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Swiss Journal of Sociology, 44 (2), 2018, 203–215
Vulnerability in Health Trajectories: Life Course Perspectives
Vulnerabilität in Gesundheitsverläufen: Lebenslaufperspektiven
Vulnérabilité dans les trajectoires de santé : perspectives du parcours de vie
Stéphane Cullati*, Claudine Burton-Jeangros**, and Thomas Abel***
1 Introduction
It is now widely acknowledged that the unequal distribution of good health across the
population results from the inuence of a range of social determinants. ese shape
often sharply distinct health patterns across and among socially disadvantaged and
advantaged groups. is study of health inequalities has been recently re-visited and
partly renewed by life course researchers (Burton-Jeangros etal. 2015; Bartley 2016).
Life course perspectives aim at providing a more comprehensive understanding of the
development of inequalities over time in specic individual health trajectories. Both
macro contexts (e. g. historical time and changing cultural representations, economic
booms and recessions) and micro contexts (e. g. family situation, working conditions,
social networks) inuence how health trajectories unfold over the life course and
therefore contribute to how health inequalities develop among and across sub-popu-
lations. Despite the general expansion of education (Meschi and Scervini2014) and
a partial decrease of gender inequalities (Dorius and Firebaugh2010) in the second
half of the twentieth century, health inequalities continue to grow in many auent
countries (Mladovsky etal. 2009; Mackenbach etal. 2016). Research shows this
to be associated with an increase in basic socioeconomic inequalities (e. g. income)
observed over the last decade (Duvoux 2017). For a better understanding of these
various trends, more research at the crossroad of sociology of health and life course
epidemiology is needed (Burton-Jeangros etal. 2015).
* NCCR “LIVES– Overcoming Vulnerability: Life Course Perspectives,” Institute of Demography
and Socioeconomics, University of Geneva, CH-1211 Geneva.
Department of General Internal Medicine, Rehabilitation and Geriatrics, University of Geneva,
CH-1211 Geneva, stephane.cullati@unige.ch.
** NCCR “LIVES– Overcoming Vulnerability: Life Course Perspectives,” Institute of Demography
and Socioeconomics, University of Geneva, CH-1211 Geneva, claudine.jeangros@unige.ch.
*** Institute of Social and Preventive Medicine, University of Bern, CH-3012 Bern,
thomas.abel@ispm.unibe.ch.
204 Stéphane Cullati, Claudine Burton-Jeangros, and Thomas Abel
SJS 44 (2), 2018, 203–215
2 Life course studies of health
A recent discussion of the classical WHO denition of health (WHO 1946)
emphasized the need to adopt a dynamic approach, hence suggesting to consider
health as “the ability to adapt and self-manage” (Huber etal. 2011). In empirical
research the individual and social patterning of health has so far tended to be only
roughly observed, through trajectories categorized with the following taxonomy:
“stability” (in good or poor conditions), “decline,” “improvement,” and uctuations
(Colerick Clipp etal. 1992). Nevertheless, this description of empirical patterns
has been hampered by the lack of population-based longitudinal data covering the
full life course. From a theoretical point of view, the pattern of health trajectories
has frequently been described along the following model: (having the best) grow-
ing, followed by (longest possible) maintaining and (latest and slowest possible)
declining health (Hertzman 1999; Ben-Shlomo etal. 2016). After the develop-
ment phase associated with childhood, health tends to slowly decline in adulthood
(Pinquart 2001; Cullati etal. 2014b), as individuals ageing is often progressively
impaired with increasing loss of functional and cognition abilities. Along with
biological ageing, patterns of health trajectories are not straight and linear (Halfon
etal. 2014; Ben-Shlomo etal. 2016) but uctuate by individuals’ characteristics
and living contexts. Variability of health trajectories is linked with both biological
factors, such as genes-environment inuences on physiological functions, brain and
microbiota developments, and a range of social factors associated with individual
life courses that shape these trajectories in an important manner (Vineis et al.
2016). Indeed, the household in which individuals grew up, the schools they at-
tended, the neighbourhoods in which they lived, their socioeconomic conditions in
adulthood (McDonough etal. 2005; Cullati 2015), their employment (Stone etal.
2015; Benson etal. 2017) and family histories (Dupre etal. 2009; Benson etal.
