Self-evaluated health of married people in Jamaica

doi:10.4236/health.2009.14055

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Vol.1, No.4, 332-341 (2009)

doi:10.4236/health.2009.14055

SciRes

Health

Self-evaluated health of married people in Jamaica

Paul A. Bourne

Department of Community Health and Psychiatry, Faculty of Medical Sciences, The University of the West Indies, Mona, Kingston 7,

Jamaica; paulbourne1@yahoo.com

Received 2 October 2009; revised 9 November 2009; accepted 10 November 2009.

ABSTRACT

Background: In the Caribbean in particular Ja-

maica, no study has been done to examine

married respondents in order to understand

reasons for their greater health status. The ob-

jectives of the current study are: 1) examine the

sociodemographic characteristics of married

people in Jamaica; 2) evaluate self-rated health

status of married people in Jamaica; 3) deter-

mine factors that account for good health status

of married people and 4) provide public health

practitioners with empirical studies that can be

used to formulate policies for men in particular

non-married men in Jamaica. Materials and me-

thods: Stratified random sampling technique

was used to select 6,783 respondents. It was a

nationally representative sample. Logistic re-

gression analysis was used to ascertain the

correlates of health status. Results: The mean

age for women in marriage in Jamaica was 6

years lower than that of men. The correlates of

good health status (including moderate health)

of respondents in descending order were self-

reported illness (OR = 0.12, 95%CI = 0.01- 0.17);

age (OR = 0.94, 95%CI = 0.93-0.96); income (OR

= 1.32, 95%CI = 1.05-1.66) and sex of respon-

dents (Or = 1.14-2.32)—χ2(df = 4) = 383.2, P <

0.05. The four variables accounted for 44.4% of

the explanatory power of the model; with

self-reported illness accounting for 32.5% of the

explanatory power. Conclusion: Marriage pro-

vides greater access to more socioeconomic

resources for its participants as well as increase

men’s unwillingness to visit medical care prac-

titioners.

Keywords: Marriage; Sexes; Health Status;

Sociodemographic Correlates; Jamaica

1. INTRODUCTION

Globally, empirical studies have shown a statistical as-

sociation between marital status and self-reported health

status. Studies found that married people have a better

self-reported health status (or self-reported health, sub-

jective wellbeing) [1-9] and/or lower mortality than non-

married people. This is no different in Jamaica, as stud-

ies have found that married Jamaicans have a better

health status than non-married Jamaicans [10,11]. Al-

though generally findings on health status in Jamaica

indicated the aforementioned, a study by Bourne &

McGrowder [12], using 15,260 rural residents, found no

statistical difference between the good health status of

married and non-married respondents. In spite of Bourne

& McGrowder’s work, the preponderance of empirical

evidence generally indicated that married people have

better health status and experience lower rates of mortal-

ity than non-married people; and so Bourne & Mc-

Growder’s study does not reduce the reality of a differ-

ence in other geographic regions in Jamaica. Within the

context of the health literature, the odds ratio of good

health status for married people is greater than that for

non-married people, and this is ascribed to different

socio-economic and lifestyle issues.

The socio-economic and lifestyle issues include the

following: greater health care-seeking behaviour [13];

social support [2-4]; better lifestyle choices [3]; better

and proper eating habits [6,7]; higher economic wellbe-

ing, more so for women [14], and that they are happier

[15,16] and more contented [17] than non-married peo-

ple. Seemingly, greater health status is associated with

marriage, or is it that those with greater health status are

more likely to get married than those who are unhealth-

ier? A study by Elwert & Christakis [18] unearthed that

the hazard ratio of mortality upon bereavement for a

spouse was 1.17 for men, indicating that men upon the

death of their spouses are 17% more likely to die them-

selves. Embedded in this finding is the benefit of mar-

riage for men, which is corroborated in research con-

ducted by Havens [19], which found that women live

longer after the death of their spouse than men [20,21].

Another research found that the odds ratio of health

status for married men in Jamaica was greater than for

non-married men up to 75 years, while for the non-mar-

P. A. Bourne / HEALTH 1 (2009) 332-341

333

ried women up to 75 years the odds ratio was greater

than that for married women. The converse was the case

post 75 years, with the odds of good health status for

women being significantly more than for men [22]. In

Jamaica for 2007, life expectancy at birth for men was

69 years and 74 years for women [23], indicating that

over the life span of the average Jamaican man, marriage

will provide him with greater health status than if he

were not married. Embedded in that finding is the fact

that mortality is greater for men than women, which

means that many men will be hospitalized before death.

