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Copyright © 2012. Nova Science Publishers, Incorporated. All rights reserved. Social Inequalities, edited by Jeffrey D. Rowsen, and Amanda P. Eliot, Nova Science Publishers, Incorporated, 2012. ProQuest

Copyright © 2012. Nova Science Publishers, Incorporated. All rights reserved. Social Inequalities, edited by Jeffrey D. Rowsen, and Amanda P. Eliot, Nova Science Publishers, Incorporated, 2012.

SOCIAL ISSUES, JUSTICE AND STATUS

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SOCIAL INEQUALITIES

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Social Inequalities, edited by Jeffrey D. Rowsen, and Amanda P. Eliot, Nova Science Publishers, Incorporated, 2012.

SOCIAL ISSUES, JUSTICE AND STATUS

SOCIAL INEQUALITIES

JEFFREY D. ROWSEN Copyright © 2012. Nova Science Publishers, Incorporated. All rights reserved.

AND

AMANDA P. ELIOT EDITORS

Nova Science Publishers, Inc. New York

Social Inequalities, edited by Jeffrey D. Rowsen, and Amanda P. Eliot, Nova Science Publishers, Incorporated, 2012.

Copyright © 2012 by Nova Science Publishers, Inc. All rights reserved. No part of this book may be reproduced, stored in a retrieval system or transmitted in any form or by any means: electronic, electrostatic, magnetic, tape, mechanical photocopying, recording or otherwise without the written permission of the Publisher. For permission to use material from this book please contact us: Telephone 631-231-7269; Fax 631-231-8175 Web Site: http://www.novapublishers.com NOTICE TO THE READER The Publisher has taken reasonable care in the preparation of this book, but makes no expressed or implied warranty of any kind and assumes no responsibility for any errors or omissions. No liability is assumed for incidental or consequential damages in connection with or arising out of information contained in this book. The Publisher shall not be liable for any special, consequential, or exemplary damages resulting, in whole or in part, from the readers‘ use of, or reliance upon, this material. Any parts of this book based on government reports are so indicated and copyright is claimed for those parts to the extent applicable to compilations of such works.

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1. Equality. 2. Social stratification. I. Rowsen, Jeffrey D. II. Eliot, Amanda P. HM821.S636 2011 305--dc23 2011017626

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Social Inequalities, edited by Jeffrey D. Rowsen, and Amanda P. Eliot, Nova Science Publishers, Incorporated, 2012.

CONTENTS Preface Chapter 1

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Chapter 2

Chapter 3

Chapter 4

Chapter 5

vii Socioeconomic and Sex Inequalities in Health of Japanese Civil Servants with International Comparisons: Role of Job Strain, Work Hours and Work-Family Conflicts Michikazu Sekine

1

Sex, Age, and Class Influences on Quality of Life in Chinese Cities Jacky Cheung

45

The Impact of Social Risk Factors on Pregnancy, Childbirth and Postpartum Period: What Should We Know About the Personal Situation of Pregnant Women in Antenatal Care? M. Goeckenjan, B. Ramsauer, N. Ehrenfeld-Lenkiewicz and K. Vetter

83

On the Predictive Validity of Measures of Modern Racism: The Moderating Role of the Salience of Racial Bias Eric Luis Uhlmann, Andrei Nicole Dedoyco Javier and T. Andrew Poehlman

107

Socio-Economic Conditions and Health in Europe: A Comparison Among the 27 EU Countries Enrico Ivaldi and Angela Testi