2017), the (normative and non-normative) transitions they experienced as well as
the dierent adversities they met during their life, aect chances of growing and
remaining in good health. e mutual inuences of dierent life spheres like work
and family impact the health trajectories in adulthood (Knecht etal. 2011; Cullati
2014; Cullati etal. 2014a; Knecht etal. 2016), as well as the period and country
in which individuals live (Sacker etal. 2011; Burton-Jeangros and Zimmermann-
Sloutskis 2016). Individual health trajectories also depend on individuals’ ability
to adapt to their living contexts, to cope with stress, such as a stressful psycho-social
environment at work (eorell 2000; Eatough etal. 2016), a poor relational envi-
ronment in the family (Lehman etal. 2009; Berg etal. 2017), life-time adversity
(Seery etal. 2010), and adapt to a health impairment (Cooper and Bigby 2014) or
the health impairment of their partner (Berg and Upchurch 2007). A sociological
perspective is thus more specically interested in documenting whether the health
trajectories of dierent social categories (dened for example along gender, social
Vulnerability in Health Trajectories: Life Course Perspectives 205
SJS 44 (2), 2018, 203–215
class or migration background) develop in parallel over time, reecting a constant
gap across these categories, or whether they diverge as individuals age, which would
indicate that, along the cumulative dis/advantage model (Dannefer 2003), social
processes dierently impact individuals as they age, or whether adaptation to the
living context vary between these categories.
A challenge for future life course studies is to consider dierent time processes
aecting individual health, such as short-term stressors (e. g. changing jobs, marital
breakup, adverse events) versus long-term adverse eects (e. g. living in poor circum-
stances for several decades). Combining life course models of health trajectories
(growing, maintaining and declining) (Hertzman 1999; Ben-Shlomo etal. 2016)
with adaptive regulation models (Boker 2015), or short-term regulatory processes
(Spini etal. 2016), is a methodological challenge, but it would improve our know-
ledge of the development of health vulnerability over the life course.
3 Vulnerability and health
Research on vulnerability rst developed in environmental science and broadened
to research elds like human development, ageing studies, life course and welfare
states studies. e concept can account for nations’, groups’ and individuals’ dif-
culties to handle a specic situation. In life course research, vulnerability has been
dened as a lack of resources putting individuals at risk of experiencing negative
consequences of stress and thus reducing their ability to eectively cope with adverse
events and recover from stress, or to take advantage of opportunities when facing
normative and non-normative events or transitions (Spini etal. 2013; Spini etal.
2017). Resources are many in types (physiological, cognitive, relational, economic,
social, cultural and institutional) and are theoretically available to most individuals.
However, depending on their genetic background and social organization processes,
levels of resources are not distributed evenly across individuals living in the same
society; such resources are dierent for individuals living in dierent societies, as
between high- and low-income countries. Furthermore, those inter-individual
dierences in level of resources can be explained by life course processes, like the
Cumulative Advantage and Disadvantage (CAD) model (Dannefer 2003) or the age-
as-level hypothesis (Lynch and Smith 2005). In the CAD model, these dierences
are expected to grow over ageing through rising divergence between the better os
and the worst os. By contrast, the age-as-leveller hypothesis suggests that higher
mortality of disadvantaged individuals reduces inequalities among those who stay
alive. e evolution of these inter-individual dierences in level of resources will
be aected by stressors and shocks (hazards, life adverse events) experienced during
the life course, be they chronic or event-based (Wheaton 1994).
206 Stéphane Cullati, Claudine Burton-Jeangros, and Thomas Abel
SJS 44 (2), 2018, 203–215
In the context of life course studies of health, and in line with the above
denition of vulnerability (Spini etal. 2017), we propose to consider that health
vulnerability emerges at the articulation of two distinct processes. On one hand, a
lack of resources is generating dierences in health trajectories between individuals, or
groups, over the life course. On the other hand, limited resources hinder recovering
from poor or disadvantaged conditions and coping with stressors, and the absence
of such compensating mechanisms maintains or even accentuates dierences in
health trajectories.
Dierences in health trajectories can have two patterns. First, in adulthood, it
results from an acceleration, earlier start, or a combination of both, of health decline,
resulting in a growing health gap between individuals or social groups over the adult
life course (Dannefer 2003; Cullati etal. 2014b). Available resources, whether
genetic, socioeconomic, relational, or a combination of these, can be determinant in
the acceleration and/or earlier start of health decline. Second, dierences in health
trajectories in middle age or at older age can lie in structural and inter-personal stress
exposures in critical and sensitive periods of the life course, resulting in a constant
and long-term gap across individuals or social groups in later health trajectories.
e life course perspective suggests indeed that a bad start in life, like experiencing
adversities (Greeneld 2010; Danese and Tan 2014) or growing up in low socioeco-
nomic conditions, can have long-term adverse health consequences ( Wadsworth and
Kuh1997), like poor quality of life (Blane etal. 2004; Wahrendorf and Blane 2015),
poor physiological risk factors of cardiovascular disease (Blane etal. 1996), chronic
conditions (Blackwell etal. 2001), poor health behaviours (Cheval etal. 2018) and
mortality (Hayward and Gorman 2004; Galobardes etal. 2008). Adversity during
adulthood, such as poor work and unstable family conditions, also result in poor
health outcomes later: single motherhood from young adulthood to middle age
(Berkman etal. 2015) and poor mid-life occupational conditions (Platts etal. 2015)
for example, have been shown to be associated at older age with reduced quality
of life and negative health outcomes, including accelerated health decline. During
old age, social participation is associated with lower mortality (Holt-Lunstad etal.
