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: 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, 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 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 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 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 Her father 2 nd Andreas, Hungarian King from the Arpads royal family Wartburg, Marburg- the saint of charity 1207-1231 Wartburg, Marburg- the saint of charity 1207-1231 Doctors of the Religion: Doctors of the Religion: Saint Theresa the Great from Avilla Saint Theresa the Great from Avilla Saint Catharina de Siena Saint Catharina de Siena

4. Which are the positive changes? Earlier interest-driven marriages- XIX. XX. century literature: Ibsen: Nora, Tolstoj: Anna Karenina Earlier interest-driven marriages- XIX. XX. century literature: Ibsen: Nora, Tolstoj: Anna Karenina High child age mortality rates, high maternal mortality- the Semmelweis saga High child age mortality rates, high maternal mortality- the Semmelweis saga Today there is no obligation, the aim is the free life-alliance Today there is no obligation, the aim is the free life-alliance Why is it not successful in several cases? Why is it not successful in several cases? Several traps of communication Several traps of communication

5. Feminist trap: It is important to acknowledge the results of feminist movements, but 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 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! Finnish example in North Karelia – lets save our husbands! Similar programme in Hungary today- initiated by our research results in Weekly of Women Similar programme in Hungary today- initiated by our research results in Weekly of Women Familist approach, not feminist is needed 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 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 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 support of the families would be one of the most important national health promoting act- the role of women is fundamental in this respect 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 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 multiple roles of women is a great challange for the women and men as well The aim: mutually learn from each other The aim: mutually learn from each other The Norvegian experience- Gro Harlem Brundtland- successful equity regulation 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. 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 child’s brain development and function, and on his or her vulnerability to stress. 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 child’s 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: Phases of disruption of mother-infant or peer bonding: 1. "protest" behaviour (acute and resistance phases of stress). 1. "protest" behaviour (acute and resistance phases of stress). 2.“despair”: locomotor inactivity and a disinterst in motivationally salient external stimuli. 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 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 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 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? 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 In the 1970s no differences in Austrian and Hungarian life expectancy Life expectancy in Hungary today: Life expectancy in Hungary today: Male 68.2, female 76.5 years-8.3 years differences in Hungary, Male 68.2, female 76.5 years-8.3 years differences in Hungary, In neighbouring Austria: In neighbouring Austria: Male 75.9- they live 7.7 years longer, Male 75.9- they live 7.7 years longer, Female 81.7- they live 5.2 years longer Female 81.7- they live 5.2 years longer

15. Research questions: Why worsened the health status during economic development? Why worsened the health status during economic development? Men and women share the same socio- economic circumstances, why are middle aged women less vulnerable? 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 chronic stress factors might explain the increased vulnerability of men? Which are the common final health destructing pathways of socioeconomic and psychosocial stress factors? 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 The samples represent the Hungarian population above age 18 according to gender, age, county and subregions Hungarostudy 1983 more than 6000 persons Hungarostudy 1983 more than 6000 persons Hungarostudy 1988 20.902 persons Hungarostudy 1988 20.902 persons Hungarostudy 1995 12.463 persons Hungarostudy 1995 12.463 persons Hungarostudy 2002 12.640 persons, t he refusal rate was 17,7% Hungarostudy 2002 12.640 persons, t he 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. 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 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 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 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 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 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 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. 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. 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 disability Self-rated health Self-rated health Treatment because of 25 types of disorders Treatment because of 25 types of disorders Illness intrusiveness Illness intrusiveness Self-rated pain Self-rated pain Sleep complaints Sleep complaints Health care related needs Health care related needs

21. Socio-economic and demographic measures: Education, Education, Income,family income Income,family income Subjective socioeconomic status Subjective socioeconomic status Subjective poverty Subjective poverty Acces to car Acces to car Access to personal computer Access to personal computer Marital status Marital status Chicago collective efficacy score Chicago collective efficacy score Family environment Family environment Housing environment Housing environment Childhood experiences Childhood experiences Self-rated socioeconomic changes Self-rated socioeconomic changes