One study found that for an elderly couple, on the hos-

pitalization of one, mortality rates increased for the other,

and that this was even greater for men than for women

[24].

The literature has provided a partial understanding of

the explanation for the better health status and/or low-

ered mortality ratios of married over non-married people.

While answering some issues, a number of other issues

are still unresolved from the literature. These unresolved

issues include 1) whether married people are healthier

because those who are likely to become married are

healthier, 2) whether men benefit more from marriage

than women, 3) whether marriage is the explanation for

better self-rated health (subjective wellbeing) and 4)

whether there are some protective effects of marriage.

With the literature providing some understanding of the

disparity in the general health status of married over

non-married people, this still does not reduce the unre-

solved issues, and can we use a wholesale sociological

explanation provided by the developed nations with dif-

ferent socialization, customs, practices, sociopolitical

milieu and economic base, or even similar developing

nations experiences, for an understanding of married

people in Jamaica? Concurrently, can we use the general

literature to formulate policies for an understanding of

married people in Jamaica? One of the questions that

was previously asked has been addressed in a longitudi-

nal study that found that happier singles were more

willing to get married [25], suggesting that marriage

attracts singles who have greater subjective wellbeing,

and this accounts for some degree of greater odds ratios

of married people being healthier than unmarried people.

A study among married and non-married men found that

mortality was greater for the latter than for the former

[26]; and this was also the case among women [27].

An understanding of other societies’ experiences un-

doubtedly aids in fashioning a framework for an under-

standing of what takes places in Jamaica. However, it

cannot be relied upon as the sole explanation for hap-

penings in Jamaica. One of the goals of public health

policy formulation is its reliance on empirical research,

in guiding decisions on how to operate because there is

an understanding of the issue at hand. All societies,

while being governed by some fundamental similarities,

have dissimilarities which must be understood in order

to prescribe appropriate measures to address those con-

cerns embedded within the particular society. An exten-

sive research of the literature found no study that has

sought to examine the rationale behind the fact that mar-

ried people record greater health status, in particular the

men, as an approach to understanding how non-married

men’s health status can be improved, and how general

health status can be increased in Jamaica. Therefore

public health policies have been structured around the

literature and studies in other geopolitical zones; al-

though those societies have different cultural practices,

customs and jurisprudence from that found in Jamaica. It

is within this limitation that the current study emerged,

to provide an explanation for what constitute the health

status of married Jamaicans, in order to guide policy

formulation and framework in this society. The objec-

tives of the current study are 1) to examine the sociode-

mographic characteristics of married people in Jamaica,

2) to evaluate self-rated health status of married people

in Jamaica, 3) to determine the factors that account for

the good health status of married people and 4) to pro-

vide public health practitioners with empirical studies

that can be used to formulate policies for men in par-

ticular non-married men in Jamaica.

2. MATERIALS AND METHODS

Secondary cross-sectional survey data were collected

jointly by the Planning Institute of Jamaica (PIOJ) and

the Statistical Institute of Jamaica (STATIN) between

May and August 2007. The survey is called the Jamaica

Survey of Living Conditions (JSLC), and it was primar-

ily collected by the aforementioned institutions as policy

assessments for programmes and policies instituted by

the government of the country. The JSLC began in 1988,

and it has been an annual survey since then. It is stan-

dard practice that the JSLC’s sample be a proportion (i.e.

one third) of the Labour Force Survey (LFC).

The last JSLC was conducted in 2007 with the sample

being 6,783 respondents. Of the sample of respondents,

15.7% (n = 1,056 respondents) were used for this study.

The only criterion for selection was being married.

Stratified random sampling was used to randomly select

a nationally representative sample for the survey. The

design was a two-stage stratified random sample with a

Primary Sampling Unit (PSU) and a selection of dwell-

ings from the primary units. The PSU is an Enumeration

District (ED), which constitutes a minimum of 100 resi-

dences in rural areas and 150 in urban areas. An ED is an

independent geographic unit that shares a common

boundary. This means that the country was grouped into

strata of equal size based on dwellings (EDs). Based on

the PSUs, a listing of all the dwellings was made, and

this became the sampling frame from which a Master

P. A. Bourne / HEALTH 1 (2009) 332-341

334

Sample of dwellings was compiled, which in turn pro-

vided the sampling frame for the labour force. A total of

620 households were interviewed from urban areas; 439

from semi-urban areas and 935 from rural areas, which

constituted 6,783 respondents. One third of the Labour

Force Survey (i.e. LFS) was selected for the JSLC. The

sample was weighted to reflect the population of the

nation. The non-response rate for the survey was 27.7%.

