Background: This paper seeks to examine changes in health inequalities in Finland from the mid-1980s to the mid-1990s. To improve our understanding of the contribution of employment status changes to class and educational differences in health within the context of changing labour market conditions, we examined the differences in ill health among social classes, educational groups, and employment status groups.
Methods: The data was derived from nation-wide Finnish Surveys on Living Conditions from 1986 and 1994. Analyses included the age range 25- 64 years. Health was measured using limiting long-standing illness and perceived health as below good. Results are presented as age-standardized prevalence percentages and odds ratios from logistic regression analyses.
Results: The pattern and size of relative social inequalities in ill health have remained generally stable during the eight-year study period in Finland. Differences between social classes have changed only slightly. Differences between educational groups have declined somewhat among men, but have remained stable among women. Compared with the employed, health among the unemployed, housewives, and pensioners has improved for both men and women. Analysing social class differences within both the employed and the non-employed showed only negligible changes.
Conclusions: Changes in social inequalities in health as indicated by class and educational differentials among Finnish men and women have mostly been negligible. The observed changes are likely to have been affected by the 1990s' labour market crisis in Finland. The rapidly increasing mass unemployment is unlikely to have been very individually selective in the short run. However, in the longer run, to the extent that unemployment remains high, this trend can be expected to change as re-entry to paid employment is likely to be more individually selective.
Marklund S., Nordlund A.Economic problems, welfare convergence and political instability. In: Kautto M, Heikkilä M, Hvinden B, Marklund S, Ploug N, editors. Nordic social policy. London: Routledge, 1999: 19- 53.
2.
Lee DJ, Turner BSConfl icts about class. Debating inequality in late industrialism . New York: Longman, 1996.
3.
Beck U., Giddens A., Lash S.Refl exive modernization. Politics, tradition and aesthetics in the modern social order. Cambridge: Polity Press, 1994.
4.
Kadushin C.Social class and the experience of ill health. Sociol Inquiry1966; 34: 67- 80.
5.
Fox J, editor. Health inequalities in European countries. Aldershot: Gower, 1989.
6.
Illsley R, Svensson P-G, editors. Health inequities in Europe. Soc Sci Med1990; 31: 223-420 (Special Issue).
7.
Lahelma E, Rahkonen O, editors. Health inequalities in modern societies and beyond. Soc Sci Med1997; 44: 721-910 (Special Issue).
8.
Vogel, J.Social report for the Nordic countries. Living conditions and inequality in the late 1980s. Copenhagen: Statistical Report of the Nordic Countries55, 1991.
9.
Lahelma E., Manderbacka K., Rahkonen O., Sihvonen A-P.Ill-health and its social patterning in Finland, Norway and Sweden . Helsinki: Stakes, Research Reports27, 1993 .
10.
Lundberg O.Orsaker till klasskillnader i sjuklighet (Causes of class differences in morbidity). SosiaallääketieteellinenAikakauslehti1990 ; 27: 23-42. (In Swedish.)
11.
Lahelma E., Rahkonen O., Huuhka M.Changes in the social patterning of health? The case of Finland. Soc Sci Med1997; 44: 789-99.
12.
Dahl E., Birkelund GESysselsettning, klasse og helse 1980-1995. En analyse av fem norske levekårsundersökelser (Employment, class and health 1980-1995 ) . Tidsskr Samfunnsforskning1999; 40: 3- 32. (In Norwegian.)
13.
Elstad JIInequalities in health related to women's marital, parental, and employment status - a comparison between the early 1970s and the late 1980s, Norway. Soc Sci Med1996; 42: 75-89.
14.
Elstad JIHow large are the differences - really? Self-reported long-standing illness among working class and middle class men. Sociol Health Illn1996; 18: 475-98.
15.
Moss N., Kjoeller M., Rasmussen NKSocioeconomic differences in longstanding illness, perceived health and health related labour market mobility in Denmark, 1998 [manuscript].
16.
Statistics Finland, 1998. http://www.stat.fi
17.
