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Family as a Social Determinant of Subjective Health in Spain

The study of the relationship between family situations and events and an individuals’ health status is of particular interest given the enormous research conducted around the socioeconomic determinants of health inequalities against the much less prolific literature on intermediate factors or mediator contexts in health. These factors, known generally as the social determinants of health, have recently proved to be particularly relevant in the analysis of health inequalities in advanced societies with very low levels of mortality. This thesis focuses on the role of family as a social determinant of inequalities in subjective health in Spain.
Picture author: Jordi Gumà Lao.

Author: iStockphoto/yaruti.

The thesis starts with a contextual study about the nature of subjective health, assessing its capacity to capture aspects of objective health conditions in Spain. From this study, the remaining three publications form the bulk of the study by analyzing the relative effects of different family statuses, household positions and a set of family transitions during the individuals’ life course (birth of children, union formation and dissolution, etc.). In addition, a specific study of the effects of selection and causation mechanisms on the relationship between family events and health is included.
One of the main findings of the study, contrasted by analysis at European level, is that in old age the benefits of partnership on health cease to be significant due to a probably strong survival selection effect that old cohorts have suffered throughout their life after being exposed to adverse health conditions until reaching old ages. This potential selection is conducted by both contextual level (levels of pre-adult mortality) and individual level (influence of lifestyle on mortality differential and single people together).
Another meaningful contribution of the work comes from the fact show that the net influence of various factors on overall health indicators as Health Related Quality of Life (HRQL) is clearly mediated by gender roles. Thus, the thesis shows that the household position is a key determinant of HRQL inequalities among women while socioeconomic status has a higher explanatory capacity than family among men. Interestingly, other dissimilarities between men and women in the studied relationship occur on the basis of family relationship analyzed (the domestic partnership and / or parenthood). In addition, incidences of causation and selection mechanisms show also to be different between men and women.
Overall, the results of this thesis highlight the need to overcome the andocentric vision in health research which has focused on economic issues, not taking into account other relevant determinants in explaining health inequalities among women. In addition, this work is a contribution to the Spanish case on the differentiation of the effects of health selection of individuals to experience different family events and the causal effects of such events on health inequalities.

Jordi Gumà Lao
Centre for Demographical Studies (CED)
Departament of Geography - UAB


“La familia como determinante social de la salud subjetiva en España. Una aproximación desde la Demografía”, Jordi Gumà Lao doctoral thesis, read at the Department of Geography and supervised by Dr. Rocío Treviño and Dr. Antonio D. Cámara.

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