127

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vi

Contents

Chapter 6

On Social Inequalities Jan Narveson

Chapter 7

Social Inequalities in the Nutritional Status of African Women Michel Garenne

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Index

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151

163 181

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PREFACE Social inequality refers to a situation in which individuals in a society do not have equal social status. Areas of potential social inequality include voting rights, freedom of speech and assembly, the extent of property rights and access to education, health care, quality housing and other social goods. This book presents current research from across the globe in the study of social inequality, including social inequalities in health and their international variations; social stratification by sex, age and social class in Chinese society; the impact of social risk factors on pregnancy, childbirth and the postpartum period; the predictive validity of modern racism and socio-economic conditions and health in Europe. Chapter 1 - Social inequalities in health and their international variations are well known. This review aims to summarize the results from a series of epidemiological studies on social inequalities in health among Japanese civil servants and their international comparisons. In the Japanese civil servants study, there were socioeconomic status (SES) and sex inequalities in job strain, work hours, and work-family conflicts. In general, low SES employees were more likely to have low job control, low job demands, low social support at work, and shift work. In addition, high SES female employees are more likely to have high work-to-family conflict. Women had low job control, high job demands, long work hours, shift work, high work-to-family conflict, and high family-to-work conflict. SES and sex inequalities in poor sleep and poor physical and mental functioning also existed (i.e. the lower the SES, the poorer the health; women had poorer health than men). Such SES and sex inequalities in health reduced considerably after adjustment for job strain, work hours and work-family conflicts. The findings from the authors‘ international comparative studies on British, Finnish and Japanese civil servants indicate

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Jeffrey D. Rowsen and Amanda P. Eliot

that, among Finnish men and women, SES inequalities in psychosocial stress were relatively smaller and work-family balances were better, which lead to somewhat smaller SES inequalities in physical health and rather reverse SES inequalities in mental health. Sex inequalities in low job control, high job demands, and long work hours among Finnish employees were also smaller than among British and Japanese employees, leading Finnish employees to have smaller sex inequalities in physical and mental functioning. These results suggest that SES and sex inequalities in job strain, work hours, and workfamily conflicts are potential determinants of SES and sex inequalities in physical and mental health and their international variations. Universal and egalitarian treatment in Finnish social democratic welfare state regime may play a role in reducing social inequalities in health. However, in the authors‘ comparative studies, the associations of work and family stresses with health risk behaviors were weak and inconsistent. In addition, while there were SES inequalities in health risk behaviors among British and Finnish men and women, such associations were not observed among Japanese men and women. These results suggest that work and family stresses have a limited value in explaining SES inequalities in health through health risk behaviors, particularly among Japanese employees. In conclusion, reducing SES and sex inequalities in job strain, work hours, and work-family conflicts may have beneficial effects on social inequalities in health. Chapter 2 - In theory, social stratification in terms of sex, age, and class can transpire in the contextual influences of the strata on their members. This hypothesis can apply to the effects of collective quality of life on personal quality of life. Gathering survey data from 2,036 working Chinese people in three Chinese cities, Hong Kong, Shanghai, and Taipei, the study examine the hypothesis in order to elucidate social stratification in Chinese societies. Results showed that the collective quality of life of class and age groups predicted the individual group member‘s quality of life. In contrast, the contextual influence of one‘s sex group was not consistent. Besides, the city could function as a geographical stratification factor to affect the inhabitant‘s quality of life. Accordingly, societal quality and opportunity in the city are beneficial to its citizens. Nevertheless, economic development (GDP per capita) did not generally boost life quality among citizens. Chapter 3 - In antenatal care clinical aspects are predominant. Sufficient data exist for the impact of the socioeconomic status of the women on health issues. The quality of intimate partner relationship, emotional aspects concerning family planning and socioeconomic contexts and characteristics are influencing the individual risk for preterm delivery, low birth weight,