Kautto M.Changes in age structure, family stability and dependency. In: Kautto M, Heikkilä M, Hvinden B, Marklund S, Ploug N, editors. Nordic social policy . London: Routledge, 1999: 54- 78.
18.
Alestalo M., Uusitalo H.Finland. In: Flora P, editor. Growth to limits, Vol. 1. Berlin : Walter de Gruyter, 1986 : 197-292.
Anttalainen M-L.Sukupuolen mukaan kahtiajakautuneet työmarkkinat Pohjoismaissa (Gender segregated labour markets in the Nordic countries). Helsinki: Tasaarvoasiain neuvottelukunta, Naistutkimusmonisteita1: 1986. (In Finnish.)
21.
Statistics Finland.Labour force statistics. Helsinki: Official Statistics of Finland, Labour Market, 1994: No 13.
22.
Rubery J., Smith M., Fagan C.Women and European employment. London: Routledge, 1997.
23.
Santamäki-Vuori T.Pitkäaikaistyöttömien työmarkkinakokemukset lamavuosina 1993- 1994 (The labour market experiences among the long-term unemployed during the recession years 1993- 1994) . Työpoliittinen tutkimus nro 131. Helsinki: Työministeriö , 1996. (In Finnish.)
24.
Uusitalo H.Four years of recession: what happened to income distribution. In: Heikkilä M, Uusitalo H, editors. The cost of cuts. Studies on cutbacks in social security and their effects in the Finland of the 1990s. Helsinki: National Research and Development Centre for Welfare and Health, 1997: 101-18.
25.
Fritzell J.Changes in the social patterning of living conditions. In: Kautto M, Heikkilä M, Hvinden B, Marklund S, Ploug N, editors. Nordic social policy . London: Routledge, 1999: 159-84.
26.
Ploug N.Cuts in and reform of the Nordic cash benefit systems. In: Kautto M, Heikkilä M, Hvinden B, Marklund S, Ploug N, editors. Nordic social policy . London: Routledge, 1999: 79- 103.
27.
Heikkilä M., Hvinden B., Kautto M., Marklund S., Uusitalo H.Conclusion: the Nordic model stands stable but on shaky ground. In: Kautto M, Heikkilä M, Hvinden B, Marklund S, Ploug N, editors. Nordic social policy . London: Routledge, 1999: 262-73.
28.
Allardt E.Filosofinen ja sosiologinen hyvää elämää koskeva keskustelu sosioekonomisen terveystutkimuksen kannalta (Philosophical and sociological debate on good life and its relevance to health research). Sosiaalilääketieteellinen Aikakauslehti1999; 36: 203-12. (In Finnish.)
29.
Roos JPLife stories of social change: four generations in Finland. Int J Oral History1985; 6: 179-90.
30.
Abel T.Measuring health lifestyles in a comparative analysis: theoretical issues and empirical findings. Soc Sci Med1991; 32: 899-908.
31.
Lahelma E., Rahkonen O., Berg M-A., Helakorpi S., Prättälä R., Puska P., et al. Changes in the health status and health behaviour among Finnish adults. Scand J Work Environ Health1997; 23 (suppl): 85-90.
32.
Roos E., Prättälä R., Lahelma E., Kleemola P., Pietinen P.Modern and healthy? Socioeconomic differences in the quality of diet . Eur J Clin Nutr1996; 44: 753- 60.
33.
Townsend P., Davidson N.Inequalities in health. The Black Report. Harmondsworth : Penguin Books, 1982.
34.
Cavelaars A. , Kunst A., Geurts J., Crialesi R., Grötvedt L., Helmert U., et al. Differences in self reported morbidity by educational level: A comparison of 11 Western European countries. J Epidemiol Community Health1998; 52: 219-27.
35.
Mackenbach J., Kunst A., Cavelaars A., Groenhof F., Geurts J., and the EU WorkingGroup on Socioeconomic Inequalities in Health. Socioeconomic inequalities in morbidity and mortality in western Europe. Lancet1997; 349: 1655-9.
36.
