COMO LAS LEYES ESTABLECEN LA IGUALDAD EN LA DEMOCRACIA

Figure 2.5.1 shows the present study's hypothesized model of the social process leading to health outcomes: the major differences between the model shown in Figure 2.1.1 on page 10 and the one below are the inclusion of a life-course framework and a mechanism for social selection. It is

expected that there are significant benefits in adopting a life-course perspective because the complexities of the social causes associated with poor health should be mostly subsumed by early-adulthood social structures (Elder and Liker, 1982; Moen et al., 1992). For instance, within the model the 'social process' initially identifies stressors related to role participation

during early adulthood; this 'anchoring' period is then expected to govern the ensuing life course.

It is hypothesized that social-role careers during early adulthood are

associated with circumstances that cause psycho-physiological reactions over the life course, which in turn affect health status.

Figxiie 2.5.1

Hypothesized social process leading to health outcomes for women

Note: Arrow-headed lines between boxes indicate presumed causal relationships. Dotted lines indicate an interaction between conditioning variables and variables at the beginning of the solid line in predicting variables at the end of the solid line.

The life course also is perceived as cumulative, and therefore directional changes over the ensuing life course within early-adulthood 'anchoring' careers may further influence health outcomes. This approach has meant that many relationships in the hypothesized process are unknown. As a result, a more exploratory type of analysis will be carried out to examine the added effects on health status of role involvement over the ensuing life course.

The process has some conceptual similarities to the 'primary^ and

'secondary" stressors identified by Pearlin (1989); and its aims contribute to Pearlin's call for alternative research:

The careful study of stressors, then, should provide the researcher with an opportunity to learn something about social life as it bears on individual functioning. The sociological study of stressors can reveal the connections between social organizations and the organization of lives. To find these connections, however, we cannot treat stress as stemming from

unconnected happenings. Instead the antecedents of stress need to be understood in terms of process, whereby broad structured and institutional forces, constellations of primar}^ and secondary stressors, and widely shared values converge over time to affect people's well-being, (p.249)

In relation to health outcomes, it is expected that stressors do not occur in isolation over the life course, and therefore it is probable that a broad range of health conditions are associated with a process that starts early in life. Particular social careers, how^ever, may accentuate certain types of stress or negative life-style factors, and as a result increase the risk of a specific health condition. Furthermore, health indicators, like physical disability,

psychological distress and self-rated health may change in meaning for people over time (Elder and Liker, 1982; Blaxter, 1990), making it difficult to study such measures using a life-course perspective.

The model shows a set of 'conditioning variables' that interact with the process. 'Uncontrolled' events, such as place of employment's closing down, are classed as conditioning variables that combine with women's social experiences or psycho-physiological levels to effect health outcomes. These events are distinct from those that are direct consequences of the process; in fact, an 'uncontrolled' event may interact with the process to cause other major life events. Other 'conditioning variables' include the effects associated with birth cohort. For instance, the recent dramatic social changes may have affected the nature of stresses or life-style factors with social roles for different cohorts, and influenced the composition of women within social-role careers. In addition to higher rates of divorce

(Carmichael and McDonald, 1986) and a greater proportion of women

delaying first marriage (Bracher, 1988), labour force participation of married women has been steadily increasing.

In relation to attitudes towards gender roles, evidence suggests that two kinds of social change have taken place (Moen, 1992):

(1) changes between cohorts where young people with more liberal orientations have replaced more conservative adults ('cohort replacement'); and

(2) to a lesser extent, changes within cohorts where people of all ages have adopted attitudes about female employment that are more in harmony with the values of an increasingly egalitarian society (individual change).

The shifts are not surprising since the work that women do within the family is undervalued by western society: they receive no wage for it,

whereas outside employment brings increased independence and financial reward. Consequently, young women appear to be less committed to

traditional forms of family life, which place them in unequal, dependent situations (Worsley and Worsley, 1990). On the other hand, there still remains considerable concern about the harm that is done to preschoolers from the employment of their mothers. This concern is not likely to disappear as younger more liberal men and women replace their conservative elders (Moen, 1992).

The complex nature of people's attitudes about recent social changes

highlights a contemporary dilemma where household role strain is thought to be responsible for considerable levels of depressive symptoms; and

paradoxically, the addition of occupational roles has been associated with better psychological well-being and physical health (Kandel et al., 1985; Verbrugge, 1983). Furthermore, in the past women who worked in a paid job while rearing children during their early-adulthood lived in a society that was less understanding of 'working' women, probably creating strain that was detrimental to their health.

It is hypothesized that younger cohorts of women who spent most of their early adulthood not employed, married with children (a 'traditional' career) have a worse health status than their non-traditional peers and older

traditional counterparts; and older cohorts of women who spent most of their early adulthood employed while rearing children have the worst health.

The link going from health to the social process in the model further reinforces the dynamic nature of the process, with health conditions, especially chronic disease expected to influence the social process not only through the severity of the illness or disability, but also in combination with the 'conditioning variables', including the recent social changes. For

example, over the last 20 years unemployment rates have had some

substantial increases, and since about 1975 they have been above six per cent (see Appendix 2.B). Unlike in the past, this trend suggests that a

competitive labour market exists that is likely to accentuate the 'healthy worker' effect for women (Bartley, 1991).

It is hypothesized that chronic disease affects marital status and

childbearing, with poor health contributing to women never marrying, to married women becoming separated or widowed, and to a smaller number of live births. Also, it is hypothesized that younger cohorts experienced a 'healthy worker' effect at earlier ages than older cohorts had when they were young; while middle-aged women demonstrate the strongest 'healthy

worker' effect.

To test the hypotheses in this study it is necessary to use a unique

methodology that not only employs information about women's social-role and health careers, but also develops measures to deal with such detailed data. The approach adopted relies on recalled transition dates of major role changes and chronic disease onset, as well as cross-sectional indicators of mental health and self-rated health. Given the emphasis on early

adulthood, a classification system was devised to create groups of social-role careers within age-defined periods. Using a variety of regression techniques (depending on the nature of the outcome indicator), tests are carried out to determine whether or not these role indicators are associated with the health measures. The types of relationships investigated include the

influence of early-adulthood social-role careers on chronic disease, levels of psychological distress, and self-rated health, as well as the effect of chronic disease on role participation over the life course. It is expected that the results will provide new insights into the dynamic and complex social processes that lead to negative health outcomes.