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Title: Empowerment of women in transforming societies, challenges and difficulties


1
Empowerment 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

2
Successful 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

3
Saint 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

4
Which 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

5
Feminist 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

6
The 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

7
The 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

8
Attachment 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.

9
Early 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

10
Gender 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?

11
Life 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
12
Life expectancy of women in 1965 and 1992
13
Aggregate mortality according to low versus high
education(Mackenbach et al, 1999)
14
What 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

15
Research 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?

16
National 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.

17
Hungarostudy 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

18
Methods
  • 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.

19
Measures
20
Self-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

21
Socio-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

22
Work 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

23
Psychosocial 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)

24
Health 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

25
Mental 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)

26
Striking gender differences in socioeconomic
predictors of premature mortality, increased
vulnerability of men in most respects
27
Socioeconomic 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
28
Socioeconomic factors and the risk (OR) of
premature mortality (40-69 years of age in 2002)
controlled for age, education, smoking, alcohol
abuse and BMI
29
Socioeconomic 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)

30
Gender 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.

31
Correlations 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?

33
Work 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
34
Work 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

35
Unpredictability, 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
36
Social 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
37
Work 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
38
Psychosocial 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

39
Psychosocial 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

40
The mediating role of mental health between
socioeconomic, psychosocial stressors and health
deterioration
41
Mental health and the risk (OR) of premature
mortality (40-69 years of age in 2002) controlled
for age, education, smoking, alcohol abuse and BMI
42
Which 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.

43
The 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

44
There is no real happiness without children
Pongrácz Tiborné www.dmrek.hu
45
The number of the wanted and the actual number of
children among men younger than 42 years of age,
according to education
46
The number of the wanted and the actual number of
children among women younger than 42 years of
age, according to education
47
Negative 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
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49
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50
What 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.
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