2010) and with improvement in self-rated health (Ichida etal. 2013), while social
network ambivalence is linked with cardiovascular reactivity (Uchino etal.2001),
and negative emotional support from family or friends impairs self-rated health
(Craigs etal. 2014). All these mechanisms conrm the delayed impact on health
of vulnerable circumstances encountered at dierent stages of the life course.
Along with structural advantages and disadvantages, the life course perspective
also emphasizes the role of “linked lives” in the development of health vulnerabil-
ity. Indeed, between individual circumstances and macrosocial environments, the
unfolding of health trajectories need to be considered in the meso-level context of
families. Individuals live in interdependence or in networks of shared relationships.
Persisting inequalities between women and men in the labour market reect the
Vulnerability in Health Trajectories: Life Course Perspectives 207
SJS 44 (2), 2018, 203–215
interdependence of their life histories, especially in the family unit (Drobnic and
Blossfeld 2004). Individual trajectories are constantly connected with the ones of
other family members, in relational patterns that can be either favourable or detri-
mental to health circumstances. However, the framing of respondents’ life by their
partner’s characteristics has so far been largely neglected by the life course research
in general (Bird and Krüger 2005), and in life course epidemiology in particular.
4 Contemporary societies and accumulation of disadvantages
In societies characterized by individualization and diversity of life styles ( Giddens
1991), bio graphic risks (Beck 1992), and gender de-standardisation of occu pational
careers (Levy and Widmer 2013), the interplay of agency and structures is of par-
ticular importance, as one of the life course principle (Elder 1998). Socio logical
conceptualizations of agency and structure can contribute to our understanding of the
processes by which inequalities in health trajectories occur over time and how social
factors (i. e., socioeconomic position, working conditions, marital and family lives,
lifestyles, gender, migration, discrimination) impact on health trajectories (Abel and
Frohlich 2012). Agency can hamper development of health vulnerability over the
life course. For example, the impact of physical activity has been shown to reduce
mortality as much as medical drugs (Naci and Ioannidis 2013). Individuals may
impact their cognitive ageing by endorsing either supportive (learning, exercise and
sexual activity) or detrimental (sleep deprivation, alcohol consumption) behaviours
(Shors etal. 2012). Alternatively, agency can accelerate health vulnerability, such
as when compliance to misleading social norms result in bad life course outcomes
(Widmer and Spini 2017), like when endorsement of risky health behaviours is a
marker of social acceptance.
Simultaneously, structures can provide, or not, to individuals the resources and
opportunities they need to live a healthy life. Educational and health care systems,
family, work and housing policies, social security all inuence life course trajectories,
oering to individuals resources at dierent stages of their life and thus aecting
their chances of staying in good health as long as possible. Socially disadvantaged
groups are structurally positioned in unfavourable conditions in society (e. g. poor
working and housing conditions) and have less material and non-material resources
to cope with the adversities of life. Such structural disadvantaged positions put them
at higher risk of experiencing health decline earlier in their life course or at a faster
rate of decline. e accumulation of such diculties is associated with health risks
that are themselves a potential source of non-normative transitions such as job loss
or divorce due to poor health conditions. Considering the social determinants of
health in a life course perspective particularly emphasizes the crucial role of social
protection regimes as mechanisms that protect most vulnerable categories from the
208 Stéphane Cullati, Claudine Burton-Jeangros, and Thomas Abel
SJS 44 (2), 2018, 203–215
new social risks generated by current arrangements in regard to work and family
lives (Ranci 2010).
5 Contributions to the special issue
is special issue gathers six empirical papers based on either quantitative or quali-
tative data, representing a range of European countries. Papers are either single-
country studies (Switzerland, France, Germany) or multi-country studies, using the
Survey of Health, Ageing and Retirement in Europe (SHARE). ree papers are
population-based cohort studies (one of teenagers, two of older people) and three
are studies of sub-groups populations (children following an obesity management
programme, survivors of childhood cancer and young adults with mental disorders).
Two papers use non-research databases (administrative data or medical records) and
two use self-reported retrospective data. Finally, two studies empirically tested the
CAD hypothesis (Dannefer 2003). Contributions in this issue are organised fol-
lowing the chronological life course, from childhood to old age.
e rst article, written by Andrea Lutz (in French), is an ethnographic study
of obese or overweight children and their parents following a paediatric obesity
management programme in a Swiss tertiary hospital. Families were recruited at
the beginning of the programme and data was collected through interviews with
the family and observations of medical consultations. e author explored the
association between the family social position and the compliance with medical
recommendations. Acceptance or resistance with medical recommendations was
assessed at the beginning of programme and a few months later. Results showed
that compliance with medical recommendations increased for all children. A gradi-
ent between socially advantaged and disadvantaged families was observable before
the programme and remained stable over the course of the programme. Among
disadvantaged families, lack of nancial resources was perceived as a barrier in
adopting a healthy diet. Families with high educational levels were more familiar
with nutrition and physical activity recommendations compared to family with
low educational backgrounds. e author interprets these results in the light of
the theory of habitus of Pierre Bourdieu, explaining the dierential internalisation
of medical recommendations by social positions.
