On 20 September 2017 at 11.00 Rainer Reile will defend his doctoral thesis ”Self-rated health: assessment, social variance and association with mortality” in the Council of the Institute of Social Studies.
Associate Professor Mall Leinsalu, PhD, Södertörn University (Sweden) and Senior Researcher, National Institute for Health Development (Estonia)
Associate Professor Ritva Prättälä, PhD, National Institute for Health and Welfare (Finland)
Description of the problem
The single question on individual’s self-rated health (SRH) –“How would you rate your health in general?”– has become a popular tool in survey research as its validity for assessing population health status and predicting mortality and morbidity outcomes has been consistently demonstrated. This dissertation analyzed the mechanisms underlying the subjective health evaluations, their social variations and associations between SRH and mortality.
Result and benefit
The findings support the existing evidence that SRH is a valid and responsive indicator of individual health that rests on a wide range of determinants that differ for negative and positive health assessments. The former is characterized mostly by the physical and psychological aspects whereas a wide range of demographic, socioeconomic and wellbeing-related factors contribute to the latter. Moreover, similar patterning of predictors of positive and negative health was also found for factors underpinning the mortality risk in an analysis stratified by SRH. Those with poor SRH had approximately 40% higher mortality during the 18-year follow-up period. SRH was found to predict subsequent mortality only among Estonians with social variations in health assessments being one of the plausible explanations. The dissertation studied SRH in the context of macroeconomic changes demonstrating the health effects of late-2000s economic recession that halted the previous trend of health improvement in Estonia and Lithuania. The reduction in existing health disparities during the recession indicates that rapid economic fluctuations may affect different socioeconomic groups disproportionately. SRH is influenced by a wide range of factors, not necessarily limited to those directly related to physical aspects of health. The social determinants affect health outcomes but are also the source of social variation in health assessments as they influence how health is conceptualized and evaluated. In this, health can be interpreted essentially as a social phenomenon that in the context of subjective health measures requires careful interpretation.