Thesis--Auburn University, 2008. / Abstract. Vita. Includes bibliographical references (p. 60-75).

Philosophiae Doctor - PhD / Populations are rapidly growing older across the globe. In South Africa, life expectancy has been on the increase over the past decade, and the proportion of older people is projected to increase dramatically over the coming years. Whilst this is a remarkable achievement, it does not mean that additional years of life will be healthy. To this end, the question being asked by researchers and policy makers is whether people are living longer and healthier lives? In order to answer this important question, health expectancies have been developed which combine morbidity and mortality data into a single index that measures population health. The health expectancies have become standard measures of population health across first world countries. Unfortunately, there is little awareness about their use in developing countries, including South Africa. The aim of this study was to estimate health expectancies based on various objective and subjective measures, in order to give a first comprehensive analysis of the health and wellbeing of older people in South Africa. The data were drawn from two nationally representative surveys namely; the WHO-Study on Global Ageing and Adult Health (SAGE) and the South African National HIV Incidence, Prevalence, Behaviour and Communication Survey (SABSSM) surveys. The results are presented in the form of five manuscripts each submitted for publication. The first manuscript estimates sexually active life expectancies and factors associated with sexual activity. The results show that older people are gaining more years of sexual activity. HIV in older women and chronic conditions in older men reduced odds of sexual activity. The second manuscript found that there was both absolute and relative compression of morbidity in older people between 2005 and 2012, based on self-rated health measure. The third manuscript estimates happy life expectancy and examines factors associated with happiness in older people. Happy life expectancy was greater for men than women, and wealth status was the strongest predictor of happiness. In the fourth manuscript, subjective and objective measures were used to estimate health expectancies. The former showed a more positive outlook compared to the latter. Gender differentials were evident in that although women live longer than men, they spent a greater part of their lifetime in poorer health than men. The fifth manuscript goes a crucial step further, to estimate the contribution of specific diseases to disability. This is important for policymakers as this identifies entry points of interventions aimed at reducing the onset and burden of disability in the elderly population. The most contributors of disability were musculoskeletal and cardiovascular diseases. The thesis concludes that the health of older people is complex and multidimensional, and therefore requires several measures to give a comprehensive analysis. When measured using subjective measures, it can be concluded that the health of older people has been improving. However, a different conclusion could be reached, if objective measures are used. It is important to continue to monitor the health status of older people, and make appropriate interventions in order to improve their health, wellbeing and quality of life.

Sociological interest in the relationship between the social structure and health began with the classic work of Durkheim, who first identified socially constructed patterns of suicide rates in Western European countries. Drawing on this structural tradition, a large literature has investigated how health is influenced and shaped by societal factors. Despite a great deal of research on the social causation of health, however, the potentially adverse effects of social structures have been rarely studied. If people's health is linked to broader social conditions, then it follows that health is also subject to societal disruption, especially in the wake of the breakdown or failure of the existing social structure. This dissertation advances our understanding of the relationship between the social structure and health at the population level, focusing on post-communist Eastern Europe as a case study. There are three interrelated goals in this dissertation: first, to elucidate differences in health and mortality outcomes between East Central Europe and the former Soviet Union; second, to numerically substantiate the association between drastic social change and the risk of death due to suicide; and third, to reveal the structural factors related to overall population health status in Eastern Europe. Using aggregate-level data for Eastern European countries for the post-communist period, I find that (1) there are growing inequalities in life expectancy and infant mortality between East Central Europe and the former Soviet Union, and mechanisms associated with disparities vary by gender and age; (2) consistent with Durkheim's theory of suicide, drastic structural change is related to increased suicide death rates for the period immediately after the collapse of communism; and (3) the malfunctioning of the social structure is inversely associated with the health status of populations. Taken together, fully understanding the health consequences of communism's fall in Eastern Europe requires research that looks beyond individual-level risk factors to incorporate the broader characteristics of the social structure in which populations are embedded. / text

Japan is the longest lived population in the world and has led the world in low mortality for over two decades. The United States, although its GDP exceeds all other countries, has a life expectancy that falls substantially below most other western countries. Taiwan, although it has an emerging economy with rapid aging population, has a life expectancy approaching that of the United States. Previous studies have investigated multiple domains of physical health for elderly Japanese, American, and Taiwanese, but very few studies have compared mortality across these countries and even fewer have examined how mortality and morbidity intersect differently across the countries to influence differences in healthy life expectancy. This dissertation is aimed at filling this gap. Based on studies in the United States and other Western countries, education is increasingly characterized as a "fundamental cause" of health -- with more years of educational attainment associated with better health. Although the association is robust for a variety of health measures and mortality in the United States and other Western countries, studies in East Asia report more modest associations or no associations. Thus, whether the association extends beyond the Western context is less clear. In my dissertation, I investigate these issues in detail. In the United States, the more-educated enjoy longer life expectancy and a compression of mortality comparing with their less-educated counterpart. Here, data from Taiwan and Japan are used to assess whether education has similar consequences in two important non-Western settings. In sum, the findings reveal that: (1) older Japanese people not only have the highest total life expectancy but also have the highest absolute healthy life expectancy in each gender group, (2) older American and Taiwanese people have similar total life expectancy in each gender group, but they have very different health profiles, (3) educational gradients on mortality/health differ across gender and country groups, and (4) within a population, having more education helps maximize lifespan, changes and delays the biological aging process in the different contexts. Overall, the results underscore the importance of international perspective in explicating health disparities, especially educational differentials in health. / text

This diploma thesis sets up two main aims: the first one is based on evaluation of mortality trends in European states using indicator life expectancy at birth and infant mortality rate. Development of age structure, indicators of demographic ageing and main causes of death is analyzed more in detail for five European states, Sweden, France, Italy, Czech Republic and Latvia. Second aim of this thesis is to describe differences of health status in Europe using descriptive statistics and cluster analysis. In this part of the thesis the differences among European states are evaluated using: health expectancy by self- perceived health, health expectancy by chronic morbidity and health expectancy based on disability. All variables are analyzed at age 65 and more and 80 and more. Conclusion of this thesis answers the question, if the Europe is, after more than twenty years, still divided from the perspective of mortality and health patterns between West Europe and former Eastern Bloc countries. Powered by TCPDF (www.tcpdf.org)

Title from first page of PDF document. Includes bibliographical references (p. 20-21).