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Social inequalities over the lifecourse and healthy ageing in Aotearoa/New Zealand: differences by Māori ethnicity and gender

Published online by Cambridge University Press:  01 September 2020

Christine Stephens Open the ORCID record for Christine Stephens [Opens in a new window] ,
Ágnes Szabó  and
Mary Breheny Open the ORCID record for Mary Breheny [Opens in a new window]
Christine Stephens*
Affiliation:
School of Psychology, Massey University, Palmerston North, New Zealand
Ágnes Szabó
Affiliation:
School of Health Sciences, Massey University, Palmerston North, New Zealand School of Health, Victoria University of Wellington, Wellington, New Zealand
Mary Breheny
Affiliation:
School of Health Sciences, Massey University, Palmerston North, New Zealand
*
*Corresponding author. Email: c.v.stephens@massey.ac.nz
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Abstract

Lifecourse approaches to healthy ageing recognise that health in older age is affected by long-term cumulative inequalities between socio-economic status (SES), gender and ethnicity groups, which begin in childhood. Combining longitudinal survey data with lifecourse history interviews from 729 older New Zealanders aged 61–81 (mean = 72, standard deviation = 4.5), we tested a lifecourse model of predictors of physical, mental and social health in older age. Latent growth curve and mediation analysis showed that the link between childhood SES and late-life health (over 10 years) was mediated by education, occupation and adult wealth. To account for the moderating effects of gender and ethnicity, we modelled the effects for sub-groups separately (225 non-Māori women, 158 Māori women, 219 non-Māori men and 127 Māori men). Childhood SES was an important predictor of later-life health, mediated by education and adult SES for all participants and for non-Māori men. However, there were significantly different pathways for Māori men and for women. Māori men and women and non-Māori women did not attain the same health benefits from higher childhood SES and education as non-Māori men. Findings point to the importance of considering the mediators of lifelong impacts on health in older age, and recognition of how membership of different socially structured groups produces different pathways to late-life health.

Keywords

lifecourseinequalitieshealthchildhood socio-economic statusNew Zealand Māori
Type
Article
Information
Ageing & Society , Volume 42 , Issue 4 , April 2022 , pp. 745 - 764
Copyright
Copyright © The Author(s), 2020. Published by Cambridge University Press

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References

Agahi, N, Shaw, BA and Fors, S (2014) Social and economic conditions in childhood and the progression of functional health problems from midlife into old age. Journal of Epidemiology and Community Health 68, 734–740.10.1136/jech-2013-203698CrossRefGoogle ScholarPubMed
Anderson, I, Crengle, S, Kamaka, ML, Chen, T-H, Palafox, N and Jackson-Pulver, L (2006) Indigenous health in Australia, New Zealand, and the Pacific. The Lancet 367, 1775–1785.10.1016/S0140-6736(06)68773-4CrossRefGoogle ScholarPubMed
Ball, K (2015) Traversing myths and mountains: addressing socioeconomic inequities in the promotion of nutrition and physical activity behaviours. International Journal of Behavioral Nutrition and Physical Activity 12, 1–7.10.1186/s12966-015-0303-4CrossRefGoogle ScholarPubMed
Beard, JR and Bloom, DE (2015) Towards a comprehensive public health response to population ageing. The Lancet 385, 658–661.10.1016/S0140-6736(14)61461-6CrossRefGoogle ScholarPubMed
Bécares, L (2015) Which ethnic groups have the poorest health? In Jivraj, S and Simpson, L (eds), Ethnic Identity and Inequalities in Britain. The Dynamics of Diversity. London: Policy Press, pp. 123–140.10.2307/j.ctt1t89504.14CrossRefGoogle Scholar
