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- school performance; social comparison; life satisfaction; “big-fish-little-pond”-effect; multilevel analysis; National Educational Panel Study; Germany (1)
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Gesundheits- und Medizinsoziologie : eine Einführung in sozialwissenschaftliche Gesundheitsforschung
(2013)
In diesem Band werden sozialwissenschaftliche Theorien vorgestellt, die sich mit Gesundheit und Krankheit beschäftigen. Die Theorien konzentrieren sich auf die Wechselbeziehungen zwischen Belastung, Bewältigung und Gesundheit. Aus ihnen lassen sich Strategien ableiten, um das für die Gesundheit relevante Verhalten, die entscheidenden Umweltbedingungen und die Strukturen des Gesundheitssystems zu beeinflussen.
Aim
Comparative research on health and health inequalities has recently begun implementing a welfare regime perspective. The aim of the study was to review the existing evidence for identifying the determinants of health and health inequalities in highly developed welfare states and to develop a theoretical model for future research approaches.
Subject
A welfare state regime typology is applied to comparatively analyse (1) the relationship between the level of economic prosperity in a society and its respective level of overall population health and (2) the nature of the corresponding relationship between economic inequalities and health inequalities in different groups of countries.
Results
Although the Social Democratic welfare states have a relatively equal distribution of material wealth as well as the highest levels of population health, they are not characterised by the smallest levels of health inequality. Rather, with respect to health equality, conservative countries seem to perform better than social democracies. We propose a comprehensive theoretical model that takes into account different factors on the structural (macro), organisational (meso) and individual (micro) level in order to contribute to a better understanding of this important challenge for public health policy and practice.
Conclusion
Future research will require an appropriate theoretical model with the potential to explain health and health inequalities in different types of welfare states. On the basis of this model, future research should test the hypothesis that in highly developed countries not only economic, but also social, cultural and lifestyle factors are important in determining health outcomes in different segments of the population.
Dieser Beitrag untersucht die Relevanz makro-struktureller Merkmale für die Gesundheit und sozioökonomische Ungleichheit in der Gesundheit von Jugendlichen in hochentwickelten Wohlfahrtsstaaten. Datenbasis ist die internationale "Health Behaviour in School-aged Child-ren (HBSC)"-Studie 2005/06. Sie umfasst 11- bis 15-jährige Jugendliche in 27 europäischen und nordamerikanischen Länder (n=134.632), die in fünf Wohlfahrtsstaatsregimes (sozialde-mokratisch, konservativ, liberal, süd- und osteuropäisch) zusammengefasst wurden. In hierar-chischen Regressionsmodellen wurden für die psychosomatische Beschwerdelast als gesund-heitliche Zielgrößee individuelle (familiärer Wohlstand) und makro-strukturelle Determinanten (Einkommensungleichheit, Ausgaben für das Gesundheitssystem, Regime-Dummies) unter Kontrolle des nationalen Wohlstands analysiert. Im liberalen Regime und damit in Ländern mit hoher Einkommensungleichheit fallen die Beschwerderate und sozioökonomische Un-gleichheiten in der Beschwerdelast am höchsten aus. Der gesellschaftliche Wohlstand und die Ausgaben für das Gesundheitssystem sind dagegen nicht mit den Beschwerden assoziiert
This paper reviews life course approaches applied in epidemiology, sociology and psychology and proposes a theoretical framework that integrates the concept of socialisation. We argue that the paradigmatic principles of interdisciplinary life course research (human agency, timing in lives, linked lives and historical context) provide a strong basis for a more holistic and theory-driven view of the life course and its interdependent pathways. The ´agency within structure´ paradigm on which these principles are based is an essential part of socialisation theory. We emphasize that socialisation theory has the potential to act as a theoretical link between social science and epidemiology, because it offers a multi-causal framework to illuminate the association between social structure and health across the life course. In order to better understand the development of health and health inequalities in a life course perspective, an interdisciplinary approach is required. The increased attention to socialisation principles might open new dialogue and empirical research perspectives for health sociology and epidemiology. Keywords: ageing, health, life course, social inequalities, socialisation theory
Objectives
Little is known about the impact of recessions on young people’s socioeconomic inequalities in health. This study investigates the impact of the economic recession in terms of youth unemployment on socioeconomic inequalities in psychological health complaints among adolescents across Europe and North America.
Methods
Data from the WHO collaborative ‘Health Behaviour in School-aged Children’ (HBSC) study were collected in 2005/06 (N = 160,830) and 2009/10 (N = 166,590) in 31 European and North American countries. Logistic multilevel models were used to assess the contribution of youth unemployment in 2009/10 (enduring recession) and the change in youth unemployment (2005–2010) to adolescent psychological health complaints and socioeconomic inequalities in complaints in 2009/10.
Results
Youth unemployment during the recession is positively related to psychological health complaints, but not to inequalities in complaints. Changes in youth unemployment (2005–2010) were not associated with adolescents’ psychological health complaints, whereas greater inequalities in complaints were found in countries with greater increases in youth unemployment.
Conclusions
This study highlights the need to tackle the impact of increasing unemployment on adolescent health and health inequalities during economic recessions.