2.1. Data Collection

The JSLC is a modification of the World Bank’s Living

Standards Measurement Study (LSMS) household survey

[22]. The instrument was a questionnaire. Face-to-face

interviews over the aforementioned period were used to

collect the data. A structure questionnaire was used, and

interviewers were trained and subsequently deployed to

collect the data. The questions covered demographic cha-

racteristics, household consumption, health, education,

housing, social welfare and related programmes, and in-

ventory of durable goods. In 2007, a question on health

status was included in the normal health conditions:

length of illness, health insurance coverage, health care-

seeking behaviour, medical expenditure, typology of

health care utilization and immunization coverage of

children.

2.2. Statistical Analysis

Data were stored, retrieved and analyzed using SPSS-PC

for Windows version 16.0. Descriptive statistics were

used to provide background information on the sample.

Chi-square analyses were used to examine the associa-

tion between non-metric variables for area of residence

and gender of respondents. Analysis of variance and

t-test were also used to examine bivariate association.

Logistic regression analyses examined the relationship

between good health status and some socio-demographic,

economic and biological variables. Forward stepwise

logistic regression was used to build the model of good

self-reported health status for the current study.

The correlation matrix was examined in order to as-

certain if autocorrelation and/or multicollinearity existed

between variables. Based on Cohen and Holliday [28]

correlation can be low (weak)—from 0 to 0.39, moder-

ate—0.4-0.69, and strong—0.7-1.0. This was used to

exclude (or allow) a variable in the model. Any correla-

tion that had at least moderate was excluded from the

model in order to reduce multicollinearity and/or auto-

correlation between or among the independent variables

[29-35]. Another approach in addressing and/or reducing

autocorrelation is that all variables identified from the

literature review were included in the model, with the

exception of those in which the percentage of missing

cases was in excess of 30%. Odds Ratios (OR) were

used for the interpretation of each significant variable.

2.3. Model

Many factors are correlated with health status, and so the

best statistical technique is multivariate analysis [36-38]

and not bivariate technique. In keeping with the

multi-nature of health status, the current study will use

multivariate analysis which is captured in Equation 1

Ht=f(Ai, Gi, HHi, ARi, lnY, EDi, MRi, Si, ∑MCt, SRIi, εi)

(1)

where Ht (i.e. self-rated good current health status in

time t) is a function of age of respondents Ai; sex of in-

dividual i, Gi; household head of individual i, HHi; area

of residence, ARi; logged income, lnC; Education level

of individual i, EDi; marital status of person i, MRi; so-

cial class of person i, Si; summation of medical expen-

diture of individual i in time period t, MCt; self-reported

illness, SRIi, and an error term (i.e. residual error).

2.4. Measures

An explanation of some of the variables in the model is

provided here. Self-reported illness status is a dummy

variable, where 1 = reporting an ailment or dysfunction

or illness in the last 4 weeks, which was the survey pe-

riod; 0 = if there were no self-reported ailments, injuries

or illnesses. While self-reported ill-health is not an ideal

indicator of actual health conditions because people may

underreport, it is still an accurate proxy of ill-health and

mortality [39,40]. Health status is a binary measure

where 1 = moderate to excellent health; 0 = otherwise,

which is determined from “Generally, how do you feel

about your health”? Answers to this question are on a

Likert scale ranging from excellent to poor. Studies have

shown that self-rated health status can be dichotomized

into good and poor health [39,41]; but Bourne [22] and

Finnas et al. [41] noted that there are issues surrounding

this approach. Bourne [22] opined that the dichotomiza-

tion of health status for females is acceptable; however

there are some challenges when this is done for males.

Both Bourne and Finnas et al. found that the inclusion of

moderate health status in poor self-reported health status

is not best; and this explains the rationale for the inclu-

sion of moderate health into good health status for this

study. Medical care-seeking behaviour was taken from

the question “Has a health care practitioner, healer, or

pharmacist been visited in the last 4 weeks?” with there

being two options—Yes or No. Medical care-seeking

behaviour therefore was coded as a binary measure

where 1 = Yes and 0 = Otherwise.