Beck, A, Franz, CE, Xian, H, Vuoksimaa, E, Tu, X, Reynolds, CA, Panizzon MS, McKenzie RM, Lyons MJ, Toomey R, Jacobson KC, Hauger RL, Hatton SN, Kremen, WS (2018) Mediators of the effect of childhood socioeconomic status on late midlife cognitive abilities: a four decade longitudinal study. Innovation in Aging 2, igy003.10.1093/geroni/igy003CrossRefGoogle ScholarPubMed
Ben, J, Cormack, D, Harris, R and Paradies, Y (2017) Racism and health service utilisation: a systematic review and meta-analysis. PLOS ONE 12, e0189900.10.1371/journal.pone.0189900CrossRefGoogle ScholarPubMed
Brandt, M, Deindl, C and Hank, K (2012) Tracing the origins of successful aging: the role of childhood conditions and social inequality in explaining later life health. Social Science and Medicine 74, 1418–1425.10.1016/j.socscimed.2012.01.004CrossRefGoogle ScholarPubMed
Brown, TH (2018) Racial stratification, immigration, and health inequality: a life course-intersectional approach. Social Forces 96, 1507–1540.10.1093/sf/soy013CrossRefGoogle Scholar
Brown, TH, Richardson, LJ, Hargrove, TW and Thomas, CS (2016) Using multiple-hierarchy stratification and life course approaches to understand health inequalities: the intersecting consequences of ethnicity, gender, SES, and age. Journal of Health and Social Behavior 57, 200–222.10.1177/0022146516645165CrossRefGoogle ScholarPubMed
Calasanti, T (2007) Bodacious berry, potency wood and the aging monster: gender and age relations in anti-aging ads. Social Forces 86, 335–355.10.1353/sof.2007.0091CrossRefGoogle Scholar
Calasanti, T and Zajicek, AM (1993) A socialist-feminist approach to aging: embracing diversity. Journal of Aging Studies 7, 117–131.10.1016/0890-4065(93)90029-JCrossRefGoogle Scholar
Chandola, T, Ferrie, J, Sacker, A and Marmot, M (2007) Social inequalities in self reported health in early old age: follow-up of prospective cohort study. BMJ 334, 990.10.1136/bmj.39167.439792.55CrossRefGoogle ScholarPubMed
Conger, RD, Conger, KJ and Martin, MJ (2010) Socioeconomic status, family processes, and individual development. Journal of Marriage and Family 72, 685–704.10.1111/j.1741-3737.2010.00725.xCrossRefGoogle ScholarPubMed
Corna, LM (2013) A life course perspective on socioeconomic inequalities in health: a critical review of conceptual frameworks. Advances in Life Course Research 18, 150–159.10.1016/j.alcr.2013.01.002CrossRefGoogle ScholarPubMed
Cosco, TD, Hardy, R, Howe, LD and Richards, M (2018) Early-life adversity, later-life mental health, and resilience resources: a longitudinal population-based birth cohort analysis. International Psychogeriatrics 31, 1249–1258.10.1017/S1041610218001795CrossRefGoogle Scholar
Crystal, S, Shea, DG and Reyes, AM (2016) Cumulative advantage, cumulative disadvantage, and evolving patterns of late-life inequality. The Gerontologist 57, 910–920.Google Scholar
Cutrona, CE and Russell, DW (1987) The provisions of social relationships and adaptation to stress. Advances in Personal Relationships 1, 37–67.Google Scholar
Dannefer, D (2003) Cumulative advantage/disadvantage and the life course: cross-fertilizing age and social science theory. Journals of Gerontology: Psychological Sciences and Social Sciences 58B, S327–S337.10.1093/geronb/58.6.S327CrossRefGoogle Scholar
Duncan, TE and Duncan, SC (2009) The ABC’s of LGM: An introductory guide to latent variable growth curve modeling. Social and Personality Psychology Compass 3, 979–991.10.1111/j.1751-9004.2009.00224.xCrossRefGoogle ScholarPubMed
Estes, CL, Biggs, S and Phillipson, C (2003) Social Theory, Social Policy and Ageing. A Critical Introduction. Maidenhead, UK: Open University Press.Google Scholar
Ferraro, KF, Schafer, MH and Wilkinson, LR (2016) Childhood disadvantage and health problems in middle and later life: early imprints on physical health? American Sociological Review 81, 107–133.10.1177/0003122415619617CrossRefGoogle ScholarPubMed
Fleras, A (1985) Towards ‘Tu Tangata’: historical developments and current trends in Maori policy and administration. Political Science 37, 18–39.10.1177/003231878503700102CrossRefGoogle Scholar
