Title: Empowerment of women in transforming societies, challenges and difficulties
1Empowerment of women in transforming societies,
challenges and difficulties
- Maria S Kopp MD, PhD,
- Institute of Behavioural Sciences,
- Semmelwis University,Budapest, Hungary
- www.behsci.sote.hu
- October 26, 2007,
- Veszprém
2Successful women in earlier centuries
- In royal families or in religious orders
- St. Magaret of Scotland 1093, granddaughter of
Gizella from Bavaria and King Stephan the first
king of Hungary, - her father was Edward, son of Anglo-Saxon King,
he lived in exil in Hungary under protection of
Saint Stephan, and married their daughter, Agatha - Margaret married to bloody Malcolm, king of
Scotland and she became the true civiliser of her
second country according to the examples of King
Stephan - every year a Scottish delegation in Pécsvárad,
where Margaret was educated
3Saint Elisabeth, the patron of Europe
- Her father 2 nd Andreas, Hungarian King from the
Arpads royal family - Wartburg, Marburg- the saint of charity 1207-1231
- Doctors of the Religion
- Saint Theresa the Great from Avilla
- Saint Catharina de Siena
4Which are the positive changes?
- Earlier interest-driven marriages- XIX. XX.
century literature Ibsen Nora, Tolstoj Anna
Karenina - High child age mortality rates, high maternal
mortality- the Semmelweis saga - Today there is no obligation, the aim is the
free life-alliance - Why is it not successful in several cases?
- Several traps of communication
5Feminist trap
- It is important to acknowledge the results of
feminist movements, but - It is not possible to turn the interests of women
against the interests of men in the society - Finnish example in North Karelia lets save our
husbands! - Similar programme in Hungary today- initiated by
our research results in Weekly of Women - Familist approach, not feminist is needed
6The good family is the most important health
promoting factor
- In the modern society it is more important- the
uncertenity of the society - The hostile, agressive family is a most important
risk factor for the children and for the partners
as well - The support of the families would be one of the
most important national health promoting act- - the role of women is fundamental in this respect
7The new situation of women
- The education of women is an important health
promoting factor for the whole family - The multiple roles of women is a great challange
for the women and men as well - The aim mutually learn from each other
- The Norvegian experience- Gro Harlem Brundtland-
successful equity regulation
8Attachment theory (Bowlby, Imre Hermann)
- Physiological, psychological and developmental
importance of the early childhood affective
mother-child bond and the negative consequences
of the disruption of this relationship. - According to follow up studies, insecure
attachment predicts later emotional instability
and health deterioration. Maltreatment at an
early age can have enduring negative effects on a
childs brain development and function, and on
his or her vulnerability to stress.
9Early life chronic stress
- Phases of disruption of mother-infant or peer
bonding - 1. "protest" behaviour (acute and resistance
phases of stress). - 2.despair locomotor inactivity and a
disinterst in motivationally salient external
stimuli. - 3."detachment""hardwired" in the brain of many
social mammals and results in high stress
vulnerability
10Gender differences in worsening premature
mortality rates in Hungary
- Although men and women share the same
socio-economic circumstances, there are
significant gender differences in worsening
mortality rates in Hungary - Socioeconomic differences are more closely
connected with male premature mortality rates - What is the explanation for the decreased
vulnerability of middle aged women during this
period of rapid economic change?
11Life expectancy of men in 1965 and 1992
Marmot M The social pattern of heath and
disease In.Health and Social Organization, Edited
by D Blane, E Brunner, R Wilkinson
Michael
12Life expectancy of women in 1965 and 1992
13Aggregate mortality according to low versus high
education(Mackenbach et al, 1999)
14What can explain the opposite changes in gender
differences in life expectancy?
- In the 1970s no differences in Austrian and
Hungarian life expectancy - Life expectancy in Hungary today
- Male 68.2, female 76.5 years-8.3 years
differences in Hungary, - In neighbouring Austria
- Male 75.9- they live 7.7 years longer,
- Female 81.7- they live 5.2 years longer
15Research questions
- Why worsened the health status during economic
development? - Men and women share the same socio-economic
circumstances, why are middle aged women less
vulnerable? - Which chronic stress factors might explain the
increased vulnerability of men? - Which are the common final health destructing
pathways of socioeconomic and psychosocial stress
factors?