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Preface

ix

infections in pregnancy, and postnatal depression. Therefore authors recommend that the gynecologists ask about the personal situation of women due to medical reasons – not only in expected risk situation but also independently of social status, education and ethnicity. Socioeconomic factors are a relevant health risk in Germany as in other countries and should not be neglected. Strategies for effective assessment of the social situation and social interventions are described as essential parts of prenatal care. Preventive strategies can be adapted to the individual situation. Chapter 4 - Modern racism was originally hypothesized to express itself when racial bias is not explicitly salient. More recent dual process models of social attitudes suggest a reconsideration of the circumstances in which modern racism measures will and will not predict relevant judgments and behaviors. From this perspective implicit (i.e., automatic and potentially unconscious) attitudes drive judgments and behaviors individuals are unwilling or unable to consciously monitor, while explicit attitudes drive consciously monitored judgments and behaviors. Although modern racism may constitute a new form of racism distinct from more traditional forms of prejudice, it is nonetheless explicitly about race in America and should therefore predict outcomes best when people are explicitly concerned about showing racial bias. The present meta-analysis found that, consistent with the dual process view, modern racism measures are better predictors of judgments of and behaviors towards Black targets when the potential for racial bias is salient. Implications for Modern Racism Theory and its integration with models of implicit social cognition are discussed. Chapter 5 - Socio-economic conditions are one of the main determinants of health inequalities. The question is still open, however, as to which component of socio-economic status affects health the most and how that relationship should be measured. The aim of this work is to propose an indicator constructed for the European countries highlighting the existing differences in social and economic conditions among the countries surveyed engendering differences in life expectancy. Data are collected from Eurostat and EU-SILC, and, after comparing some methods proposed in the literature, the indicator is applied to classify the 27 EU countries according to differentials in life expectancy at birth. Chapter 6 - Authors are different, we humans. Everyone is different from everyone else. If there are ―natural‖ features of people relevant to their evaluation in various contexts, then there will also be a basis for dividing people into groups along the relevant spectra - the strong, the quick, the dextrous, the brilliant, and so on. In those contexts, it will be plausible to say

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that some people do better, and so, in that sense (only), ―are‖ better, than others in those respects. That some people simply are ―better‖ than others, without reference to context or point, is either meaningless or deployed in the context of ideological claptrap in support of various tyrannies - or, most likely, both. (authors take this to be too obvious to need mention, were it not that there seems no limit to people‘s capacity to misquote out of context in matters like this.) Chapter 7 - The study investigates the social inequalities in female adult nutritional status using empirical data from Africa. The 70 Demographic and Health Surveys (DHS) conducted in 33 countries of sub-Saharan Africa provided the data on anthropometric characteristics of women aged 20-49 years and their household socioeconomic characteristics. Nutritional status was defined by adult height and by the body-mass-index (BMI). Socioeconomic status was defined by an Absolute Wealth Index (AWI) counting the number of modern goods and amenities in the household, on a scale ranging from 0 to 14. On average, African women were 158.7 cm tall and had an average BMI of 22.4 kg/m². Both height and BMI were linearly correlated with AWI. Women living in the poorest households were on average 4.0 cm shorter than women in the wealthiest households, and had a 5.3 kg/m² lower BMI. Major variations were found by urban residence and by large groups of body shape, after controlling for wealth, age and cohort effects. Compared with women in Central and Coastal West Africa, women living in the Sahelian band were taller (+3.2 cm) and thinner (-0.6 kg/m²); women living in Eastern Africa were shorter (-2.4 cm) and fatter (+1.4 kg/m²), and women living in Southern Africa were somewhat taller (+0.8 cm) and fatter (+0.9 kg/m²). These differences seem to be due to a combination of genetic and diet factors and their interactions. These findings are compared with socioeconomic differentials in women anthropometry among European, North-American and Indian women.

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Chapter 1

SOCIOECONOMIC AND SEX INEQUALITIES IN HEALTH OF JAPANESE CIVIL SERVANTS WITH INTERNATIONAL COMPARISONS: ROLE OF JOB STRAIN, WORK HOURS AND WORK-FAMILY CONFLICTS Copyright © 2012. Nova Science Publishers, Incorporated. All rights reserved.

Michikazu Sekine* Department of Welfare Promotion and Epidemiology University of Toyama, Graduate School of Medicine and Pharmaceutical Sciences 2630 Sugitani, Toyama, Japan

ABSTRACT Social inequalities in health and their international variations are well known. This review aims to summarize the results from a series of epidemiological studies on social inequalities in health among Japanese civil servants and their international comparisons. In the Japanese civil servants study, there were socioeconomic status (SES) and sex inequalities in job strain, work hours, and work-family conflicts. In general, low SES employees were more likely to have low job control, low job demands, low social support at work, and shift work. In addition, * TEL: +81-(0)76-434-7272; FAX: +81-(0)76-434-5022 E-mail: [email protected]