Flores, M and Kalwij, A (2014) The associations between early life circumstances and later life health and employment in Europe. Empirical Economics 47, 1251–1282.10.1007/s00181-013-0785-3CrossRefGoogle Scholar
Frieling, MA, Davis, WR and Chiang, G (2013) The SF-36v2 and SF-12v2 health surveys in New Zealand: norms, scoring coefficients and cross-country comparisons. Australian and New Zealand Journal of Public Health 37, 24–31.10.1111/1753-6405.12006CrossRefGoogle ScholarPubMed
Fritze, T, Doblhammer, G and van den Berg, GJ (2014) Can individual conditions during childhood mediate or moderate the long-term cognitive effects of poor economic environments at birth? Social Science and Medicine 119, 240–248.10.1016/j.socscimed.2014.07.011CrossRefGoogle ScholarPubMed
Gasper, D and van Staveren, I (2003) Development as freedom – and as what else? Feminist Economics 9, 137–161.10.1080/1354570032000078663CrossRefGoogle Scholar
Geiser, C (2013) Data Analysis with Mplus. New York, NY: Guilford.Google Scholar
Greenfield, EA and Moorman, SM (2018) Childhood socioeconomic status and later life cognition: evidence from the Wisconsin Longitudinal Study. Journal of Aging and Health 31, 1589–1615.10.1177/0898264318783489CrossRefGoogle ScholarPubMed
Gruenewald, TL, Karlamangla, AS, Hu, P, Stein-Merkin, S, Crandall, C, Koretz, B and Seeman, TE (2012) History of socioeconomic disadvantage and allostatic load in later life. Social Science and Medicine 74, 75–83.10.1016/j.socscimed.2011.09.037CrossRefGoogle ScholarPubMed
Hämmig, O and Bauer, GF (2013) The social gradient in work and health: a cross-sectional study exploring the relationship between working conditions and health inequalities. BMC Public Health 13, 1170.10.1186/1471-2458-13-1170CrossRefGoogle ScholarPubMed
Harris, R, Cormack, D, Stanley, J, Curtis, E, Jones, R and Lacey, C (2018) Ethnic bias and clinical decision-making among New Zealand medical students: an observational study. BMC Medical Education 18, 18.10.1186/s12909-018-1120-7CrossRefGoogle ScholarPubMed
Hayward, MD and Gorman, BK (2004) The long arm of childhood: the influence of early-life social conditions on men's mortality. Demography 41, 87–107.10.1353/dem.2004.0005CrossRefGoogle Scholar
Hinze, SW, Lin, J and Andersson, TE (2012) Can we capture the intersections? Older Black women, education, and health. Women's Health Issues 22, e91–e98.10.1016/j.whi.2011.08.002CrossRefGoogle Scholar
Hoffmann, R, Kröger, H and Pakpahan, E (2018) Pathways between socioeconomic status and health: does health selection or social causation dominate in Europe? Advances in Life Course Research 36, 23–36.10.1016/j.alcr.2018.02.002CrossRefGoogle Scholar
Hooyman, N, Browne, CV, Ray, R and Richardson, V (2002) Feminist gerontology and the life course. Gerontology and Geriatrics Education 22, 3–26.10.1300/J021v22n04_02CrossRefGoogle Scholar
Jatrana, S and Blakely, T (2008) Ethnic inequalities in mortality among the elderly in New Zealand. Australian and New Zealand Journal of Public Health 32, 437–443.10.1111/j.1753-6405.2008.00276.xCrossRefGoogle ScholarPubMed
Jemal, A, Thun, M, Ward, E, Henley, S, Vilma, C and Murray, T (2008) Mortality from leading causes by education and race in the United States, 2001. American Journal of Preventive Medicine 34, 1–8.10.1016/j.amepre.2007.09.017CrossRefGoogle ScholarPubMed
Jones, D (2006) The persistence of American Indian health disparities. American Journal of Public Health 96, 2122–2134.10.2105/AJPH.2004.054262CrossRefGoogle ScholarPubMed
Kaikkonen, JE, Mikkilä, V, Magnussen, CG, Juonala, M, Viikari, JS and Raitakari, OT (2013) Does childhood nutrition influence adult cardiovascular disease risk? Insights from the Young Finns Study. Annals of Medicine 45, 120–128.10.3109/07853890.2012.671537CrossRefGoogle ScholarPubMed
Karlsen, S, Bécares, L and Roth, M (2012) Understanding the influence of ethnicity on health. In Craig, G, Atkin, K, Chattoo, S and Flynn, R (eds), Understanding ‘Race’ and Ethnicity. London: Policy Press, pp. 115–32.Google Scholar