16National representative surveys in the Hungarian
population
- The samples represent the Hungarian population
above age 18 according to gender, age, county and
subregions - Hungarostudy 1983 more than 6000 persons
- Hungarostudy 1988 20.902 persons
- Hungarostudy 1995 12.463 persons
- Hungarostudy 2002 12.640 persons, the refusal
rate was 17,7 - Skrabski,Á.Kopp MS, Rózsa S, Réthelyi J, Rahe RH
(2005)Life meaning an important correlate of
health int he Hungarian population, International
Journal of Behavioral Medicine, 12,2, 78-85.
17Hungarostudy 2006 Follow-up study
- Among the 12.640 persons in Hungarostudy 2002
those who agreed to participate in the follow up
study - 4.689 persons were interviewed again until 2006,
322 persons deceased - 1130 men and 1529 women were included into the
present study who in 2002 were between the age of
40-69 - 99 men (8.8) and 53 women (3.5) died from the
40-69 years old age groups till 2006 - We analysed the predictors of early death on the
basis of Hungarostudy 2002 data of the deceased
and survived middle aged people - Kopp MS, Skrabski Á, Székely A, Stauder A,
Williams R (in press) Chronic stress and social
changes, socioeconomic determination of chronic
stress, Annals of New York Academy of Sciences
18Methods
- Logistic regression analyses were used to
calculate odds ratios of risk of death up to 2006
in men and women separately, of age 40-69 in
2002. - The effects of socioeconomic factors, work
related measures, social support, self-reported
physical and mental health and behavioural
factors on early death were analysed after
adjustment for age, education, smoking, alcohol
abuse and BMI.
19Measures
20Self-rated health
- Self-rated disability
- Self-rated health
- Treatment because of 25 types of disorders
- Illness intrusiveness
- Self-rated pain
- Sleep complaints
- Health care related needs
21Socio-economic and demographic measures
- Education,
- Income,family income
- Subjective socioeconomic status
- Subjective poverty
- Acces to car
- Access to personal computer
- Marital status
- Chicago collective efficacy score
- Family environment
- Housing environment
- Childhood experiences
- Self-rated socioeconomic changes
22Work stress measures
- Job security (Rahe, Tolles, 2002)
- Control at work (Kopp et al, 2000)
- Dissatisfaction with work and with boss (Rahe,
Tolles,2002) - Occupational troubles in the last 5 years (Rahe,
Tolles, 2002) - Social support at work (Kopp et al, 2000)
- The number of working hours per week days and on
weekend days - Personal and family income
- Employment status
23Psychosocial indicators
- Shortened ways of coping (Folkman, Lazarus, 1980)
- Stress and coping (Rahe, 2002)
- Dysfunctional attitude score (Weissman,1979)
- Life events (Rahe, 2002)
- Marital stress score
- Social capital measures
- TCI shortened cooperativeness and sensation
seeking - Womens health
- Ethnic identity
- Religious involvement
-
- Perceived social support (Caldwell,1987)
- Anomie- inability for long term planning
Eurobarometer study - Self-efficacy score (Schwarzer, 1992)
- Meaning in life (R.Rahe, 2002)
- Shortened hostility score (Cook-Medley, 1954)
- Purposes in Life (Crumbaugh, Maholick,1964)
24Health behaviour and lifestyle factors
- Alcohol abuse (AUDIT)
- Morning alcohol consumption
- Non stop alcohol after beginning
- Self-blame because of alcohol
- Drug consumption
- Smoking history
- Suicidal behaviour
- Sport- regular physical activity
- Body weight and height- BMI
-
-
25Mental health indicators
- Shortened Beck Depression Score
- WHO Wellbeing (Bech,1996)
- within WHO cheerfulness
- Shortened Hopelessness Score (Beck, 2000)
- Hospital Anxiety Score (HAS)
- Vital exhaustion (Appels, 1988)
- Type D Personality (Dennolet, 2000)
- that is Negative affect (NA)
- and Behavioral inhibition (BI)
26Striking gender differences in socioeconomic
predictors of premature mortality, increased
vulnerability of men in most respects
27Socioeconomic factors and the risk (OR) of
premature mortality (40-69 years of age in 2002)
according to the Hungarostudy Epidemiological
Panel (HEP) 2005 follow up study
28Socioeconomic factors and the risk (OR) of
premature mortality (40-69 years of age in 2002)
controlled for age, education, smoking, alcohol
abuse and BMI
29Socioeconomic factors as predictors of early
death
- Education (lower or higher than secondary school)
predicted only male premature mortality, the
odds ratio was 1.84 for men - Among men subjective poverty, subjective social
status were also significant predictors of
mortality - Among women only the family related socioeconomic
measures were significant predictors of
mortality, namely no car and no personal
computer in the family ontological security
measures (M. Marmot, 2004)
30Gender paradox of subjective social status
- According to ecological analysis of Hungarostudy
2002 data - negative evaluation of subjective social status
by women increased significantly the male
mid-aged mortality - r for female SSS and male mid-aged mortality
was -.597 p.000 - That is, the subjective evaluation of the
relative social deprivation by women might be a
risk factor for male health - But higher education of women was protective for
male mid-aged mortality - Kopp MS, Skrabski Á, Kawachi I, Adler NE (2005)
Low socioeconomic staus of the opposite gender is
a risk factor for middle aged mortality, J.
