Aija Duntava: A View on the Invisible: A Study of Relationships between Different Aspects of Health in Populations

Abstract

This thesis studies relationships between different aspects of health. Health is a multi-faceted concept consisting of various aspects: most commonly morbidity, functional limitation, subjective health, and mortality. The relationships between these aspects, however, are not fully understood, so this thesis aims at contributing to our knowledge on the topic. Three studies are included, each with a particular aim within the general objective.

The firststudy is a systematic review of the articles that have attempted to study more than two aspects of health in one model. The review maps out the field of study, presenting and summarising the results of the articles selected to review, thereby also highlighting gaps in the research. One of its conclusions is that studies approaching health as one interconnected system are rare and that the relationships between the different aspects of health do not consistently show significant effects on each other. Additionally, many population groups in terms of age and place of residence are understudied. The findings from the systematic review have largely guided the scientific curiosity of the following two empirical studies.

The second study proposes and tests a parsimonious model of health structure consisting of morbidity, functional limitation, and subjective health on the adult respondents of European Social Survey (n=32,679) using structural equation modelling. The findings suggest that, in general, the proposed model holds true but there are age and gender differences in the health structure.

The third study explores the variations in the health structure of the adult population in 17 countries in three European regions (North, East, and West). The results show that the model does not apply in all the studied groups across the regions. Clear gender difference in health structure exist in the Western and Northern parts of Europe but not in the East. As to age groups, the analyses show that young adults are similar in their health structure across the regions while there are regional differences between the other two age groups.

This thesis shows that it is necessary to study the relationships between different aspects of health as one interconnected system. Furthermore, when health is at centre of scientific inquiry its multiple dimensions as well as age, gender, and regional variations should be acknowledged and taken into account.