This study aims to determine whether educational differentiation (i.e. early and long tracking to different school types) relate to socioeconomic inequalities in adolescent smoking. Data were collected from the WHO-Collaborative 'Health Behaviour in School-aged Children (HBSC)' study 2005/2006, which included 48,025 15-year-old students (Nboys = 23,008, Ngirls = 25,017) from 27 European and North American countries. Socioeconomic position was measured using the HBSC family affluence scale. Educational differentiation was determined by the number of different school types, age of selection, and length of differentiated curriculum at the country-level. We used multilevel logistic regression to assess the association of daily smoking and early smoking initiation predicted by family affluence, educational differentiation, and their interactions. Socioeconomic inequalities in both smoking outcomes were larger in countries that are characterised by a lower degree of educational differentiation (e.g. Canada, Scandinavia and the United Kingdom) than in countries with higher levels of educational differentiation (e.g. Austria, Belgium, Hungary and The Netherlands). This study found that high educational differentiation does not relate to greater relative inequalities in smoking. Features of educational systems are important to consider as they are related to overall prevalence in smoking and smoking inequalities in adolescence.
The aim of this study is to examine the impact of class-level class climate on school-aged children’s life satisfaction. Data was derived from the German National Educational Panel Study (NEPS) using sixth grade school-aged children (n = 4,764, 483 classes). Class climate includes indicators of teachers' care and monitoring, demands, interaction, autonomy, as well as school-aged children's attitudes towards schoolwork at the class- and individual-level. Results showed that individual perceived class climate in terms of teachers' care and monitoring and autonomy was positively related to life satisfaction, whereas school-related demands were related to lower life satisfaction. Besides teachers' care and monitoring at class-level, indicators of class climate were not associated with school-aged children’s life satisfaction, while the individual perceived class climate is more important for life satisfaction.
Background
Features of schools and classes are closely related to students´ health and wellbeing. However, class composition (e.g. in terms of school performance) has rarely been examined in relation to students´ health and wellbeing. This study focuses on the so called Big-Fish-Little-Pond-Effect (BFLPE), by investigating whether the level of high-performing students in classroom is negatively associated with psychosomatic complaints of students who perceive themselves as poor performers.
Methods
Data were derived from the German sample of the WHO-Collaborative “Health Behaviour in School-aged Children (HBSC)” study 2013/2014. The sample included 5226 11-, 13- and 15-year-old students. Individual perceived school performance (PSP) was included (very good/good vs. average/below average PSP) at the individual student-level. At the class-level, school performance in class was generated by aggregating the share (in percentage) of students who report a very good/good PSP to the class-level, indicating the percentage of students with good/very good PSP in classroom. Using multilevel regression models, the association between class-level school performance (in percentage of students with very good/good PSP) and individual psychosomatic complaints were analyzed, stratified by students´ individual PSP.
Results
Students who report average/below average PSP showed higher likelihoods of psychosomatic complaints (Odds Ratio: 1.75; 95% Confidence Interval: 1.52–2.03) compared to counterparts with very good/good PSP. The aggregated class-level PSP was not significantly associated with psychosomatic complaints. However, in line with the BFLPE, results further revealed that students with average/below average PSP, who attend classes with a higher percentage of students who report very good/good PSP, had higher likelihoods of psychosomatic complaints (Odds Ratio: 1.91; 95% Confidence Interval: 1.01–4.01) compared to classmates with very good/good PSP.
Conclusions
This study revealed that class composition in terms of PSP was differentially associated with students´ psychosomatic complaints, depending on their individual PSP. Findings highlight the vulnerability of students with poor PSP placed in classes with a higher percentage of students with good PSP. Results of this study therefore indicate a need for initiatives for low performing students from teachers and school staff in class.
In allen hochentwickelten Ländern hat sich in den letzten 30 Jahren der Gesundheitsstatus der Bevölkerung deutlich verbessert. Ein wesentlicher Grund dafür ist die gestiegene wirtschaftliche Prosperität. Diese ist heute aber ungleicher verteilt als vor 3 Jahrzehnten. Die Unterschiede in der Verfügbarkeit materieller Ressourcen und die Diskrepanzen im sozioökonomischen Status hängen eng mit der Gesundheitslage der Bevölkerung zusammen. Ländervergleiche zeigen, dass eine auf ökonomische Gleichheit ausgerichtete Wohlfahrtspolitik, wie sie für die skandinavischen Länder typisch ist, mit relativ günstigen gesundheitlichen Indikatoren korreliert. Bisher ist allerdings nicht geklärt, wie ökonomische Ungleichheit und gesundheitliche Lage zusammenhängen. Als besonders unklar erweist sich in neueren Studien der Zusammenhang von ökonomischer und gesundheitlicher Ungleichheit. In diesem Beitrag geben wir einen Überblick zu den vorliegenden länderübergreifenden Analysen. Diese zeigen, dass die skandinavischen Länder dank ihrer intensiv umverteilenden Wohlfahrtspolitik zwar das höchste Ausmaß von ökonomischer, aber nicht von gesundheitlicher Gleichheit erreichen. Wir entwickeln auf der Basis dieser überraschenden Erkenntnis Vorschläge für künftige empirische Untersuchungen. Die Vorschläge gehen von der Annahme aus, dass in wohlhabenden Gesellschaften mit hohem Reichtum nicht mehr nur materielle, sondern verstärkt immaterielle Lebensbedingungen über die Verteilung gesundheitlicher Ungleichheit entscheiden. Als entscheidender Parameter wird die Verfügbarkeit von gesundheitsfördernden, „salutogenen” Potenzialen und Kompetenzen des Selbstmanagement in benachteiligten Gruppen der Bevölkerung postuliert.