Frameworks of analysis

This thesis examines the factors associated with the health and well-being of older people, using the framework shown in Figure 1.2. Drawing from the fundamental cause theory (Link & Phelan, 1995; Link et al., 2008), this research focuses on the role of different types of resources in explaining inequality in health and well-being in old age. These resources do not only refer to socioeconomic resources including education and income but other forms of resources such as social support (Henning-Smith, 2016). Social support is conceptualized to include the structural characteristics of the individual's social network as well as the functional aspects of this social relationship (Fernández– Ballesteros, 2002).The structural characteristics are measured by older people's living arrangements, while the functional aspect is measured by exchange of support with children. Following previous research, I add a network approach to the fundamental cause theory and argue that not only do the personal resources of the older people matter but also those people they have a relationship with, particularly their children (Zimmer et al., 2016), who are an important part of their social network.

The two main dependent variables in the present study are physical health and subjective well-being of older people. Some research used physical health as an indicator of well- being, but they are examined separately in this research as physical health is an important determinant of subjective well-being. Subjective well-being represents a broader concept that not only taps into the physical health of older people but also captures other aspects of well-being such as emotional and mental well-being. Bowling (2004) distinguished

28

between macro and micro definitions of subjective well-being. This approach is adopted in this research by examining how these resources influence the subjective well-being at the micro and macro level.

Since physical health has been consistently shown to be a strong determinant of well- being in old age (Kim & Kim, 2003; Lee et al., 2014), this thesis investigates the factors associated with physical health and then examines its relationship with well-being in subsequent analysis. This study focuses on the role of children’s education in parental health, controlling for older parents’ individual characteristics, including their living arrangement. Education of children represents a familial resource that can benefit older people through several mechanisms, including social support, social influence and access to resources. However, as pointed out earlier, previous studies mainly used one or two components of the disablement process to measure physical health. This is addressed in this research by using different health indicators that correspond to the different stages of the disablement process to examine whether the relationship found between functional limitations and children’s education also extends to impairments and disability, controlling for the individual characteristics of older people and that of their children.

Social support is another form of a resource that can impact the well-being of older people. Two types of social support, including living arrangements and intergenerational exchange of support, are the main focus of the present study. Previous studies have shown that the living arrangements of older people can influence their subjective well-being, either positively or negatively. The greater availability of different types of support in a co-residential arrangement can positively impact the well-being of older people, but the presence of conflicts and lack of privacy in the household can negatively affect the well- being of older people. The current study recognizes these different impacts of living arrangements on older people, but it also argues that not only does the actual living arrangement matter, but whether this arrangement corresponds with older people's preferred arrangement also has an impact on the well-being of older people. It is hypothesized that lack of concordance between the actual and preferred living arrangements of older people will have a negative impact on their well-being, because it may reflect older people’s or their children’s lack of resources to have living arrangement concordance. For example, older people may prefer to live independently from their children, but their unstable economic condition may motivate them to live with their children for support. They may also want to live away from their children, but their

29

children's financial difficulty may force them to accommodate them in their own household. It is acknowledged that older people's characteristics, including their physical health and the characteristics of their children, will also be associated with their living arrangement concordance. The influence of these different factors will be empirically tested in this research, but they will not be the main focus of the study.

Although the type of household that older people live in and whether living in this household type corresponds to their preference can affect their well-being, the household is not an adequate unit of analysis because the flow of support can extend beyond the household. This is addressed in this research by looking at the intergenerational exchange of support within and beyond the household, controlling for older people’s living arrangement concordance, their personal characteristics, their health status and the characteristics of their children. However, unlike previous studies that focused only on unidirectional (either giving or receiving only) flow of support, this research considers the bidirectional flow of support. To capture the diversity of types of support that flow between children and parents but also cognizant that these types of support are not substitutable, distinction is made between these different types of support. The intergenerational flow of these different types of support are assumed to be influenced by the characteristics of older people and that of their children, but these relationships will not be empirically tested in this research.