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2

Michikazu Sekine high SES female employees are more likely to have high work-to-family conflict. Women had low job control, high job demands, long work hours, shift work, high work-to-family conflict, and high family-to-work conflict. SES and sex inequalities in poor sleep and poor physical and mental functioning also existed (i.e. the lower the SES, the poorer the health; women had poorer health than men). Such SES and sex inequalities in health reduced considerably after adjustment for job strain, work hours and work-family conflicts. The findings from our international comparative studies on British, Finnish and Japanese civil servants indicate that, among Finnish men and women, SES inequalities in psychosocial stress were relatively smaller and work-family balances were better, which lead to somewhat smaller SES inequalities in physical health and rather reverse SES inequalities in mental health. Sex inequalities in low job control, high job demands, and long work hours among Finnish employees were also smaller than among British and Japanese employees, leading Finnish employees to have smaller sex inequalities in physical and mental functioning. These results suggest that SES and sex inequalities in job strain, work hours, and work-family conflicts are potential determinants of SES and sex inequalities in physical and mental health and their international variations. Universal and egalitarian treatment in Finnish social democratic welfare state regime may play a role in reducing social inequalities in health. However, in our comparative studies, the associations of work and family stresses with health risk behaviors were weak and inconsistent. In addition, while there were SES inequalities in health risk behaviors among British and Finnish men and women, such associations were not observed among Japanese men and women. These results suggest that work and family stresses have a limited value in explaining SES inequalities in health through health risk behaviors, particularly among Japanese employees. In conclusion, reducing SES and sex inequalities in job strain, work hours, and work-family conflicts may have beneficial effects on social inequalities in health.

1. INTRODUCTION Social inequalities in mortality rates have widened in several European countries in the last couple of decades, despite overall reductions in mortality rates (Acheson, 1998; Mackenbach et al., 2003; Mackenbach et al., 2008). Mackenbach et al. (2003) reported that, although mortality rates declined in both non-manual and manual workers in 6 western European countries, the rate ratio of mortality rates of manual workers to those of non-manual workers increased. The established coronary risk factors (i.e. cigarette smoking, hypertension, and hypercholesterolemia) were more common in groups of low

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Socioeconomic and Sex Inequalities …

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socioeconomic status (SES)(Marmot et al.,1991) and are potential causes of SES inequalities in health. However, these differences explained no more than one third of the mortality difference among SES groups of British men (Marmot, Shipley, & Rose, 1984). In addition, the international MONICA studies indicated that the international variations in the three established coronary risk factors accounted for less than half of the international variations in coronary heart disease mortality rates (WHO MONICA Project, 1994). As a consequence, other potential risk factors explaining SES inequalities in health, including psychosocial stresses related to working and family life, have been widely investigated (Bosma et al., 1997). It is also well-known that there are sex inequalities in somatic and psychological symptoms. The prevalence of poor perceived health and poor physical health was higher in women than in men (Martikainen et al., 2004). Psychiatric symptoms, including sleep complaints, are more frequently observed among women than men (Lahelma, Martikainen, Rahkonen, & Silventoinen, 1999; Doi, Minowa, Okawa, & Uchiyama, 2000; Doi & Minowa, 2003). Although biological factors, health behaviors, and reporting differences have been suggested as possible explanations for the sex inequalities in health (Verbrugge, 1985), sex inequalities in psychosocial stresses related to working and family life may also be one of the possible explanations for the sex inequalities in health. Meanwhile, the magnitude and patterns of SES and sex inequalities in health change over time and differ among countries. For example, although the mortality rates of non-manual workers were lower than those of manual workers in 9 European countries, the absolute difference in mortality rates between non-manual and manual workers varied among the 9 countries and was the smallest in Sweden (Vagero & Erikson, 1997). A recent study on sex inequalities in depression in 23 European countries showed that depression was more prevalent among women than among men in almost all countries and the sex inequalities were relatively smaller in Nordic countries with no significant differences in Finland (Van de Velde, Bracke, & Levecque, 2010). Navarro and his colleagues provided a conceptual pathway from power resources, through welfare state, labor market, SES and income inequalities and wealth, to health and health inequalities and showed that welfare state and labor markets aimed at reducing social inequalities had better level of population health in wealthy European countries (Navarro, et al., 2006; Borrell, Espelt, Rodríguez-Sanz, & Navarro, 2007). Smaller SES and sex inequalities in working and family life may contribute to smaller social inequalities in health.