e article of André Berchtold etal. examines individual trajectories of somatic
complaints from the age of 16 to 30 a cohort of 1 161 young adults living in
Switzerland. Somatic complaints included minor health symptoms, like headaches,
stomach aches, sleep disturbance, lack of appetite, lack of concentration, vertigo,
nervousness and fatigue. e prevalence of somatic symptoms among those young
adults increased over time and frequency of symptoms was associated with future
life milestones achievement. Using data from the Transition from Education to
Vulnerability in Health Trajectories: Life Course Perspectives 209
SJS 44 (2), 2018, 203–215
Employment study (TREE), Berchtold and colleagues aimed at identifying patterns
of somatic complaints trajectories and at assessing if these patterns are associated
with socio-economic and critical life events factors. ey build sequences of somatic
symptoms and clustered them, using a hidden mixture transition distribution model.
Based on indices of t and a combination of covariates inuencing the probability
of belonging to a cluster, a nal model with ve groups was discussed. e clusters
are characterised by the variability of somatic complaints over time and average
scores of somatic complaints. ese groups were distinct at study baseline and
remained distinct during the whole study follow-up. ey were associated with
gender, educational achievement and the experience of critical life events. Berchtold
and colleagues also showed that higher consumption of tranquilisers and sleeping
pills was associated with higher overall somatic scores. As these groups of somatic
complaints trajectories were already distinct at the age of 16, it suggested that ado-
lescents with poor somatic complaints trajectories were experiencing a situation of
vulnerability before inclusion in the study, i. e. before adolescence, and that these
conditions continued throughout adolescence and young adulthood. Dierences
between trajectories were largely inuenced by early experiences and less by transi-
tions (entry to the labour force, founding of a family life) and life events taking
place over the course of young adulthood. Berchtold etal.’s ndings contribute
to the understanding of health vulnerability by showing that the onset of somatic
complaints is linked with early-life, thus providing preliminary evidence that sup-
ports the critical/sensitive period model (Kuh and Ben-Shlomo 2004).
e article by Isabel Baumann etal. focuses on employment of young adults
with mental disorder living in Switzerland. Following the CAD hypothesis ( Dannefer
2003), the authors expected that an early onset of mental disorders would be more
strongly and negatively associated with employment prospects compared to a later
onset. ey also expected handicapped children beneting from special needs educa-
tion to be more likely to nd a job than those attending regular education. Using
data from the Swiss Federal Social Insurance Oce, they examined the association
between educational trajectories, educational attainment and type of diagnosis
(externalising vs. internalising problems) and being currently employed. Baumann
etal. showed that special needs education for adolescent with mental disorder was
associated with being currently employed, independent of educational attainment.
Special needs education may protect individuals from the potential adverse eects
of the social norms dened by the school system and the labour market and thus
channel individuals into future sheltered vocational training programs and sheltered
employment. Special needs education may thus, be a protective factor against the
development of health vulnerability, by maintaining educational and relational
resources of individuals. e authors also found that onset of mental disorders
in late adolescence or young adulthood was associated with a higher risk of being
unemployed compared to individuals diagnosed in childhood and adolescence. is
210 Stéphane Cullati, Claudine Burton-Jeangros, and Thomas Abel
SJS 44 (2), 2018, 203–215
initial result needs to be conrmed with new research using eective age of onset
of mental disorder (such information was not available to the authors). Last, the
authors found that both types of mental disorders (externalising vs. internalising
problems) were associated with being unemployed.
e article of Agnès Dumas is a qualitative study of a cohort of 80childhood
cancer survivors living in France. Using in-depth interviews with patients diagnosed
between 1970 and 1985 and aged 36years (average) at the time of the interview,
the author assessed patient’s perceived long-term impact of cancer and their coping
strategies, how the cancer was incorporated in their identity and how cancer was
discussed with their family, friends, children and signicant others. e objective
was to assess gender dierences in health-related beliefs and stereotypes. First, the
author showed that cancer was surrounded by a lack of family communication
when participants were children, explained by the medical context of the 1970s and
1980s where priority was given only to patient survival, not patient communication.
