A comparison of socioeconomic differences in physical functioning and perceived health among male and female employees in Britain, Finland and Japan

Abstract

We compared the pattern of socioeconomic inequalities in physical functioning and perceived health among male and female employees in Britain, Finland and Japan. Participants were male and female public sector employees in Britain, Finland and Japan, who were economically active and 40–60 year-olds at the time of data collection. We measured perceived health and physical functioning (SF-36 physical component summary) with standardized health questionnaires. The results obtained here reconfirm the similarity of the patterns of ill-health of those with lower socioeconomic status among non-manual men and women in Britain and Finland. These data also provide good evidence for a socioeconomic gradient in ill-health among Japanese non-manual men, although this gradient was less systematic. For Japanese men poorer health of manual workers as compared to non-manual workers was well demonstrated. However, among Japanese women socioeconomic differences in health were small and inconsistent. In conclusion, Britain, Finland and Japan—representing ‘liberal’, ‘Nordic’ and ‘conservative’ welfare state regimes—produce broadly similar patterns of socioeconomic differences in health among men. However, different patterns of labour force participation and welfare provision in different welfare regimes may bring about different patterns of socioeconomic differences in health for working women. This is exemplified by the lack of health inequalities among employed Japanese women.

Introduction

In industrialized western European and north American countries health follows a hierarchical pattern: the lower the socioeconomic status, the poorer the health. European comparisons show that the magnitude of socioeconomic inequalities in ill-health and mortality vary among countries (Mackenbach, Kunst, Cavelaars, Groenhof, & Geurts, 1997a; Cavelaars et al., 1998; Kunst, Groenhof, Mackenbach, & Health, 1998; Lahelma et al., 2002). Furthermore, even when similar levels of inequalities in total mortality are observed, very different specific causes may be responsible; alcohol associated causes and cardiovascular diseases being important contributors to overall inequalities (Kunst et al., 1998).

These results highlight the importance of comparative studies in identifying the common and unique determinants of socioeconomic inequalities in health. Comparative studies help us to identify countries or settings with particularly large or small inequalities in health. Such studies can provide a possibility to try to identify the circumstances that are associated with inequalities in health. Small inequalities may, for example, be related to small inequalities in material conditions of life, favourable working conditions and equitable distribution of welfare services. These in turn limit the behavioural choices that individuals can make in terms of smoking, use of alcohol, exercise and intake of fruit and vegetables (Laaksonen, Prättälä, Helasoja, Uutela, & Lahelma, 2003). Comparing countries may sometimes be the only feasible way to evaluate how policy affects health inequalities, and thus help us to distinguish which among a multitude of factors has the greatest potential to reduce health differences. Simultaneously comparative studies improve our understanding of the limits and generalisability of explanations of inequalities in health obtained in particular national settings.

Relatively little comparative research on socioeconomic inequalities in health that include countries of non-European heritage are available. However, analyses of Japan indicate that socioeconomic inequalities in mortality, ill-health and risk factors exist, but the magnitude and pattern of these inequalities are not as consistent as in western countries (Kagamimori, Iibuchi, & Fox, 1983; Kagamimori et al., 1998; Netherlands Central Bureau of Statistics, 1992; Kawakami, Haratani, Hemmi, & Araki, 1992). For example, an earlier comparison of socioeconomic inequalities in risk factors among British and Japanese employed men showed, that although a ‘western inequality pattern’ was observed for some risk factors, it could not be observed for weight (BMI), waist-to-hip-ratio and HDL cholesterol (Martikainen, Ishizaki, Marmot, Nakagawa, & Kagamimori, 2001). Thus, caution is needed against uncritical extrapolation of results on health inequalities from western countries to non-western countries, such as Japan.

The aim of this study is to compare the patterns of socioeconomic inequalities in physical functioning and perceived health among male and female government employees in Britain, Finland and Japan. These three countries represent the ‘liberal’, the ‘Nordic’ or ‘social democratic’ and the ‘conservative’ welfare regimes, respectively, each characterised by a different pattern of welfare production and allocation (Mackenbach et al. (1990), Esping-Andersen (1999)). Previous evidence of health inequalities being associated with welfare regimes is inconclusive (Mackenbach et al., 1997a). ‘A welfare regime can be defined as the combined, interdependent way in which welfare is produced and allocated between state, market and family’ (Esping-Andersen, 1999, p. 35). Under this broad definition of a welfare regimes there are at least three factors that may be put forward as having a significant contribution for socioeconomic differences in health. These relate to the following: (1) differences in the direct material consequences of redistributive income policies and universalistic and egalitarian principles in the provision of social benefits, education and health care; (2) differences in the psychosocial and psychological consequences of these policies in terms of sense of belonging, feelings of cohesion and sense of security; and (3) differences in the working of the labour market in terms of gender segregation, the male ‘bread-winner’ model and the ability of women to participate in paid work.