Epidemiology and Community Health 59,675-678.
31Correlations of male and female social status and
male mid aged mortality
Korrelációs együtthatók, középkoró férfiak
halálozása
32- Which might be the chronic stressors, that is the
toxic components of lower socioeconomic
situation among men?
33Work related factors and the risk(OR) of
premature mortality (40-69 years of age in 2002)
according to the Hungarostudy Epidemiological
Panel (HEP) 2005 follow up study
34Work related predictors of early death
- Work related factors, first of all job
insecurity, low control in work, low personal and
family income and low employment grade were
significant predictors of early death only among
men - Among women only low social support at work was
significant predictor of early death, but after
controlling for traditional risk factors its
effect disappeared
35Unpredictability, anomie, demoralization and the
risk(OR) of premature mortality (40-69 years of
age in 2002) according to the Hungarostudy
Epidemiological Panel (HEP) 2005 follow up study
36Social support and the risk (OR) of premature
mortality (40-69 years of age in 2002) according
to the Hungarostudy Epidemiological Panel (HEP)
2005 follow up study
37Work related and other psychosocial factors the
risk (OR) of premature mortality (40-69 years of
age in 2002) controlled for age, education,
smoking, alcohol abuse and BMI
38Psychosocial stressors as significant predictors
of early death among men
- Not living with spouse, no social support from
spouse and no social support from child (ren)
were highly significant predictors of early death
only among men - After controlling the data according to the
traditional risk factors among the work related
factors, job insecurity remained significant
predictor of early death among men - Anomie, that is unpredictability ther is no
point in making plans for the future, no meaning
in life, rivalry and hopelesness significantly
predicted premature male mortality
39Psychosocial predictors of early death among
women
- Among women dissatisfaction with personal
relations, family problems are the most important
stressors - In the case of women the broader personal and
family relations are the most important health
related factors - in these respects there were no fundamental
changes during the last decades
40The mediating role of mental health between
socioeconomic, psychosocial stressors and health
deterioration
41Mental health and the risk (OR) of premature
mortality (40-69 years of age in 2002) controlled
for age, education, smoking, alcohol abuse and BMI
42Which are the protective factors for women?
- Relative economic deprivation, rival attitude and
social distrust are all less important risk
factors for women - The socio-economic differences are less important
regarding the middle aged female mortality
differences. - Neighborhood cohesion, religious involvement and
reciprocity were not so much influenced by sudden
socio-economic changes, therefore the protective
network of women remained relatively unchanged.
43The most important challanges of the families
- The Hungarian society is family freendly
- According to 87.3 the marriage is the best way
of life - according to 70,5 there is no real happiness
without children - Basic concept it would be fundamental to support
the birth of the wanted, desired children! - In Hungary today
- No child
2,5 - One child
11,3 - Two children
60,3 - Three children
20,4 - More children
5,5
44There is no real happiness without children
Pongrácz Tiborné www.dmrek.hu
45The number of the wanted and the actual number of
children among men younger than 42 years of age,
according to education
46The number of the wanted and the actual number of
children among women younger than 42 years of
age, according to education
47Negative discrimination of women with higher
education
- In low educational strata the number of actual
children is the same as the number of wanted
children - It would be the task of the society, of the civic
organisations to help the highly educated women
to have to possibility to give birth to their
wanted, desired children - beside the possibility to work in their
profession - Most important steps flexible work,
long-distance work - family friendly working places- the achievement
might increase
48(No Transcript)
49(No Transcript)
50What could be the next steps?