Reactions to this silence was dierent between men and women: men were satised
with it while women wanted to have known more. Second, men displayed more
frequently than women a passive attitude toward their treatment (e. g., avoidance
of or delay in medical follow-ups), and were more reluctant to seek medical care.
is result was in line with the existing literature on social norms of “masculinity”
and conrmed the view that men living with cancer are more likely to prioritize the
preservation of their health than to the preservation of their “masculinity,” or male
identity. According to Dumas, reluctance to undergo medical surveillance reected
compliance of male cancer patients with the “hegemonic masculinity” norm, despite
having a risk of cardiovascular mortality eight times higher compared to the general
population. Dumas’ contribution to the understanding of health vulnerability is
double: rst, it shows that health vulnerability is embedded in an historical context,
i. e. here a period that preferred a lack of communication about cancer; second,
agency is a driver of health vulnerability, through conformity to misleading norms
(Widmer and Spini 2017), i. e. “hegemonic masculinity” in the present case, that
results in noncompliance with medical recommendations.
e article of Valérie-Anne Ryser et al. studies the association between health
status and life satisfaction in the second half of life, to assess whether individuals who
experience low levels of life satisfaction are also more likely to be in poorer health
status, suggesting a potential accumulation of disadvantage (Dannefer 2003). e
study was based on the SHARE database, waves2 and4 (treated as cross-sections),
including 12countries, and tested health-related inequalities with the concentration
index. To order participants from worst to best health status, the authors build a
continuous latent health index based on 32health indicators. e analysis was con-
ducted separately by country. Findings allowed identifying that the most vulnerable
groups were those for whom disadvantages in life satisfaction and disadvantages in
health status and other covariates cumulated. For example, higher life satisfaction
Vulnerability in Health Trajectories: Life Course Perspectives 211
SJS 44 (2), 2018, 203–215
was concentrated among respondents with better health status; poor life satisfaction
was concentrated among women, unmarried participants, and those with poor adap-
tation processes, and in all countries, but with large variations. e contribution of
Ryser et al. provides support to the CAD hypothesis in that individuals with health
disadvantages also report poor life satisfaction. e large inter-countries variation
in the association between health status and life satisfaction suggests implementing
national policy interventions, and support the life course perspective emphasizing
the role of context in the study of health vulnerability.
e article of Nadine Reibling et al. examined the role of fertility history on health
status at older age and whether this association varied across 13 European countries.
Authors used the SHARE database and three indicators of health (number of chronic
conditions, self-rated health and depression). Findings suggest that parenthood and
the number of children was weakly associated with health in later life, in contrast
with the timing of the rst child which was strongly associated with health. However,
the pattern of the association was u-shape: delaying rst childbirth until 30years
was good for health, while it became detrimental after 35years, in particular for
women. Findings also show a dierential eect by cohort: timing of rst birth
became less important for later health in younger cohorts. Finally, wide variation
between welfare regimes were observed. Among women, the association between
fertility timing and health was weak in Eastern and Southern countries and strong
in Continental and Scandinavian countries. Among men, the association was strong
in Continental countries only, otherwise timing was weakly associated with their
health status. Reibling’s paper brings a contribution to the importance of timing
in normative transitions, and supports the hypothesis of sensitive periods (Kuh and
Ben-Shlomo 2004). It also emphasises the importance of time and broader national
contexts in understanding the potential benets of timing of rst birth.
e papers of this Special Issue show the potential of adding a life course
perspective to health inequalities research and to the study of health vulnerability.
Adopting a dynamic denition of health adds an important dimension in the under-
standing of how societies produce specic patterns of health across social categories.
e issue also conrms the importance of combining qualitative and quantitative
research to assess the complex mechanisms that articulate life circumstances, the
experience of critical events and health trajectories over the whole life course.
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Jean Michel Bonvin
Stephan Dahmen (dir./Hrsg.)
Reformieren durch Investieren?
Chancen und Grenzen des
Sozialinvestitionsstaats in
der Schweiz
Investir dans la protection
sociale – atouts et limites pour
la Suisse
www.seismoverlag.ch/info@seismoverlag.ch
www.editions-seismo.ch/info@editions-seismo.ch
L’Etat d’investissement social se présente comme une
stratégie de réforme de l’Etat social en vue de répondre
aux nombreuses critiques auxquelles il est actuellement
soumis. La conversion des États sociaux européens
à l’investissement social vise ainsi à restaurer leur
légitimité et à relever les défis démographiques et
économiques posés aux États sociaux contemporains.
Suivant les partisans de cette conception, la réorientation
des dépenses sociales vers l’investissement dans la
formation et le développement du capital humain –
notamment en facilitant l’accès à l’emploi, en accroissant
les investissements dans les enfants et en privilégiant
une nouvelle conception de la politique sociale comme
facteur productif – permettra de réduire les inégalités
sociales et de contribuer à la viabilité des États sociaux
contemporains. Cet ouvrage examine la forme prise par
l’investissement social en Suisse et les effets qui en
résultent. Il discute de manière analytique et critique les
fondements idéologiques et les implications pratiques de
la stratégie de l’investissement social.
Jean-Michel Bonvin est professeur ordinaire de sociologie
et de socioéconomie à l’Université de Genève, Stephan
Dahmen est chargé d’enseignement et doctorant à la
Faculté des Sciences de l’éducation de l’Université
de Bielefeld.
