The possible absence of a healthy-worker effect: a cross-sectional survey among educated Japanese women

Abstract

ObjectivesDespite being highly educated in comparison with women in other member countries of the Organisation for Economic Cooperation and Development, Japanese women are expected to assume traditional gender roles, and many dedicate themselves to full-time housewifery. Women working outside the home do so under poor conditions, and their health may not be better than that of housewives. This study compared the self-rated health status and health behaviours of housewives and working women in Japan.DesignCross-sectional survey.SettingA national university in Tokyo with 9864 alumnae.ParticipantsA total 1344 women who graduated since 1985 and completed questionnaires in an anonymous mail-based survey.Primary and secondary outcome measuresHealth anxiety and satisfaction, receipt of health check-ups, eating breakfast, smoking, and sleep problems according to job status and family demands: housewives (n=247) and working women with (n=624) and without (n=436) family demands. ORs were used for risk assessment, with housewives as a reference.ResultsAfter adjustment for satisfaction with present employment status and other confounding factors, working women were more likely than housewives to feel health anxiety (with family demands, OR: 1.68, 95% CI1.10 to 2.57; without family demands, OR: 3.57, 95% CI 2.19 to 4.50) and health dissatisfaction (without family demands, OR: 3.50, 95% CI 2.35 to 5.21); they were also more likely than housewives to eat an insufficient breakfast (with family demands, OR: 1.91, 95% CI 1.22 to 3.00; without family demands, OR: 4.02, 95% CI 2.47 to 6.57) and to have sleep problems (ORs: 2.08 to 4.03).ConclusionsNo healthy-worker effect was found among Japanese women. Housewives, at least those who are well educated, appear to have better health status and health-related behaviours than do working women with the same level of education.

Factors associated with employment status before and during pregnancy: Implications for studies of pregnancy outcomes

“…The difference likely lies in caregiving and maternity leave, creating a far more complex scenario of potential confounding and selection bias in studying occupation and pregnancy outcomes. A recent study in Japan, for example, found little evidence of a healthy worker effect even among highly educated women, which the authors hypothesized might be due to strong social norms towards traditional caregiving/homemaking roles for women [Nishikitani et al, ].…”

Factors affecting workforce participation and healthy worker biases in U.S. women and men

“…However, in studies in which healthy worker biases cannot be well accounted for (e.g., some occupational cohorts), making valid comparisons of results between studies might be challenging, given the observations of this and other studies suggesting that the magnitude of bias might vary by population characteristics [6,7]. …”

“…However, in many populations, substantial proportions of healthy women opt out of the workforce for reasons unrelated to health, such as to provide childcare [5]. Investigators have also found evidence suggestive of weaker healthy worker biases caused by healthy women leaving the workforce after marriage among U.S. white women in the 1960s and in a contemporary population of college-educated Japanese women [6,7]. …”

Female non-regular workers in Japan: their current status and health

“…Owing to various work preferences, both regularly employed and non-regularly employed women had different factors that threatened their health. A previous nationally representative survey suggested that a shift toward diverse employment patterns might be a cause of deteriorating health among the entire working population, regardless of employment status14 ) .…”