Kok, AA, Aartsen, MJ, Deeg, DJ and Huisman, M (2017) The effects of life events and socioeconomic position in childhood and adulthood on successful aging. Journals of Gerontology: Psychological Sciences and Social Sciences 72B, 268–278.Google Scholar
Kuh, D, Richards, M, Cooper, R, Hardy, R and Ben-Shlomo, Y (2014) Life course epidemiology, ageing research and maturing cohort studies: a dynamic combination for understanding healthy ageing. In Kuh, D, Cooper, R, Hardy, R, Richards, M and Ben-Shlomo, Y (eds), A Life Course Approach to Healthy Ageing. Oxford: Oxford University Press, pp. 3–15.Google ScholarPubMed
Lahelma, E, Pietiläinen, O, Chandola, T, Hyde, M, Rahkonen, O and Lallukka, T (2019) Occupational social class trajectories in physical functioning among employed women from midlife to retirement. BMC Public Health 19, 1525.10.1186/s12889-019-7880-0CrossRefGoogle Scholar
Lynch, SM and Brown, JS (2011) Stratification and inequality over the life course. In Binstock, A and George, L (eds), Handbook of Aging and the Social Sciences, 7th Edn. Oxford: Elsevier, pp. 105–117.10.1016/B978-0-12-380880-6.00008-3CrossRefGoogle Scholar
Marengoni, A, Angleman, S, Melis, R, Mangialasche, F, Karp, A, Garmen, A, Meinow, B and Fratiglioni, L (2011) Aging with multimorbidity: a systematic review of the literature. Ageing Research Reviews 10, 430–439.10.1016/j.arr.2011.03.003CrossRefGoogle ScholarPubMed
Marmot, M (2004) Status Syndrome: How Social Standing Directly Affects Your Health and Life Expectancy. London: Bloomsbury 10.1111/j.1740-9713.2004.00058.xCrossRefGoogle Scholar
Mazzonna, F (2014) The long-lasting effects of family background: a European cross-country comparison. Economics of Education Review 40, 25–42.10.1016/j.econedurev.2013.11.010CrossRefGoogle Scholar
Moody, HR (2006) Aging: Concepts and Controversies. Thousand Oaks, CA: Pine Forge Press.Google Scholar
Moorman, SM, Carr, K and Greenfield, EA (2018) Childhood socioeconomic status and genetic risk for poorer cognition in later life. Social Science and Medicine 212, 219–226.10.1016/j.socscimed.2018.07.025CrossRefGoogle ScholarPubMed
Muthén, LK and Muthén, BO (2017) Mplus User's Guide, 8th Edn. Los Angeles, CA: Muthén and Muthén.Google Scholar
Nurius, PS, Fleming, CM and Brindle, E (2019) Life course pathways from adverse childhood experiences to adult physical health: a structural equation model. Journal of Aging and Health 31, 211–230.10.1177/0898264317726448CrossRefGoogle ScholarPubMed
Perry, B (2015) The Material Wellbeing of New Zealand Households: Trends and Relativities Using Non-income Measures, with International Comparisons. Wellington: Ministry of Social Development.Google Scholar
Ranzijn, R (2010) Active ageing – another way to oppress marginalized and disadvantaged elders?: Aboriginal elders as a case study. Journal of Health Psychology 15, 716–723.10.1177/1359105310368181CrossRefGoogle ScholarPubMed
Read, JNG and Gorman, BK (2006) Gender inequalities in US adult health: the interplay of race and ethnicity. Social Science and Medicine 62, 1045–1065.10.1016/j.socscimed.2005.07.009CrossRefGoogle ScholarPubMed
Sadana, R, Blas, E, Budhwani, S, Koller, T and Paraje, G (2016) Healthy ageing: raising awareness of inequalities, determinants, and what could be done to improve health equity. The Gerontologist 56, S178–S193.10.1093/geront/gnw034CrossRefGoogle ScholarPubMed
Schaan, B (2014) The interaction of family background and personal education on depressive symptoms in later life. Social Science and Medicine 102, 94–102.10.1016/j.socscimed.2013.11.049CrossRefGoogle ScholarPubMed
Schafer, MH and Ferraro, KF (2011) Distal and variably proximal causes: Education, obesity, and health. Social Science & Medicine 73, 1340–1348.10.1016/j.socscimed.2011.08.010CrossRefGoogle Scholar
Shuey, KM and Willson, AE (2008) Cumulative disadvantage and black–white disparities in life-course health trajectories. Research on Aging 30, 200–225.10.1177/0164027507311151CrossRefGoogle Scholar
