Education differentials in functional status among older adults in three Asian societies: Taiwan, Thailand, and the Philippines.

Abstract

Despite a long history of research into socioeconomic inequalities in health, it is still unknown whether and how the association is manifest among older adults living in non-western societies, and whether longitudinal and cross-national data sources assist in sorting out the pathways through which socioeconomic status impacts upon health. This research explores these issues via the impacts of education on functional status outcomes in survey samples of older adults living in Taiwan, Thailand, and the Philippines. The Taiwan sample is employed for the more detailed and longitudinal analyses due to its richness. A psychosocial perspective forms the basis for the theoretical orientation guiding the hypothesis testing. Three analyses form the core of the empirical investigation. The first involves a cross-national examination comparing effects of education on functional status across the three societies. The second is a comprehensive cross-sectional examination of the pathways connecting education and functional status in Taiwan. This includes the impact of the education of a child and thus expands the investigation across two generations. The third is an examination of the influence of education on transitions in function over a four-year period among Taiwanese. Results suggest education influences functional status across samples, but the association is more complex than previously thought. There are variations in magnitude across societies and evidence of a dual process taking place, the first involving the influence of education on the onset or prevention of functional disorder, the second involving the impact of education on the progression or severity of functional disorder. The impact of education is strong in the former case, but minimal in the latter. Economic and social changes are taking place in a number of Asian societies in conjunction with rapid population aging. These factors make the setting an interesting and important one for a study of this nature. The research has implications for future health care and policy planning in these societies. The concluding chapter discusses these, and provides an explication of the findings that may be considered to be anomalous to previous research.