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Michikazu Sekine

Japan has enjoyed the consistent improvement in population health and longevity during the post-war periods, which may be attributable to the equalization of economic and educational levels among Japanese people (Marmot & Davey Smith, 1989). Such egalitarian policies originated from a series of reforms under the Allied Occupation which included the dissolution of great financial conglomerates and antitrust policies, agricultural land reforms, labor democratization, tax reforms, and educational reforms for equal opportunity (Tachibanaki, 1998). In addition, universal health care services (e.g. National Insurance System) and social security system may have contributed to the population health. However, after the burst of Japanese bubble economy in 1990‘s, The working and living environments have changed dramatically including the introduction of competitive market principles and a budget reduction in public expenditure on healthcare and welfare services. (Doi, 2008) For example, Japan‘s labor market was characterized by lifetime employment, senioritybased wages/promotion, and low natural rate of unemployment (Flath, 2000). There were strong social cohesion and solidarity. However, after the bubble burst, Japanese society has been facing job insecurity, income inequality, educational inequality, and privatization of public services (Kawachi, Fujisawa, & Takao, 2007). Gini index, a measure of income inequality, increased to 0.32 - 0.34, which is close to that in Britain and much larger than those in Nordic counties (OECD Stat Extracts). SES inequalities in self-rated health and mortality rates have also increased (The Ministry of Health, Labour and Welfare, 2003; Kondo, Subramanian, Kawachi, Takeda, & Yamagata, 2008). Thus, the magnitude and patterns of SES inequalities in health and their underlying mechanisms need to be investigated in Japanese population. We conduct the Japanese civil servants study (the JACS study), an epidemiological study of Japanese public sector employees (Table 1), in collaboration with the British civil servants study (the Whitehall II study) and the Finnish civil servants study (the Helsinki Health Study)(Sekine, Lahelma, & Marmot, 2011). Britain, Finland and Japan are examples of the liberal, social democratic, and conservative welfare state regimes, respectively (Esping-Andersen, 1990; Esping-Andersen, 1999). International comparisons of countries with different welfare state regimes may provide further understanding of how social inequalities in health and their international variations are generated. This review aims to introduce a conceptual framework of the Japanese civil servants study and the international comparative studies, a summary of the findings and their policy implications.

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Table 1. Main Findings on Socioeconomic Status (SES) and Sex Inequalities in Health of Japanese Civil Servants Authors

Main Measures

Main Results

Sekine et al (2006a)

job strain, work hours, domestic roles, work-family conflicts, physical and mental health (SF-36)

Disadvantaged work and family characteristics tended to be accumulated among low grade employees but the magnitude and patterns of the SES inequalities somewhat differed between men and women. In men and women, low job control, high job demands, low social support, short and long work hours, shift work, being unmarried, high family-towork conflict and high work-to-family conflict were independently associated with poor physical and mental functioning In men, the age-adjusted odds ratio (OR) of low grade employees for poor physical functioning was 1.93 in comparison to high grade employees. The grade difference was mildly attenuated, when adjusted for work and family characteristics (OR=1.72). The age-adjusted OR of the low grade employees for poor mental functioning was 1.88. The grade difference was attenuated and no longer significant when adjusted for work and family characteristics (OR=1.51). In women, low grade employees had poor physical and mental functioning but the associations were not significant. (Social Science and Medicine, 63, 430-445)

Table 1. (Continued) Authors

Main Measures

Main Results

Sekine et al (2006b)

sleep quality(PSQI), physical and mental health (SF-36)

In men, high grade employees had better physical and mental health and better sleep quality than low grade employees.

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In women, high grade employees were likely to have better sleep and health than low grade employees but the associations were not linear. (Journal of Public Health, 28, 63-70) Sekine et al (2006c)

job strain, work hours, domestic roles, work-family conflicts, sleep quality(PSQI)

In men and women, low job control, high job demands, low social support, short and long working hours, shift work, being single, high family-to-work conflict and high work-to-family conflict were independently associated with poorer sleep quality. In men, the age-adjusted OR of low grade employees for poor sleep quality was 1.64 in comparison to high grade employees. The difference in sleep was attenuated and no longer significant, when work and family characteristics were adjusted for (OR=1.25). Among women, there was no significant grade difference in sleep. Women tended to have poorer sleep quality than men (the age-adjusted OR=1.75). The gender difference was attenuated and no longer significant when adjustments were made for work and family characteristics (OR=1.04). (Sleep, 29, 206-216)

Authors

Main Measures

Main Results

Sekine et al (2006d)

sleep quality(PSQI), physical and mental health (SF-36), sickness leave, hospital admission.

