectability from disfavoured social positions’. Within this theme, and framed by dominant norms of patriarchal femininity, we explored the constructs of normative and altruistic, norm-breaking, and troubled femininity.Conclusions: Gender-sensitive interventions are needed to strengthen young women’s further education and positions in the labour market and to preventing exposure to violence. More research on health experiences related to the multitude of constructs of femininities in various social contexts and across the life course is needed to help design and implement such interventions.
7.
Norström, Fredrik, 1974-, et al.
(författare)
Is unemployment in young adulthood related to self-rated health later in life? : Results from the Northern Swedish cohort
2017
Ingår i: BMC Public Health. - : BioMed Central. - 1471-2458. ; 17
Tidskriftsartikel (refereegranskat) abstract
BACKGROUND: Many studies have reported that unemployment has a negative effect on health. However, little is known about the long-term effect for those who become unemployed when they are young adults. Our aim was to examine how unemployment is related to long-term self-rated health among 30 year olds, with an emphasis on how health differs in relation to education level, marital status, previous health, occupation, and gender.METHODS: In the Northern Swedish Cohort, 1083 teenagers (~16 years old) were originally invited in 1981. Of these, 1001 participated in the follow-up surveys in 1995 and 2007. In our study, we included participants with either self-reported unemployment or activity in the labor force during the previous three years in the 1995 follow-up so long as they had no self-reported unemployment between the follow-up surveys. Labor market status was studied in relation to self-reported health in the 2007 follow-up. Information from the 1995 follow-up for education level, marital status, self-reported health, and occupation were part of the statistical analyses. Analyses were stratified for these variables and for gender. Analyses were performed with logistic regression, G-computation, and a method based on propensity scores.RESULTS: Poor self-rated health in 2007 was reported among 43 of the 98 (44%) unemployed and 159 (30%) of the 522 employed subjects. Unemployment had a long-term negative effect on health (odds ratio with logistic regression 1.74 and absolute difference estimates of 0.11 (G-computation) and 0.10 (propensity score method)). At the group level, the most pronounced effects on health were seen in those with upper secondary school as their highest education level, those who were single, low-level white-collar workers, and women.CONCLUSIONS: Even among those becoming unemployed during young adulthood, unemployment is related to a negative long-term health effect. However, the effect varies among different groups of individuals. Increased emphasis on understanding the groups for whom unemployment is most strongly related to ill health is important for future research so that efforts can be put towards those with the biggest need. Still, our results can be used as the basis for deciding which groups should be prioritized for labor-market interventions.
8.
Annandale, Ellen, et al.
(författare)
Theorising women's health and health inequalities : shaping processes of the 'gender-biology nexus'.
2018
Ingår i: Global Health Action. - : Informa UK Limited. - 1654-9716 .- 1654-9880. ; 11:sup3, s. 1-10
Tidskriftsartikel (refereegranskat) abstract
Since the theoretical frameworks and conceptual tools we employ shape research outcomes by guiding research pathways, it is important that we subject them to ongoing critical reflection. A thoroughgoing analysis of the global production of women's health inequality calls for a comprehensive theorization of how social relations of gender and the biological body mutually interact in local contexts in a nexus with women's health. However, to date, the predominant concern of research has been to identify the biological effects of social relations of gender on the body, to the relative neglect of the co-constitutive role that these biological changes themselves may play in ongoing cycles of gendered health oppressions. Drawing on feminist and gender theoretical approaches, and with the health of women and girls as our focus, we seek to extend our understanding of this recursive process by discussing what we call the 'shaping processes' of the 'gender-biology nexus' which call attention to not only the 'gender-shaping of biology' but also the 'biologic-shaping of gender'. We consider female genital mutilation/cutting as an illustration of this process and conclude by proposing that a framework which attends to both the 'gender-shaping of biology' and the 'biologic-shaping of gender' as interweaving processes provides a fruitful approach to theorising the wider health inequalities experienced by women and girls.
9.
