Social protection, work and family strain: disadvantage effects in US and Europe

描述（由申请人提供）：美国在健康方面正在失去优势：我们在预期寿命方面的排名在欧洲国家中接近垫底，美国和13个欧洲国家的主要慢性病的比较表明，美国的疾病患病率高于任何比较国家。美国女性的预期寿命（LE）分化趋势最为明显，但美国男性预期寿命和婴儿死亡率也表现不佳。健康差距在社会经济弱势群体中最大，但即使受过良好教育的美国人的健康状况也比许多欧洲人差。我们假设，对美国人健康劣势的解释源于二战后美国家庭，尤其是女性所面临的具有挑战性的社会背景。自二战以来，美国社会的特点是：高生育率；女性劳动力市场参与率高；劳动法和家庭保护政策薄弱；家庭不稳定，单亲家庭增加。这些因素的结合或汇合创造了一场“完美风暴”，威胁到脆弱的家庭，甚至对相对有利的家庭也施加了极端的压力。这种社会条件可能通过影响健康行为或通过更直接的生理机制发挥作用。我们已经为这种条件的汇合开发了一个理论框架，该框架建立在工作压力模型的基础上，包含了需求、控制和支持的维度，但增加了一个与家庭相关的重要维度，将压力模型从工作扩展到家庭生活。随着时间的推移，美国人，尤其是女性，经历了全职工作的高要求，往往伴随着高家庭要求，加上低正式支持（社会保护政策）或来自其他家庭成员的非正式支持。这种结合，特别是在工作控制力较弱的工人中，会导致累积的不利因素，随着时间的推移，对健康造成损害。为了了解这些社会条件是否解释了风险的跨地区变化，我们必须了解“风险”的分布和/或毒性是否在不同地区有所不同。我们借鉴了正在进行的研究，包括HRS、SHARE和ELSA，国家一级的死亡率数据（使用人类死亡率文件）以及从CPS、SIPP、SHARELIFE和OECD收集的公共政策数据。我们提出了四个具体目标：目标1：描述1920-1960年出生的女性在美国和欧盟的工作-家庭压力分布。目的2：评估美国和欧洲工作-家庭压力对心血管疾病风险行为和生物标志物、中风和心脏病发病率、心血管疾病死亡率和预期寿命的差异毒性。目的3：评估工作-家庭压力的分布或毒性是否能解释心血管疾病和预期寿命的地理和时间变化。目标4：评估工作-家庭压力趋势对美国和欧洲死亡率社会经济不平等的影响。

DESCRIPTION (provided by applicant): The United States is losing ground in health: our ranking in life expectancy is near the bottom of European countries and comparisons of major chronic conditions in the US and 13 European countries showed the US to have higher disease prevalence than any comparison country. The diverging life expectancy (LE) trends have been most distinct for American women, but the US also fares poorly with regard to male life expectancy and infant mortality. The health gap is largest among socioeconomically disadvantaged groups, but even well- educated Americans have worse health than many of Europeans. We hypothesize that the explanations for the American health disadvantage have roots in the challenging social context faced by families, and in particular women, in post-WWII America. Since WWII, American society has been marked by: high fertility; high female labor market participation; weak labor laws and family protection policies; and family instability, and increased single parenthood. The combination or convergence of these factors created a "perfect storm" that threatened vulnerable families and imposed extreme stresses even on the relatively advantaged. Such social conditions might work via influencing health behaviors or through more direct physiological mechanisms. We have developed a theoretical framework for this confluence of conditions that builds on the job strain models incorporating dimensions of demand, control and support but adds an important dimension related to family that extends the strain model beyond work to family life. Over time Americans, especially women, have experienced high demands in terms of full time work often with high family demands, coupled with low formal support ( social protection policies) or informal support from other family members. This combination especially among workers with low job control leads to a cumulative disadvantage taking its toll in health over time. In order to understand whether these social conditions account for cross area variations in risk we must understand whether either the distribution and/or the toxicity of the "risk" vary across areas. We draw from ongoing studies including HRS, SHARE and ELSA, mortality data at a country level (using the human mortality files) and data on public policies, collected from the CPS,SIPP and SHARELIFE and OECD. We propose 4 specific aims: Aim 1: Describe the distribution of work-family strain for females born 1920-1960, across the US and EU. Aim 2: Assess the differential toxicity of work-family strain on CVD risk behaviors and biomarkers, incidence of stroke and heart disease, CVD mortality, and life expectancy in the US and Europe. Aim 3: Assess whether distributions or the toxicity of work-family strain explain geographic and temporal variations in CVD and life expectancy. Aim 4: Assess impacts of trends in work-family strain on socioeconomic inequalities in mortality in the US and Europe.