144 Seiten/pages, SFr. 28.—
Als Antwort auf den zunehmenden Druck, mit dem sich
der Sozialstaat konfrontiert sieht, hat sich das Konzept
sozialer Investitionen als Reformstrategie entwickelt. Der
sozialinvestive Umbau euro päischer Wohlfahrtsstaaten
verspricht sowohl Antworten auf drängende Legitimations-
fragen als auch auf gegenwärtige demografische und
ökonomische Herausforderungen des Wohlfahrtstaates zu
liefern. Die Neuausrichtung der Ausgaben des Sozialstaates
auf Investitionen in Human kapital, etwa durch die Verbes-
serung des Zugangs zu Beschäftigung, den Ausbau der
Investitionen in Kinder und eine konsequente Neubestimmung
von Sozialpolitik als Produktivfaktor ermögliche es sowohl
bestehende soziale Ungleichheiten zu reduzieren als auch die
Nachhaltigkeit moderner Wohlfahrtstaaten zu gewährleisten.
Welche Ausprägungen hat das Sozialinvestitionsparadigma in
der Schweiz angenommen und welche Auswirkungen ergeben
sich aus dem sozialinvestiven Umbau des Sozialstaates?
Das Buch liefert eine kritische Analyse und diskutiert die
ideologischen Grundlagen und praktischen Implikationen
sozialer Investitionen.
Jean Michel Bonvin ist Professor an der Fachhochschule
Westschweiz (éésp) Waadt und Lehrbeauftragter an der
Universität Genf. Stephan Dahmen ist Lehrbeauftragter und
Doktorand in Erziehungswissenschaften an der Universität
Bielefeld.
Mit Beiträgen in deutscher und französischer Sprache.
Avec des contributions en allemand et en français.
... Understanding social inequalities in health [Grundy, Sloggett 2003;Shanahan, Boardman, 2009;Blane et al., 2013] and overcoming vulnerabilities [Cullati, Burton-Jeangros, Abel, 2018;Spini et al., 2013] has been a central challenge in public health research and practice [Jacob et al., 2019]. The family life course framework articulates how the lives of individual family members are interconnected [Szydlik, 2012[Szydlik, , 2016. ...
... This philosophy serves to unite all healthcare providers in a common approach to working with families as partners in care. The goal of this discussion is to point to areas in need of development, with a particular focus on families in vulnerable circumstances [Arber, Evandrou, 1993;Cullati, Burton-Jeangros, Abel, 2018;Isengard, 2018;McNeill, 2010]. ...
... Life course epidemiology is now an established field in demography and social epidemiology [Jacob et al., 2019;Kuh, Shlomo, Ezra, 2004]. Patterns of family/ household structures and partnership dynamics could be used to identify the life course trajectories at which health differences emerge [Cullati, Burton-Jeangros, Abel, 2018]. The present study adds to a growing body of research evidence indicating that gender differences are substantial, comparable across countries with diverse welfare conditions. ...
Article
Full-text available
The diversity of family structures and the quality of social relationships are closely tied to one another. Individual characteristics such as parenting, grandparenting, partnership, cohabitation, living apart together, living solo and other contextual factors (for instance intergenerational help and care) shape partnership histories related to health dynamics; these histories vary greatly depending on gender and country. Over the last 20 years, researchers have considered the Northern Europe as a region of weak family ties and the Southern Europe as a region of strong family ties. This study interprets the household size as an age-related factor and focuses on two empirical questions: (1) Are there gender differences related to health patterns, and how do they change over time? (2) What kind of country-specific differences in the household size dynamics can be observed among West European men and women in the second part of life? The study uses descriptive elements of sequence analysis and regression analysis based on the panel data from seven waves of the SHARE project (Survey of Health, Ageing and Retirement in Europe) collected between 2004 and 2017. The study shows that there are gender differences in the life-course transition to a single-person household. This type of household become more common with time and with individual’s increasing age. The statistical patterns can be helpful in identifying those life stages that are crucial to stabilization of functional health within the context of demographic change. Ethics statement. The SHARE project has been running since 2002. It was originally established at the Mannheim Research Institute for the Economics of Aging (MEA) of the University of Mannheim. Since 2011, it is being operated under the umbrella of the Max Planck Society at the Max Planck Institute for Social Law and Social Policy and is centrally coordinated by the Munich Center for the Economics of Aging. The SHARE study was subject to several ethics reviews: The Ethics Committee of the University of Mannheim, Ethics Council of the Max Planck Society and by national ethics committees. This study was conducted in full accordance with the World Medical Association (WMA) (Declaration of Helsinki, last revised at the 64th WMA Meeting held in Fortaleza, Brazil in October 2013). Written consents from all participants involved in this study were obtained.
... The longitudinal approach proposed by the life course theory considers the health of individuals as trajectories that evolve continuously following human development throughout the life span [6]. Health trajectories may represent a decline, as can be expected with ageing, involving the progressive loss of functional and cognitive abilities, or they may indicate an improvement, in the case of recovery from illness and associated disability [7]. These individual health trajectories are shaped through the long term influences of biological and social mechanisms but also by individual resources [6]. ...