Linander, Ida, 1987-
(författare)
“It was like I had to fit into a category” : people with trans experiences navigating access to trans-specific healthcare and health
2018
Doktorsavhandling (övrigt vetenskapligt/konstnärligt) abstract
Background: Trans issues have received increased attention over the last couple of years and important changes have been made in the legislation relating to gender reassignment and in trans-specific healthcare practices. At the same time, many people with trans experiences report poor mental health, bad experiences when encountering the healthcare and a tendency to postpone seeking care due to being badly treated. Previous research has also shown that gender norms guide the evaluation that precedes access to gender-confirming medical procedures. Critical studies examining practices within trans-specific healthcare in the Swedish context and health among people with trans experiences are limited, especially qualitative interview studies involving people with trans experiences.Aim: To analyse how constructions of trans experiences and gender can affect trans-specific healthcare practices, experiences of navigating access to gender- confirming medical procedures, inhabitancy of different spaces and, ultimately, health.Conceptual framework: Three areas of theory are used for the conceptual framework: trans studies, queer phenomenology and Foucauldian theories of power and governmentality.Methods: The thesis includes three sub-studies (generating four articles): two interview studies that build on interviews with 18 people with trans experiences, and a policy analysis of the guidelines for trans-specific healthcare published by the Swedish National Board of Health and Welfare. For the interview studies, grounded theory and thematic analysis were used as the analytical method. The guidelines were analysed using Bacchi’s method: “What’s the problem represented to be?”.Results: The participants experienced trans-specific healthcare as difficult to navigate due to waiting times, lack of knowledge and/or support and relationships of dependency between healthcare users and providers. In the evaluation, gender is reconstructed as linear – stereotypical, binary and stable – and the space for action available to care-seekers is affected by discourses existing both inside and outside trans-specific healthcare. The difficulties in navigating access to care were experienced as creating ill-health. In order to negotiate access to gender-confirming medical procedures, the participants took responsibility for the care process by, for example, ordering hormones from abroad, acquiring medical knowledge and finding alternative support. The linear gendered positioning was variously resisted, negotiated and embraced by the participants.The analysis of the guidelines showed that gender identity is constructed as a fixed linear essence but that the guidelines also open up space for a non-linear embodiment. Gender dysphoria is closely constructed in relation to psychiatric knowledge and mental health and the gate-keeping function among mental healthcare professionals is reconstituted in the guidelines. Hence, care-seekers are constructed as not competent enough to make decisions concerning access to gender-confirming medical procedures.The participants experienced several different spaces, such as bars, public toilets and changing rooms, gyms and cafés, as unsafe and as contributing to ill-health. In order to overcome the barriers to comfortably inhabiting spaces, the participants performed a kind of labour; for example, preparing in order to visit public baths and to answer transphobic comments and questions. Some spaces, such as trans-separatist, feminist and queer spaces, were experienced as safer and contributed to improved health through experiences of belonging, being able to share bad experiences and being able to relax.Conclusions: Trans-specific healthcare practices need to become more affirming and change so that care-seekers have more space for self- determination. Trans-specific healthcare needs more resources in order to decrease waiting times, improve knowledge and support, and hence to improve access to gender-confirming medical procedures. Actions need to be initiated to make spaces safer in order to improve the health of people with trans experiences.
10.
Landstedt, Evelina, 1978-, et al.
(författare)
Associations between adolescent risk for restrictive disordered eating and long-term outcomes related to somatic symptoms, body mass index, and poor well-being
2018
Ingår i: British Journal of Health Psychology. - : Wiley-Blackwell. - 1359-107X .- 2044-8287. ; 23:2, s. 496-518
Tidskriftsartikel (refereegranskat) abstract
ObjectiveTo date, no longitudinal, community-based studies have examined the association between disordered eating emerging in adolescence and long-term physical well-being. This study sought to explore the longitudinal associations between risk for restrictive disordered eating (DE-R; those not presenting with binge-purge symptoms) in adolescence and trajectories of functional somatic symptoms (FSS) and body mass index (BMI), and several indicators of poor physical well-being across early- to mid-adulthood, including medication, number of doctor visits, and sick leave. DesignData were obtained from the Northern Swedish Cohort Study (N=1,001), a prospective longitudinal study including four time points from age 16 to 42years. MethodsA cumulative measure of DE-R risk was computed. Latent class growth analysis was used to identify subpopulation trajectories of FSS and BMI. The three-step method for auxiliary variables and logistic regressions were used to assess associations between DE-R and the trajectory classes as well as indicators of poorphysical well-being. ResultsThree trajectories were identified for FSS. A gender by BMI interaction led to a classification of four BMI trajectories in men, but three in women. The presence of DE-R risk in adolescence increased odds of unfavourable FSS development, increasing BMI in women, and continually low BMI in men. Indicators of poor physical well-being at ages 21, 30, and 42years were associated with DE-R risk in adolescence. ConclusionsData spanning nearly three decades suggest that physical well-being impairment is related to DE-R risk measured earlier in life, underscoring the urgency for targeted, gender-sensitive preventive interventions for teenagers. What is already known on this subject? Disordered eating is linked to poor physical and mental well-being and quality of life. No longitudinal studies have examined long-term physical well-being consequences of adolescent disordered eating risk. What does this study add? Non-purging disordered eating symptoms in adolescence predict adverse physical well-being outcomes in middle-aged men and women. Targeted interventions and preventative work during adolescence are needed.