3. RESULTS

3.1. Demographic Characteristics of

Sample and Bivariate Analyses

The sample was 1,056 respondents: 49.4% males and

P. A. Bourne / HEALTH 1 (2009) 332-341

335

Table 1. Demographic characteristics of sample, n=1,056.

Characteristic N Percent

Sex

Male 522 49.4

Female 534 50.6

Area of residence

Urban 236 30.9

Semi-urban 217 20.5

Rural 513 48.6

Self-reported illness

Yes 259 24.6

No 795 75.4

Social class

Poorest 20% 153 14.5

Poor 181 17.1

Middle 185 17.5

Wealthy 238 22.5

Wealthiest 20% 299 28.3

Medical care-seeking behaviour

Yes 173 65.3

No 92 34.7

Health insurance coverage

Public 239 22.8

Private 57 5.4

Other 61 5.8

None 691 65.9

Self-rated health status

Very good 301 28.7

Good 440 42.0

Moderate (or fair) 221 21.1

Poor 72 6.9

Very poor 14 1.3

Age Median (Range) 48.0 years (79 years)

Length of illness Median (Range) 7 days (0 )

50.6% females. Of the sample, 24.6% reported an illness;

48.6% dwelled in rural areas; 34.1% had health insur-

ance coverage; 65.3% visited health care practitioners

(including healers) in the last 4 weeks; 70.7% indicated

at least good self-rated health status, and the median age

of marriage was 48.0 years (Range = 79 years); while

the median length of illness was 7 days (Range = 0 day)

(Table 1). Of those who reported an illness, 72.4% indi-

cated that the ailment was diagnosed by a medical practi-

tioner. The illnesses were colds (6.8%); diarrhoea (0.8%);

asthma (3.8%); diabetes mellitus (18.2%); hypertension

(34.5%); arthritis (9.1%); and 19.3% indicated an un-

specified illness.

A significant statistical difference was found between

the sexes and age of respondents. The mean age of males

was 53.7 years (SD = 15.3 years) compared to 48.0 years

(SD = 14.5 years) for females—t statistic = 6.32, P <

0.001. A statistical correlation was found between self-

reported illness and sex of respondents—χ2(df = 1) = 8.21,

P = 0.003. Twenty-one percent of males reported an ill-

ness compared to 28% of females. Concurrently, no sig-

nificant statistical correlation existed between self- re-

ported diagnosed illness and sex of respondents—χ2(df =

7) = 7.70, P = 0.36. Similarly none was found between

medical care-seeking behaviour and sex of respondents

—χ2(df = 1) = 0.02, P = 0.50. 64.9% of males visited

ahealth care practitioner (including healer) in the last 4

Table 2. Self-reported illness by sex controlled for by area of

residence.

Sex

Area of

residence

Self-reported

illness Male Female

Total

Yes 19.4 23.1 69

Urban

No 80.6 76.9 256

Total 165 160 325

Yes 20.0 20.7 44

Semi-urban

No 80.0 79.3 172

Total 105 111 216

Yes 21.9 34.7 146

Rural

No 78.1 65.3 367

Total 251 262 513

weeks compared to 65.6% of females. A cross tabulation

between self-rated health status and sex revealed no sig-

nificant statistical association—χ2(df = 4) = 3.33, P =

0.51.

A moderate relationship was found between self-rated

health status and age controlled for sex of respondents,

correlation coefficient = 0.48; P < 0.05. Furthermore, the

mean age of respondents who indicated very good health

status was 43.4 years (SD = 11.2 years); 48.8 years (14.1

years) for those who recorded good health status; 59.0

years (SD = 14.7 years) moderate health status; 65.8

years (SD = 13.5 years), poor health status; and 65.8

years (SD = 10.6 years) for those with very poor health

status—F statistic [4, 1043] = 75.1, P < 0.001. Concur-

rently, a cross-tabulation between self-reported illness

and sex of respondents controlled by area of residents

revealed that the significant statistical difference was

found between rural males and females—χ2(df = 1) =

10.3, P = 0.001: 34.7% of rural females reported an ill-

ness compared to 21.9% of rural males (Table 2).

