Chapter 44: Socioeconomic Determinants of Women's Health: The Changing Landscape of Education, Work, and Marriage

Social factors shape the health and well-being of women throughout life. Critical social determinants of health include education, financial resources, occupational characteristics, and social relationships.[1], [2], [3], [4], [5], [6], [7], [8] These social conditions are established predictors of major health behaviors, health care access, morbidity, and mortality, although the independent causal effects of each remain controversial. These factors are relevant for the health of both men and women, but throughout life the distribution and consequences of most social resources are highly gendered. Historically, boys and girls have been tracked into distinct educational paths, leading to divergent occupational opportunities and financial resources. However, the educational attainment gap has largely been eliminated in recent cohorts in the US,10 and women in the baby-boomer cohorts entered the labor force at unprecedented rates. Marriage has also changed rapidly for recent cohorts of women. Divorce and non-marital childbearing are now common, marriages are more egalitarian (in terms of partner characteristics[11], [12], [13], [14] and, to a lesser degree, the division of labor within the home15) and, because of increases in educational attainment and labor market participation, women are less financially dependent on a spouse.13 These trends have resulted in dramatic differences in the social backgrounds of current cohorts of adult women compared to earlier cohorts, and are important considerations in understanding differences in their morbidity and mortality trajectories.