It is also hypothesized in this research that the impact of living arrangement concordance on the well-being of older people will be moderated by the presence or absence of exchange of support. For example, an older person may not be living in their preferred living arrangement but may be receiving different types of support from children living outside their household. In this case, the negative impact of a lack of living arrangement concordance may be buffered by the flow of intergenerational support.

Although the framework shows the different relationships between the variables, only a subset of key relationships is the main focus of this thesis. These relationships are represented by heavy arrow lines in Figure 1.2 to distinguish them from the other relationships.

30

Figure 1. 2. Framework of analysis for micro-level determinants of health and well-being

Legend

The relationship is the focus of the study

The relationship is tested but not the main focus of the study Represents interaction effects

The relationship is hypothesized but not empirically tested Intergenerational

exchange of support Actual living

arrangement Physical Health

• Impairments • Functional limitations • Disability Preferred living arrangement Living arrangement concordance Children’s characteristics Older person’s

characteristics _{Subjective well-being}

• Self-rated health • Life satisfaction • Psychological

31

To complement the first part of the analysis on micro-determinants of health and well-being, the second part of the analysis focuses on the role of macro-level socioeconomic resources in disability-free life expectancy (DFLE) of older people at the subnational level. In doing so, we get a more comprehensive picture of the factors associated with health and well-being among older Filipinos at the national and sub-national level.

The primary dependent variable in this analysis is disability-free life expectancy (DFLE). The focus of this research is on the role of macro-level socioeconomic factors in DFLE at the regional level. The relationship between socioeconomic resources on DFLE is conceptualized in Figure 1.3. Several indicators of socioeconomic resources, including poverty incidence, educational attainment, and living arrangements are hypothesized to explain regional variation in DFLE, based on the predictions of fundamental cause theory. Other factors such as policies and programs designed to promote the well-being of older people in the country will also impact DFLE, but they are not empirically tested in this analysis due to data limitations.

Figure 1. 3. Relationship between macro-level factors and health expectancy

In summary, this thesis is guided by the predictions of the fundamental cause theory which states that the health and well-being of older people is driven primarily by resources. In this research, resources are not limited to the resources of older people, but also of that of their children. Chapter 4 focuses on children’s education, as a proxy of this type of resource, and examines its association with parental health. In settings where there is strong intergenerational support, just like in the Philippines, children’s education can serve as a familial resource that can benefit all members of the family including that of the parents. It is expected that education of children will be positively associated with the health status of their parents, not only because

Societal, Economic and Demographic Factors

Economic resources Health infrastructure Demographic trends Formal programs and

policies

Disability-free life expectancy

32

higher education translates to higher income, but it also means that they have access to knowledge and information that are beneficial to the health of older people.

Another type of resource that is examined in this research is social support, which is the focus of chapters 5 and 6. Social support is defined in terms of its structural and functional aspects. Chapter 5 focuses on the structural aspect while Chapter 6 focuses on the functional aspect. The structural aspect is measured in terms of living arrangement and is conceptualized as a household resource that may have significant implications for the well-being of older people. To extend the fundamental cause theory, it is hypothesized that the influence of this household resource on well-being is dependent on whether this available resource is aligned with the preferred or perceived to be the ideal resource of older people. The expected relationship between the concordance of the available resource (actual living arrangement) and preferred or ideal resource (living arrangement preference) is guided by person-environment fit, cognitive dissonance, and self-discrepancy theories. The functional aspect of social support is measured in terms of the transfer of resources across generations. Since different types of resources may have different meanings and require different forms of delivery, it is expected that their impact on well-being will also vary. Hence, to add another dimension to the fundamental cause theory, I distinguish between different types of resources that are exchanged between older parents and children, and the direction of this exchange; and examine their associations with parental well- being. The expected relationship between different types of intergenerational support and older people’s well-being is informed by the social exchange and equity perspective theories.

To complement chapters 4, 5 and 6, which examine the association between individual and household-level resources on health and well-being of older people, chapter 7 examines the role of macro-level resources on the well-being of older people at the regional level. Different types of resources, such as children’s education and living arrangement as examined in the previous chapters, are also used in this chapter, in addition to broader socioeconomic indicators such as poverty incidence and regional gross domestic product.

33