Stephens, C (2017) From success to capability for healthy ageing: shifting the lens to include all older people. Critical Public Health 27, 490–498.10.1080/09581596.2016.1192583CrossRefGoogle Scholar
Stephens, C and Breheny, M (2018) Healthy Ageing: A Capability Approach to Inclusive Policy and Practice. London: Routledge.CrossRefGoogle Scholar
Stephens, C, Breheny, M and Mansvelt, J (2015) Healthy ageing from the perspective of older people: A capability approach to resilience. Psychology & Health 30, 715–731.10.1080/08870446.2014.904862CrossRefGoogle ScholarPubMed
Stoller, E and Gibson, R (2000) Advantages of using the life course framework in studying aging. In Stoller, E and Gibson, R (eds), Worlds of Difference: Inequality in the Aging Experience. Thousand Oaks, CA: Pine Forge Press, pp. 19–32.10.4135/9781483328539CrossRefGoogle Scholar
Szabó, Á, Allen, J, Stephens, C and Alpass, F (2019) Is retirement associated with physical health benefits? A longitudinal investigation with older New Zealanders. Age and Ageing 48, 267–272.10.1093/ageing/afy176CrossRefGoogle ScholarPubMed
Tabachnick, BG and Fidell, LS (2007) Using Multivariate Statistics. Boston, MA: Allyn and Bacon/Pearson Education.Google Scholar
Tobias, M, Blakely, T, Matheson, D, Rasanathan, K and Atkinson, J (2009) Changing trends in indigenous inequalities in mortality: lessons from New Zealand. International Journal of Epidemiology 38, 1711–1722.CrossRefGoogle ScholarPubMed
Townsend, P and Davidson, N (1982) Inequalities in Health: The Black Report. Harmondsworth, UK: Penguin.Google Scholar
van Doorslaer, E and Koolman, X (2004) Explaining the differences in income-related health inequalities across European countries. Health Economics 13, 609–628.10.1002/hec.918CrossRefGoogle ScholarPubMed
Victor, C (2010) Ageing, Health and Care. Bristol, UK: Policy Press.10.2307/j.ctt1t89bvgCrossRefGoogle Scholar
Wahrendorf, M (2015) Previous employment histories and quality of life in older ages: sequence analyses using SHARELIFE. Ageing & Society 35, 1928–1959.10.1017/S0144686X14000713CrossRefGoogle Scholar
Wahrendorf, M, Blane, D, Bartley, M, Dragano, N and Siegrist, J (2013) Working conditions in mid-life and mental health in older ages. Advances in Life Course Research 18, 16–25.10.1016/j.alcr.2012.10.004CrossRefGoogle ScholarPubMed
Walker, A (2009) Why is ageing so unequal? In Cann, P and Dean, M (eds), Unequal Ageing. Bristol, UK: Policy Press.pp.141-158.Google Scholar
Walker, A (2013) Active ageing: a policy for all ages? Paper presented at the 20th IAGG World Congress of Gerontology and Geriatrics, Seoul, June.Google Scholar
Ware, JE, Keller, SD and Kosinski, M (1998) SF-12: How to Score the SF-12 Physical and Mental Health Summary Scales. Available at www.researchgate.net/publication/242636950_SF-12_How_to_Score_the_SF-12_Physical_and_Mental_Health_Summary_Scales.Google Scholar
West, SG, Taylor, AB and Wu, W (2012) Model fit and model selection in structural equation modeling. In Hoyle, RH (ed.), Handbook of Structural Equation Modeling. New York, NY: Guilford, pp. 209–231.Google Scholar
Wilkinson, RG (2005) The Impact of Inequality: How to Make Sick Societies Healthier. London: Routledge.Google Scholar
Woodward, A and Blakely, T (2014) The Healthy Country. Auckland: Auckland University Press.Google Scholar
World Health Organisation (1948) Constitution of the World Health Organization. Available at http://www.who.int/about/mission/en/Google Scholar
Zhang, Z, Hayward, MD and Yu, YL (2016) Life course pathways to racial disparities in cognitive impairment among older Americans. Journal of Health and Social Behavior 57, 184–199.10.1177/0022146516645925CrossRefGoogle ScholarPubMed
Zimmer, Z, Hanson, H and Smith, K (2016) Childhood socioeconomic status, adult socioeconomic status, and old-age health trajectories: connecting early, middle, and late life. Demographic Research 34, 285–320.10.4054/DemRes.2016.34.10CrossRefGoogle Scholar