- Support the psychological skills for harmonious
communication in the families- from childhood to
old age - Support the birth of wanted children
- Counterbalance the negative discrimination
against highly educated women help of paralell
profession and child care - Control the work related stress
- Support the mutual trust, life alliance within
the familes
51- Kopp MS, Réthelyi J (2004) Where psychology meets
physiologychronic stress and premature
mortality- the Central-Eastern-European health
paradox, Brain Research Bulletin ,62,351-367. - Kopp MS, Skrabski Á, Réthelyi J, Kawachi I, Adler
N (2004) Self Rated Health, Subjective Social
Status and Middle- Aged Mortality in a Changing
Society, Behavioral Medicine,30, 65-70. - Kopp MS (interview) (2000) Stress The invisible
Hand in Eastern Europe s Death Rates, Science,
288, 9.June 2000, 1732-1733. - Skrabski,Á.Kopp MS, Rózsa S, Réthelyi J, Rahe RH
(2005)Life meaning an important correlate of
health int he Hungarian population, International
Journal of Behavioral Medicine, 12,2, 78-85. - Kopp MS, Skrabski Á, Kawachi I, Adler NE (2005)
Low socioeconomic staus of the opposite gender is
a risk factor for middle aged mortality, J.
Epidemiology and Community Health, 59,675-678. - Kopp,M., Skrabski, Á., Szántó, Zs., Siegrist,
J. Psychosocial determinants of premature
cardiovascular mortality differences within
Hungary, J ournal of Epidemiology Community
Health 60,782-788. - Kopp MS., Stauder A, Purebl Gy. , Janszky I,
Skrabski Á (in press) Work stress and mental
health in a changing society, European Journal
of Public Health. - Kopp MS, Skrabski Á, Székely A, Stauder A,
Williams R (in press) Chronic stress and social
changes, socioeconomic determination of chronic
stress, Annals of NewYork Academy of Sciences - Balog P, Janszky I, Leineweber C, Blom M, Wamala
SP, Orth-Gomer K (2003) Depressive symptoms in
relation to marital and work stress in women with
and without coronary heart disease. The Stockholm
Female Conary Risk Study. Journal of
Psychosomatic Research, 54, 113-119. - Blom M, Janszky I, Balog P, Orth-Gomer K, Wamala
SP (2003) Social Rlations in women with coronary
heart disease. The effects of work and Marital
stress. Journal of Cardiovascular Risk 10
(3)201-206.
52- Kopp MS, Réthelyi J (2004) Where psychology meets
physiologychronic stress and premature
mortality- the Central-Eastern-European health
paradox, Brain Research Bulletin ,62,351-367. - Kopp MS, Skrabski Á, Réthelyi J, Kawachi I, Adler
N (2004) Self Rated Health, Subjective Social
Status and Middle- Aged Mortality in a Changing
Society, Behavioral Medicine,30, 65-70. - Kopp MS (interview) (2000) Stress The invisible
Hand in Eastern Europe s Death Rates, Science,
288, 9.June 2000, 1732-1733. - Kopp MS, Skrabski Á, Szedmák S (2000)
Psychosocial risk factors, inequality and
self-rated morbidity in a changing society,
Social Sciences and Medicine 51, 1350-1361. - Kopp MS, Skrabski Á, Kawachi I, Adler NE (2005)
Low socioeconomic staus of the opposite gender is
a risk factor for middle aged mortality, J.
Epidemiology and Community Health, 59,675-678. - Kopp MS, Skrabski Á, Szántó Zs, Siegrist J (2006)
Psychosocial determinants of premature
cardiovascular mortality differences within
Hungary, J. Epid. Community Health - Kopp M, Kovács M (2006) The Quality of Life of
the Hungarian population (in Hungarian)
Semmelweis Publ., Budapest - Balog P, Janszky I, Leineweber C, Blom M, Wamala
SP, Orth-Gomer K (2003) Depressive symptoms in
relation to marital and work stress in women with
and without coronary heart disease. The Stockholm
Female Conary Risk Study. Journal of
Psychosomatic Research, 54, 113-119. - Blom M, Janszky I, Balog P, Orth-Gomer K, Wamala
SP (2003) Social Rlations in women with coronary
heart disease. The effects of work and Marital
stress. Journal of Cardiovascular Risk 10
(3)201-206.Skrabski Á, Kopp MS, Kawachi I
(2004) Social capital and collective efficacy in
Hungarycross-sectional associations with middle
aged female and male mortality rates, J
Epidemiology and Community Health,58,340-345. - Skrabski ,Á, Kopp MS, Kawachi I.(2003) Social
capital in a changing societycross sectional
associations with middle aged female and male
mortality rates, J Epidemiology and Community
Health 57, 2, 114-119. - Skrabski,Á.Kopp MS, Rózsa S, Réthelyi J, Rahe RH
(2005)Life meaning an important correlate of
health int he Hungarian population, International
Journal of Behavioral Medicine, 12,2, 78-85.