A cross-tabulation between self-reported illness and

area of residence revealed a significant statistical rela-

tionship—χ2(df = 2) = 8.20, P = 0.017: 28.5% of rural

respondents reported an illness compared to 21.2% of

urban and 20.4% of semi-urban respondents. Similarly a

significant statistical association existed between

self-reported diagnosed illness and area of resi-

dence—χ2(df = 14) = 24.93, P = 0.035. Hypertension

was greatest among rural respondents (40.9%) as well as

asthma (4.7%); unspecified ailments were greatest

among urban residents (28.6%) as well as diabetes mel-

litus (21.4%), and colds were greatest among semi-urban

respondents (17.8%) (Table 3).

A significant statistical correlation existed between

self-rated health status and area of residence—χ2(df = 8) =

24.8, P< 0.001. Rural respondents recorded the greatest

very poor health status (2.2%) compared to semi-urban

(0.0%) and urban dwellers (0.9%). With respect to poor

P. A. Bourne / HEALTH 1 (2009) 332-341

336

Table 3. Self-reported illness by area of residence.

Area of residence

Urban Semi-urban Rural Total

Characteristic

% % % %

Self-reported diagnosed illness

Cold 2.9 17.8 5.4 6.8

Diarrhoea 0.0 0.0 1.3 0.8

Asthma 2.9 2.2 4.7 3.8

Diabetes mellitus 21.4 15.6 17.4 18.2

Hypertension 21.4 33.3 40.9 34.5

Arthritis 11.4 8.9 8.1 9.1

Unspecified 28.6 15.6 16.1 19.3

Non-diagnosed 11.4 6.7 6.0 7.6

Total 70 45 149 264

Table 4. Self-reported health status by area of residence.

Area of residence

Urban Semi-urban Rural Total

Characteristic

% % % %

Self-rated health status

Very good 31.6 31.3 25.8 28.7

Good 42.1 46.7 39.9 42.0

Moderate 21.7 17.3 22.3 21.1

Poor 3.7 4.7 9.8 6.9

Very poor 0.9 0.0 2.2 1.3

Total 323 214 511 1,048

Table 5. Self-rated health status by social class (in %).

Social class

Poorest 20% Poor Middle Wealthy Wealthiest20% Total

Self-reported health status

% % % % % %

Very good 20.5 17.7 26.2 34.9 36.3 28.7

Good 42.4 42.5 43.7 39.9 42.0 42.0

Fair 23.2 28.7 22.4 18.1 16.9 21.1

Poor 12.6 8.3 7.7 5.0 4.1 6.9

Very poor 1.3 2.8 0.0 2.1 0.7 1.3

Total 151 181 183 238 295 1048

Table 6. Self-rated health status by self-reported illness.

Self-reported illness

Yes No

Total

Characteristic

% % %

Self-rated health status

Very good 4.3 36.8 28.8

Good 24.8 47.5 41.9

Moderate 45.0 13.3 21.1

Poor 21.7 2.0 6.9

Very poor 4.3 0.4 1.3

Total 258 788 1,046

P. A. Bourne / HEALTH 1 (2009) 332-341

337

Table 7. Self-rated health status by self-reported diagnosed illness (in %).

Self-reported diagnosed illness

Cold Diarrhoea Asthma Diabetes Hypertension Arthritis Unspecified No Total

Self-rated

health status

% % % % % % % % %

Very good 22.2 0.0 0.0 2.1 3.3 0.0 3.9 10.0 4.6

Good 44.4 0.0 22.2 20.8 17.6 33.3 29.4 40.0 25.5

Moderate 33.3 50.0 33.3 50.0 47.3 41.7 43.1 35.0 44.1

Poor 0.0 0.0 33.3 20.8 27.5 25.0 21.6 10.0 21.7

Very poor 0.0 50.0 11.1 6.3 4.4 0.0 2.0 5.0 4.2

Total 18 2 9 48 91 24 51 20 263

Table 8. Logistic regression: Correlates of good self-rated health status of married

people in Jamaica.

Explanatory variables OR Std. Error 95% CI R2

Self-reported illness 0.12 0.18 0.01-0.17 0.325

Age 0.94 0.01 0.93-0.96 0.102

Log income 1.32 0.12 1.05-1.66 0.010

Sex (male) 1.63 0.18 1.14-2.32 0.007

Chi square = 383.2

LR = 873.9

health status rural dwellers recorded the greatest per-

centage (9.8) and semi-urban (4.7%) and urban respon-

dents (3.7%) (Table 4). Conversely, rural respondents

recorded the lowest very good health status (25.8%)

compared to other residents.