22. Work stress measures: Job security (Rahe, Tolles, 2002) Job security (Rahe, Tolles, 2002) Control at work (Kopp et al, 2000) Control at work (Kopp et al, 2000) Dissatisfaction with work and with boss (Rahe, Tolles,2002) Dissatisfaction with work and with boss (Rahe, Tolles,2002) Occupational troubles in the last 5 years (Rahe, Tolles, 2002) Occupational troubles in the last 5 years (Rahe, Tolles, 2002) Social support at work (Kopp et al, 2000) Social support at work (Kopp et al, 2000) The number of working hours per week days and on weekend days The number of working hours per week days and on weekend days Personal and family income Personal and family income Employment status Employment status

23. Psychosocial indicators: Perceived social support (Caldwell,1987) Perceived social support (Caldwell,1987) Anomie- inability for long term planning Eurobarometer study Anomie- inability for long term planning Eurobarometer study Self-efficacy score (Schwarzer, 1992) Self-efficacy score (Schwarzer, 1992) Meaning in life (R.Rahe, 2002) Shortened hostility score (Cook-Medley, 1954) Purposes in Life (Crumbaugh, Maholick,1964) Purposes in Life (Crumbaugh, Maholick,1964) Shortened ways of coping (Folkman, Lazarus, 1980) Shortened ways of coping (Folkman, Lazarus, 1980) Stress and coping (Rahe, 2002) Stress and coping (Rahe, 2002) Dysfunctional attitude score (Weissman,1979) Dysfunctional attitude score (Weissman,1979) Life events (Rahe, 2002) Life events (Rahe, 2002) Marital stress score Marital stress score Social capital measures TCI shortened cooperativeness and sensation seeking TCI shortened cooperativeness and sensation seeking Womens health Womens health Ethnic identity Ethnic identity Religious involvement Religious involvement

24. Health behaviour and lifestyle factors: Smoking history Smoking history Suicidal behaviour Suicidal behaviour Sport- regular physical activity Sport- regular physical activity Body weight and height- BMI Body weight and height- BMI Alcohol abuse (AUDIT): Alcohol abuse (AUDIT): Morning alcohol consumption Morning alcohol consumption Non stop alcohol after beginning Non stop alcohol after beginning Self-blame because of alcohol Self-blame because of alcohol Drug consumption Drug consumption

25. Mental health indicators: Shortened Beck Depression Score Shortened Beck Depression Score WHO Wellbeing (Bech,1996) WHO Wellbeing (Bech,1996) within WHO cheerfulness within WHO cheerfulness Shortened Hopelessness Score (Beck, 2000) Shortened Hopelessness Score (Beck, 2000) Hospital Anxiety Score (HAS) Hospital Anxiety Score (HAS) Vital exhaustion (Appels, 1988) Vital exhaustion (Appels, 1988) Type D Personality (Dennolet, 2000) Type D Personality (Dennolet, 2000) that is Negative affect (NA) that is Negative affect (NA) and Behavioral inhibition (BI) 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 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 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) 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 According to ecological analysis of Hungarostudy 2002 data negative evaluation of subjective social status by women increased significantly the male mid- aged mortality: 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 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 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 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. 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? 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 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 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 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 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 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 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 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 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 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. 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. 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! Basic concept: it would be fundamental to support the birth of the wanted, desired children! In Hungary today: In Hungary today: No child 2,5 % No child 2,5 % One child 11,3 % One child 11,3 % Two children 60,3 % Two children 60,3 % Three children 20,4 % Three children 20,4 % More children 5,5 % More children 5,5 %

44. There is no real happiness without children LituaniaBelgiumFinnland West Germany SloveniaPoland East Germany Czech Republic HollandItalyHungary21,3% 31,8 % 41,6 % 49,0 % 51,3 % 54,5 % 59,5 % 60,6 % 61,7 % 62,1 % 70,5 % 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 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 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 beside the possibility to work in their profession Most important steps: flexible work, long-distance work Most important steps: flexible work, long-distance work family friendly working places- the achievement might increase family friendly working places- the achievement might increase

50. What could be the next steps? Support the psychological skills for harmonious communication in the families- from childhood to old age Support the psychological skills for harmonious communication in the families- from childhood to old age Support the birth of wanted children Support the birth of wanted children Counterbalance the negative discrimination against highly educated women – help of paralell profession and child care Counterbalance the negative discrimination against highly educated women – help of paralell profession and child care Control the work related stress Control the work related stress Support the mutual trust, life alliance within the familes Support the mutual trust, life alliance within the familes

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