Poor sleep and health were more prevalent among low grade employees than among high grade employees. Low grade employees were more likely to be absent from work among men, while such associations were not observed among women.

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High grade employees were more likely to be admitted to hospital in the previous year but the associations were not statistically significant. (Complementary Therapies in Medicine, 14, 133-143) Sekine et al (2010)

job strain, work hours, domestic roles, work-family conflicts, physical and mental health (SF-36)

Low employment grade, high demands, long work hours, shift work, being unmarried, having no young children, high family-to-work conflict and high work-to-family conflict were more common among women than among men and were independently associated with poor physical and mental functioning. The age-adjusted ORs of women for poor health functioning were 1.80 for poor physical functioning and 1.77 for poor mental functioning. When adjusted for employment grade and work and family characteristics, the sex differences in health functioning attenuated and were no longer statistically significant (ORs =1.08 for poor physical functioning and 0.96 for poor mental functioning). (Social Science and Medicine, 71, 2091-2099.)

Michikazu Sekine

8 State level

Welfare state regime Liberal (market-based welfare) Conservative (family- and church-based welfare) Social democratic (government-based welfare)

Social policies Labor regulations (full employment policy, etc.) Family policies (parental leave, etc.) Social security (unemployment benefits, etc.) Education, housing, health care (universalism or not) , pensions, etc.

Societal level

Individual level

Corporate governance

Work stress Physical stress Work overtime Psychosocial stress Job strain Effort-reward imbalance Job insecurity

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Community

Biological level

Work-family conflicts Work-to-family conflict Family-to-work conflict

Culture, History

Family stress Spouse role Parental role Child care Elderly care

Behavioral changes Cigarette smoking Heavy drinking Unhealthy food habits Physical inactivity

Pathophysiological changes Psycho-neuro-endocrino-immune network Hypo-thalamo-pituitary system Acute and chronic stress reactions

Health outcomes Physical and psychological problems (e.g. metabolic syndrome, cardiovascular diseases, depression) Population health, Health inequalities

Source: Sekine et al., 2011. Figure 1. Conceptual Pathway from Welfare State Regime, through Physical and Psychosocial Stresses, Work-family Balance and Health Risk Behaviors, to Health Outcomes.

Figure 1 shows a conceptual framework from welfare state regime, through physical and psychosocial stresses, work-family balance and health risk behaviors, to health outcomes in our study (Sekine et al., 2011). Different welfare states provide different social policies such as labor market policies, family-related policies and social security policies, which may affect physical

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Socioeconomic and Sex Inequalities …

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and psychosocial working and family conditions and work-family balance, with modifications by corporate governance, local community and culture and history. Such physical and psychosocial stresses may result in pathophysiological changes directly and indirectly, through behavioral changes, leading to the deterioration in health. In the pathway from social factors to health outcomes, the magnitude and patterns of SES and sex inequalities in physical and psychosocial stress, health risk behaviors and heath may differ among countries with different welfare state regimes, generating the international variations in social inequalities in health. We hypothesize that (1) SES and sex inequalities in work and family characteristics exist; (2) such inequalities contribute to SES and sex inequalities in health; (3) the differences in the magnitude and patterns of SES and sex inequalities in work and family characteristics among countries with different welfare state regimes explain the international variations in SES and sex inequalities in health; (4) the universal and egalitarian policies of social democratic welfare state regime in Finland may have beneficial effect on reducing social inequalities in health.