Valkonen T., Martelin T., Rimpelä A., Notkola V., Savela S.Socio-economic mortality differences in Finland 1981-90. Helsinki: Statistics Finland, Population, 1993: 1.
37.
Martikainen P., Valkonen T.Lama ja ennenaikainen kuolleisuus (Economic recession and premature death). Helsinki: Statistics Finland, Population, 1995: 11. (In Finnish.)
38.
Valkonen T., Jalovaara M.Kuolleisuus koulutusasteen mukaan 1987- 95 (Mortality by level of education 1987- 95 ) . Causes of death. Helsinki: Statistics Finland, Health, 1996: 5. (In Finnish.)
39.
Karisto A.Class and health: the development of the class pattern of morbidity in Finland, 1964- 87. In: Hansen EJ, Ringen S, Uusitalo H, Erikson R, editors. Welfare trends in Scandinavian countries. Armonk, NY: ME Sharpe , 1993: 163- 90.
40.
Fritzell J., Lundberg O.Välfärdsförändringar 1968- 1991 (Changes in Welfare 1968- 1991 ) . In: Fitzell J, Lundberg O, editors. Vardagens villkor. Levnadsförhållanden i Sverige under tre decennier. Stockholm: Brombergs, 1994: 235-59. (In Swedish.)
41.
Bartley M., Owen C.Relation between socioeconomic status, employment and health during economic change, 1973- 93. Br Med J1996; 313: 445-9.
42.
Warr PBWork, unemployment and mental health. Oxford: Clarendon Press, 1987.
43.
Lahelma E.The patterning of responses to unemployment: deprivation and adaptation . In: Levin LS, McMahon L, Ziglio E, editors. Economic change, social welfare and health in Europe. European Series, No. 54. Copenhagen: WHO Regional Publications , 1994: 5- 22.
44.
Sauli H., Ahola A., Lahelma E., Savolainen J.Living conditions in figures. Helsinki: Central Statistical Office of Finland, Living Conditions, 1989: 1B.
45.
Ahola A., Djerf K., Heiskanen M., Vikki K.Elinolotutkimus 1994. Aineiston keruu. (1994 Survey of Living Conditions. Collection of the data.)Helsinki: Tilastokeskus, Elinolot, Muistio, 1995: 2. (In Finnish.)
46.
Blaxter M.A comparison of measures of inequality in morbidity. In: Fox J, editor. Health inequalities in European countries. Aldershot: Gower, 1989: 199- 230.
47.
Manderbacka K.How do respondents understand survey questions on ill-health?Eur J Public Health1998; 8: 319-24.
48.
Manderbacka K.Examining what self-rated health question is understood to mean by respondents. ScanJ Soc Med1998; 26: 145-53.
49.
Lundberg O. , Manderbacka K.Assessing the reliability of a measure of self-rated health. Scan J Soc Med1996; 24: 218- 24.
50.
Martikainen P., Aromaa A., Heliövaara M., Klaukka T., Knekt P., Maatela J., et al. Reliability of perceived health by sex and age. Soc Sci Med1999; 48: 1117-22.
51.
Fienberg SEThe analysis of cross-classified categorical data. Cambridge : The MIT Press, 1980.
52.
Healy MJRGLIM: an introduction. Oxford: Oxford University Press, 1988.
53.
Francis B, Green M, Payne C, editors. The Glim System, Release 4 [Manual]. Oxford: Clarendon Press , 1994.
54.
Mannila S.Työhistoria ja syrjäytyminen ( Work history and social exclusion) . Helsinki: Työministeriö, Työpoliittisia tutkimuksia , 1993: No 52. (In Finnish.)
55.
Kortteinen M., Tuomikoski H.Työtön. Tutkimus pitkäaikaistyöttömien selviytymisestä (The unemployed. A study of the coping of the long-term unemployed). Hämeenlinna : Hanki ja Jää; 1998. (In Finnish.)
56.
Lahelma E., Arber S., Rahkonen O., Silventoinen K.Widening or narrowing inequalities on health? Comparing Britain and Finland from the 1980s to 1990s. Sociol Health Illn2000; 22: 110-36.
