A lower socio-economic position is associated with poorer physical and general health and higher mortality.1–4
In the multitude of studies conducted on socio-economic inequalities in health, a wide variety of socio-economic indicators have been used. However, individual studies have mostly concentrated on only one or a few socio-economic indicators at a time, or tried to find the most important one.5–7
Furthermore, studies that have included a variety of indicators simultaneously have mainly been limited to one national context only.
To increase our understanding of the production of socio-economic inequalities in health, and of the exact ways in which socio-economic circumstances together influence health, multiple socio-economic circumstances need to be analysed simultaneously. Different indicators reflect different dimensions of a person's socio-economic circumstances and differ in their associations with health outcomes and in the related causal processes.5,8–13
Among the conventional socio-economic indicators, i.e. education, occupational class and income, education primarily indicates non-material resources such as knowledge and skills, and is likely to influence health through health behaviours. Occupational class reflects work-related status and working conditions. Education contributes to occupational class and through this to income.11,12,14
Income, wealth and other dimensions of financial situation such as economic difficulties measure material resources and may influence health through health behaviours and living conditions.15,16
Childhood socio-economic circumstances may affect adult health either directly or indirectly through other factors and later circumstances, or by leading to accumulation of disadvantage across the lifecourse.17,18
In addition to studying multiple socio-economic circumstances, comparing different populations and societal and cultural contexts can further add to our understanding of socio-economic inequalities in health. International comparisons enable us to identify the determinants of these inequalities in different countries and to assess the generalizability of findings from one national setting to another. Nevertheless, we lack studies comparing associations of multiple socio-economic circumstances with health across affluent western societies. We seek to compare associations of socio-economic circumstances with physical functioning between employees from Finland and Britain. Previous studies using single socio-economic indicators have found only small differences in socio-economic inequalities in physical and general health between these countries.3,19–22
It is, however, possible that inequalities vary between Finland and Britain when considering multiple socio-economic circumstances, as these two western European countries have also dissimilarities between them. They differ e.g. in their patterns of welfare provision and allocation, labour markets, social and family structures, and income distributions which may all contribute to the socio-economic inequalities in health.23,24
Differences exist also in their social and economic history. Rapid social and economic transformation took place in Finland only after the WWII, when the UK had already a long history as an affluent industrial society. In Finland, the expanding public sector recruited employees from rural settings, which may cause the Finnish cohort to have a more rural background. Thus, the origins of the white-collar employees within the cohorts may vary, and could also influence the class composition to some degree.25
However, the cohorts share many similarities, consisting of public sector employees in white-collar occupations from western European capital cities and from the same age-groups, which increases the comparability.
We aim to examine key indicators of past and present socio-economic circumstances. Our research questions are:
- What kind of associations and pathways can be found between the conventional indicators of adult socio-economic position and physical functioning?
- Are childhood and current economic difficulties associated with physical functioning and other socio-economic circumstances?
- What kind of similarities and dissimilarities can be found between the two cohorts?
Our previous study examined the associations of the same set of socio-economic indicators with common mental disorders (CMD) and found childhood and current economic difficulties to be associated with the outcome.26
By examining physical health using a similar framework, we aim to deepen the understanding of similarities and dissimilarities in the socio-economic patterning of the physical and the mental domain of health among Finnish and British employees.