Article
Full-text available
Background Defining and measuring Health presents a challenge, partly due to its conceptual pluralism. To measure Health as an ability to adapt and self-manage, we developed an approach within the theoretical framework of resources and reserves over the life course, recently proposed in the literature. We aimed to (i) use the conceptual framework developed to identify indicators of deteriorating health reserves, (ii) construct an overall health measure from these indicators, (iii) evaluate the association between the overall health measure and subsequent health outcomes and (iv) assess the robustness of our method. Methods We used data from 7,043 individuals born in 1958 in Great Britain included in the National Child Development Study. An overall health measure was constructed via the sum of three selected indicators of deteriorating health reserves in mid-life: chronic widespread pain (CWP), Clinical Interview Schedule - revised (CIS-r), and allostatic load (AL). A three-category variable was defined: impaired/medium/optimal overall health. We explored criterion validity by modelling the relationships between the overall health measure, or each reserve taken separately at 44–45 years, and self-rated health at 46 years and mortality up to 58 years, corresponding to 14 years of follow up, using Cox and logistic regressions respectively. We performed comparative analyses to assess the robustness of the method. Results Having an impaired overall health measure was significantly associated with all-cause premature mortality (HR impaired = 2.74 [1.86; 4.05]) and an increased risk of later fair/poor/very poor self-rated health (OR impaired = 7.50 [6.29; 8.95]). The overall health measure had a greater effect on the self-rated health estimates than each indicator of deteriorating health reserves considered separately (OR AL medium = 1.82 [1.59; 2.09]; OR AL high = 2.74 [2.37; 3.16]; OR CIS-r = 5.20 [4.45; 6.08]; OR CWP = 2.85 [2.53; 3.21]). CIS-r and allostatic load were also associated with premature mortality contrary to chronic widespread pain (HR AL medium 1.82 [1.27; 2.61]; HR AL high = 3.10 [2.19; 4.40]; HR CIS-r = 1.77 [1.22; 2.56]; HR CWP = 1.32 [0.98; 1.76]). The multiple comparative analyses conducted allowed us to assess the robustness of our method within this cohort. Conclusions We proposed a method for measuring Health in mid-life in line with the concept of Health as the ability to adapt and self-manage and the concept of health reserves. This method may be applied and further developed within the field of social and positive epidemiology.
... We approached vulnerability through the lens of health inequalities. Along with developments in life course epidemiology, we aimed to contribute to the understanding of why health inequalities remain persistent in highincome countries, despite an overall improvement in population health (Cullati et al., 2018a). Analysing health trajectories implies approaching health as a dynamic feature that, beyond biological ageing, is shaped by a number of exposures, including genetic and biological make-up, family and work conditions, and societal and environmental factors (Burton-Jeangros et al., 2015). ...
Chapter
Full-text available
This chapter discusses how vulnerability takes on contrasting and ambivalent meanings when approached at different levels. More specifically, the chapter stresses that institutional approaches do not necessarily align with the perceptions and experiences of those who are defined as vulnerable. Over the last several decades, scientific knowledge, and technical and medical measures have supported the development of the prevention and management of vulnerability. However, despite social and public health interventions, vulnerability reduction remains unequal across social groups. Starting from this mismatch, this chapter focuses on how individuals in vulnerable circumstances develop their own strategies and meanings in a context of adversity, along but also against collective definitions of and responses to vulnerability. Based on research conducted in LIVES on health trajectories, the first section of the chapter shows the importance of paying attention to various understandings of vulnerability while stressing their situated character. The second section illustrates the argument in greater depth by using elements from a qualitative study on the experience of HIV-infected women’s trajectories to highlight contradictions between their own understandings of vulnerability and its medical framing. In conclusion, the chapter stresses the importance to policy making of defining vulnerability based on people’ s needs and their own assessments.
... Life course theories take a multifaceted approach to understanding health trajectories by considering the mental, physical and social health of individuals over time (e.g. Cullati, Burton-Jeangros, & Abel, 2018;Farrington, 2005;Laub & Sampson, 1993). In this respect, sociodemographic factors, life events, but also changes in current malleable outer and inner circumstances may be relevant for changes in aggressive behavior. ...
