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.

Public Health Relevance

With the vast majority of women in the labor force who also have young children and with the aging of societies virtually across the globe, there is an urgent public health need to provide both formal (policy) and informal (family) support to women and their families. Evidence suggests that work family strain has an adverse impact on health outcomes for low wage employees and young children and perhaps other groups. Countries in which a number of work family policies have been implemented seem to fewer adverse population health outcomes. This situation is particularly severe in the US where fertility and labor force participation among women is high and where state and federal policies promoting the health of families is very limited.

National Institute of Health (NIH)
National Institute on Aging (NIA)
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Special Emphasis Panel (ZAG1-ZIJ-3 (M1))
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Patmios, Georgeanne E
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Harvard University
Schools of Public Health
United States
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Moustgaard, Heta; Avendano, Mauricio; Martikainen, Pekka (2018) Parental Unemployment and Offspring Psychotropic Medication Purchases: A Longitudinal Fixed-Effects Analysis of 138,644 Adolescents. Am J Epidemiol 187:1880-1888
Berkman, Lisa F (2018) The trials of trials: RCTs to assess causal questions about social interventions. Eur J Public Health 28:207-208
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Hessel, Philipp; Avendano, Mauricio (2016) Economic downturns during the life-course and late-life health: an analysis of 11 European countries. Eur J Public Health 26:766-771
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Adjaye-Gbewonyo, Kafui; Avendano, Mauricio; Subramanian, S V et al. (2016) Income inequality and depressive symptoms in South Africa: A longitudinal analysis of the National Income Dynamics Study. Health Place 42:37-46
Montez, Jennifer Karas; Zajacova, Anna; Hayward, Mark D (2016) Explaining Inequalities in Women's Mortality between U.S. States. SSM Popul Health 2:561-571
van Hedel, Karen; Mejía-Guevara, Iván; Avendaño, Mauricio et al. (2016) Work-Family Trajectories and the Higher Cardiovascular Risk of American Women Relative to Women in 13 European Countries. Am J Public Health 106:1449-56
Lopez-Arana, Sandra; Avendano, Mauricio; van Lenthe, Frank J et al. (2016) The impact of a conditional cash transfer programme on determinants of child health: evidence from Colombia. Public Health Nutr 19:2629-42
Riina, Elizabeth M; Lippert, Adam; Brooks-Gunn, Jeanne (2016) Residential Instability, Family Support, and Parent-Child Relationships Among Ethnically Diverse Urban Families. J Marriage Fam 78:855-870

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