2. SES AND SEX INEQUALITIES IN JOB STRAIN, WORK HOURS, AND WORK-FAMILY CONFLICTS In post-industrialized society, while physical and chemical stresses at workplace have reduced, psychosocial stresses have increased. In addition, the present work characteristics at public sector are, more or less, influenced by the ideas of the New Public Management, which implements management practices found in private sectors. The NPM was first introduced for the UK government reforms in 1980‘s. The organizational reforms include the reduction in the number of employees for improving efficiency and the change in the corporate governance with a strong emphasis on higher decision latitudes and responsibilities of top management (Hood, 1991). These are more result-oriented, leading to higher psychological strain for employees (Noblet, Rodwell, & McWilliams, 2006). Among various psychosocial work stresses, low job control, high job demands, and low social support at work are considered to be stressful (Karasek, 1979) and are associated with an increased risk for health risk behaviors (Lallukka et al., 2008), metabolic syndrome (Chandola, Brunner, & Marmot, 2006), coronary heart diseases (Bosma et al., 1997), musculoskeletal

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Michikazu Sekine

diseases (Hoogendoorn, van Poppel, Bongers, Koes, & Bouter, 2000), and depression (Paterniti, Niedhammer, Lang, & Consoli, 2002). In addition, working overtime was associated with poor perceived general health, cardiovascular diseases, injuries, health risk behaviors, and increased mortality (Caruso, Hitchcock, Dick, Russo, & Schmit, 2004). In the Whitehall II study, there were SES inequalities in such psychosocial work stresses (Marmot et al., 1991), and the SES inequalities explained some of SES inequalities in long spells of sick leave (North et al., 1993). Family life is another important component of adult life. Employed men and women occupy multiple roles as employee, spouse, caregiver and parent. These multiple roles can be hypothesized to have a health-promoting or health-damaging impact (Martikainen, 1995; Chandola, et al., 2004). It has been reported that both high work-to-family conflict and family-to-work conflict are associated with anxiety disorder, depression, and poor physical health (Frone, Russell, & Lynne Cooper, 1997; Frone, 2000). SES inequalities in work characteristics potentially influence on SES inequalities in family life and work-family conflicts, which may result in SES inequalities in health. Figure 2 shows the age-adjusted SES inequalities in job strain, work hours, and work-family conflicts of Japanese civil servants (Sekine, Chandola, Martikainen, Marmot, & Kagamimori, 2006a). Job strain and work-family conflicts were evaluated by job demand-control-support model (Karasek, 1989; Bosma et al., 1997) and work-to-family conflict and family-to-work conflict measures (Grzywacz & Marks, 2000; Chandola et al., 2004) (Appendixes 1 and 2). Low employment grade (i.e. low SES) was associated with low control and low demands at work. Low grade employees were also likely to have low social support but this association was significant only for men. There was no significant grade difference in long work hours among men, whereas high grade female employees had longer work hours. While high grade male employees tended to be married, high grade female employees tended to be unmarried. No significant grade difference in raising young children was found among men and women. While there were no significant grade differences in family-to-work conflict in men and women, high grade female employees were likely to have high work-to-family conflict. These results suggest that some of the disadvantaged work and family characteristics tend to be accumulated among low SES individuals but the magnitude and patterns of SES inequalities in work and family characteristics somewhat differ between men and women (i.e. high grade female employees had both health-promoting and health-damaging work and family characteristics.).

Social Inequalities, edited by Jeffrey D. Rowsen, and Amanda P. Eliot, Nova Science Publishers, Incorporated, 2012.

Socioeconomic and Sex Inequalities … *

*

*

39.9

40

11

37.0 35.7 34.4

+

30.9

31.3 28.2 27.7 25.8 20.9

24.0 21.5

25.5 18.6 20.8

19.6

20

17.0

8.4

0 low control

high dem ands

low support

grade I ( n = 378 )

long w ork hours

grade II （n = 513 )

high f-w conflict

high w -f conflict

grade III ( n = 1634 )

(i) Men (n=2525) (%) 100.0

100

*

*

91.8 *

80

72.2 *

56.9

60 44.3

35.0

40

Copyright © 2012. Nova Science Publishers, Incorporated. All rights reserved.

50.3

48.2 36.3

45.6 43.4

41.4

31.5

32.4

28.0

15.5

20

13.5 0.0

0 low control

high dem ands

low support

grade I ( n = 20 )

long w ork hours

grade II （n = 171 )

high f-w conflict

high w -f conflict

grade III ( n = 1071 )

(ii) Women (n=1262) (%) Abbreviations: *: p