Article
Full-text available
Background A substantial amount of youths living in youth residential care demonstrate clinical levels of aggression during the course of their placements, which poses a major risk to care continuity. Yet developmental trajectories of aggressive behavior can vary. Objective We investigated if changes in quality of life (QoL), psychopathological symptoms and perceived self-efficacy predict aggressive behavior trajectories in youths with clinical aggression levels living in closed youth residential care in Germany. Method Youths (n=63; 76.2% female; ages 11-17, M=14.4, SD=1.30) answered well-established questionnaires at two data collection points (T1 and T2) over an average of 6.5 months. Professional caregivers rated youths’ aggressiveness in the ‘aggressive behavior’ subscale of the Child Behavior Checklist (CBCL). Two trajectories were retrospectively identified for youths demonstrating aggressive behavior at or above the borderline clinical range – ‘stable-high’ trajectories with persevering aggressive behavior ratings (CBCL T≥67 at T2) and ‘improved’ trajectories with improved aggressive behavior ratings (CBCL T<67 at T2). We conducted binary logistic regression analyses to calculate if changes in self-reported QoL, psychopathology and perceived self-efficacy might predict trajectories of aggressive behavior. Results Youths were more likely to belong to the ‘improved’ than ‘stable-high’ aggressive behavior trajectory if they reported greater QoL improvements in regards to relationship with peers (B=0.89, SE=0.45, p=.014) and managing school requirements (B=0.69, SE=0.69, p=.010), greater reductions in substance use (B=-0.26, SE=0.16, p=.029) and suicide ideation (B=-0.32, SE=0.17, p=.020), as well as improvements in perceived self-efficacy, dependent on initial aggression level (B=0.05, SE=0.03, p=.034). Those with ‘improved’ trajectories were also less likely to experience placement disruptions. Conclusion In light of our exploratory findings, incorporating various life domains into closed residential care plans, focusing on emotion regulation, substance use prevention, and providing an environment that encourages self-efficacy could reduce aggressive behavior and subsequent placement disruptions. Implications for youth welfare policy and future research are discussed.
Chapter
Every individual is endowed with a specific health trajectory during the course of life. Over time, health trajectories are gradually interspersed with the advent of biological faults that the body is not fully able to recover from, on its own, leading to the beginning of an aging trajectory and its sequel, an aging phenome. Molecular biomarkers of health are quantitative measurements of health status by means of analysis of nucleic acids, metabolites and cells in body fluids, scans of organs and assessments of organ function. Health is currently viewed as intrinsic to each age group e.g. the body function of elderlies will not perform equally well as the body of young adults, but older people can still be considered healthy. In contrast, viewing everyone’s health as a collection of basal optimal values of true relevance for optimal body function, established during childhood to early adulthood, specific to each person, and used as a reference point, would allow to determine future health deviations from the individual norm. We here attempt to provide a glimpse to how a state of good health could be maintained by adhering to the individual reference values of personalized molecular biomarkers of health under periodical clinical supervision.
Article
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Background: Social and policy changes in the last several decades have increased women's options for combining paid work with family care. We explored whether specific combinations of work and family care over the lifecourse are associated with variations in women's later life health. Methods: We used sequence analysis to group women in the English Longitudinal Study of Ageing according to their work histories and fertility. Using logistic regression, we tested for group differences in later life disability, depressive symptomology and mortality, while controlling for childhood health and socioeconomic position and a range of adult socio-economic circumstances and health behaviours. Results: Women who transitioned from family care to either part-time work after a short break from the labour force, or to full-time work, reported lower odds of having a disability compared with the reference group of women with children who were mostly employed full-time throughout. Women who shifted from family care to part-time work after a long career break had lower odds of mortality than the reference group. Depressive symptoms were not associated with women's work and family care histories. Conclusion: Women's work histories are predictive of their later life disability and mortality. This relationship may be useful in targeting interventions aimed at improving later life health. Further research is necessary to explore the mechanisms linking certain work histories to poorer later life health and to design interventions for those affected.
Article
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Poor childhood family conditions have a long-term effect on adult mental health, but the mechanisms behind this association are unclear. Our aim was to study the pathways from problematic family relationships in adolescence to midlife psychological distress via disadvantages in early adulthood. Participants of a Finnish cohort study at the age of 16 years old in 1983 were followed up at ages 22, 32 and 42 years old (N = 1334). Problems in family relationships were measured with poor relationship with mother and father, lack of parental support in adolescent’s individuation process and poor home atmosphere, and mental health was assessed using Kessler’s Psychological Distress Scale (K10). We analyzed the indirect effects of adolescent family relations on mental health at age 42 years old via various disadvantages (somatic and psychological symptoms, relationship/marital status, low education/unemployment and heavy drinking) at ages 22 and 32 years old. Problematic adolescent family relationships were associated with midlife psychological distress in women (0.19; 95% CI 0.11, 0.26) and men (0.13; 95% CI 0.04, 0.21). However, after adjustment for adolescent psychological symptoms, the association was only significant for women (0.12; 95% CI 0.04, 0.20). Poor family relationships were associated with various disadvantages in early adulthood. The association from poor family relationships (16 years old) to psychological distress (42 years old) was in part mediated via psychological symptoms in women (0.03; 95% CI 0.01, 0.04) and men (0.02; 95% CI 0.00, 0.04) and in women also via heavy drinking in early adulthood (0.02; 95% CI 0.00, 0.03). Adolescent family relationships have a role in determining adult mental health. Targeted support addressing psychological well-being and hazardous drinking for adolescents with problematic family relationships might prevent disadvantages in early adulthood, and further prevent poor midlife mental health.
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