BACKGROUND: Women's longevity is an important health issue: if they live longer than men do, their additional life years are mainly years of poor health and disability. These health situations affect the quality of life and usually require a high level of care. In this context, this gender gap questions both its causes and the circumstances in which these disabilities are experienced. It was shown that some of these differences are due to social determinants that are unevenly distributed between men and women, in relation to their different professional, social or family life course experiences. Yet, the literature provides a rich but fragmented overview of the exposure paths within these life course experiences to explain the gender health differences.
OBJECTIVES. Our project proposes to develop a holistic approach to these differences, implemented using a new database, the CONSTANCES cohort. It allows constructing specific indicators to reflect the different health dimensions, from the biological functioning to disabilities, which could be emblematic of these gender differences. The objective is to highlight where the differences are located, and then to highlight exposure paths across the life course that could explain them. We intend to identify social determinants at the crossroads of professional, social and family life course; we assume that some circumstances (living conditions, jobs, family situation) can modify these exposure paths and modulate health risks. In total, the project intends to explain health differences between women and men, but also within women and men populations.
METHODS. The project is based on five tasks built around CONSTANCES data. We will work on the sample of 45 years of age or older (n=81,400 people at the end of 2018). Different methods will be used 1) To specify gender differences in relation to a number of diseases and disabilities (based on prevalence, disability-free life expectancies); 2) To qualify differences in biological functioning and provide, in relation to Task 1, a clinical and functional picture to analyse the gender health differences. 3) To shed light on the exposure paths contributing to the gender health differences established in Tasks 1-2, linked to critical situations within professional, family and social histories (based on composite indicator of stressful exposures; analyses using multivariate and nested models; pathway typologies and sequence analyses; structural equations; path analyses). 4) To adopt a quasi-experimental approach to analyse whether the reform of parental leave (APE) in France - which increased periods of inactivity with a mixed effect on mothers' careers - had a long-term effect on their health (based on method of double differences). 5) To carry out a collective reflection on the limits of measures of critical social and family situations in surveys.
PERSPECTIVES. Our project involves five teams from France and abroad, gathering researchers who have been working for a long time in the field of life courses and/or social determinants of health. Our project will build on this expertise and this new health data: we intend to shed light on the issue of gender differences in health by taking into account exposures related to gendered life courses. More generally, this project aims to broaden the scope of the social determinants of health at the intersection of the professional and family spheres; one approach being also to consider the impact of public policies. In doing so, this project also aims to broaden the scope of levers for action to improve the health status of the general population and, potentially, reduce health differences between population groups.
Madame Emmanuelle CAMBOIS (INED - Démographie économique)
The author of this summary is the project coordinator, who is responsible for the content of this summary. The ANR declines any responsibility as for its contents.
Ined - Démo éco INED - Démographie économique
INSERM - LEASP Epidémiologie et analyses en santé publique : risques, maladies chroniques et handicaps
KCL King's College / Department of Global Health & Social Medicine
HCPDS Harvard / Harvard Center for Population and Development Studies
Help of the ANR 368,445 euros
Beginning and duration of the scientific project: May 2020 - 48 Months