A statistical association existed between self-reported

health status and social class—χ2(df = 16) = 49.5, P <

0.001. The wealthiest 20% of respondents recorded the

highest very good self-reported health status (36.3%)

compared to the wealthy (34.9%); middle class (26.2%);

poor (17.7%) and the poorest 20% (20.5%) (Table 5).

Conversely, the middle class recorded the least very poor

health status compared to the other social classes. How-

ever, as the social class increased from poorest 20% to

wealthiest 20%, the poor health status of the individual

declined (Table 5).

There is significant correlation between self-reported

health status and self-reported illness—χ2(df = 4) = 318.6,

P < 0.001. A moderately strong association was found

between the two mentioned variables, coefficient corre-

lation = 0.48 (Table 6). Based on Table 6, 4.3% of those

who indicated having an illness recorded very good

health status compared to 36.8% of those who did not

indicate an ailment. Of those who indicated having an

illness in the last 4 weeks, 26% recorded at least poor

health status compared to 2.4% of those who had not

indicated an ailment.

A statistical correlation existed between self-rated

health status and self-reported diagnosed illness—χ2(df =

28) = 47.9, P=0.011. The association between the two

variables is a moderate one, correlation coefficient =

0.39. Respondents who indicated chronic illness (i.e.

diabetes mellitus, hypertension and arthritis) were more

likely to record moderate health status. Of those with

chronic illnesses, 231.9% of hypertensive respondents

indicated at least poor health status compared to 27.1%

of the diabetics, and 25% of the arthritic respondents.

Forty-four percent of asthmatic respondents indicated

that their health status was at least poor health status

(Table 7). Less than 5% of respondents who indicated a

chronic illness recorded very good self-reported health

status. Furthermore, when self-rated health status and

self-reported illness were controlled by sex and age of

respondents, the correlation coefficient increased to 0.43,

P < 0.001. And when self-rated health status and

self-reported illnesses were controlled by sex, age and

social class of respondents, the correlation coefficient

increased even further to 0.44, P < 0.001.

3.2. Multivariate Analysis

The correlates of good health status (including moderate

health) of respondents in descending order were self-

reported illness (OR = 0.12, 95%CI = 0.01-0.17); age

(OR = 0.94, 95%CI = 0.93-0.96); income (OR = 1.32,

95%CI = 1.05-1.66) and sex of respondents (Or = 1.14-

2.32)—χ2(df = 4) = 383.2, P < 0.05. The four variables

accounted for 44.4% of the explanatory power of the

model, with self-reported illness accounting for 32.5%

of the explanatory power. Marital status, education, so-

cial class, area of residence and other variables that were

identified as significant in relation to self-reported health

status using bivariate analysis, dissipated when they

were included among other variables in a general collec-

tion of variables (Table 9).

P. A. Bourne / HEALTH 1 (2009) 332-341

338

4. DISCUSSION

The current study found that the mean age for married

people in Jamaica was 50 years. On disaggregating the

data it was revealed that the mean age for married fe-

males was 6 years less than that for their male counter-

parts (54 years). This finding adds some explanation to

the disparity in life expectancy of the sexes in Jamaica,

as females are expected to live 6 years longer than males

[23,42] and with females who are married 6 years earlier

than males; this indicates that the advantage of good

health status in married couples does not dissipate the

life expectancy gap between the sexes. In wanting to

understand why married people have better health status,

we found that 51% of married Jamaicans were at least

wealthy which more than for the unmarried populace is.

Embedded in this finding is the access to financial re-

sources which are not available to unmarried Jamaicans,

and this accounts for greater health insurance coverage

(34%) compared to the populace (21%); less time spent

in illness (7 days compared to 10 days for the popula-

tion), and they seek more preventative measures, which

accounts for the lower time spent receiving medical care.

Comparatively 16 out of every 100 Jamaicans reported

an illness in 2007 and this was 25 out of every 100 for

married people, which indicates two things: 1) their

willingness to recognize that they are experiencing

ill-health, and 2) the identification of this group’s will-

ingness to first accept illness means that they address

this more than unmarried people before severity comes

into focus, which accounts for the lowered number of

days recorded for them in illness.

In a study conducted by Hambleton et al. [36], on eld-

erly Barbadians, it was found that self-reported current

illness accounted for 87.7% of the variability in

self-rated health status, and in this research we found it

accounted for 73%. Embedded in these findings is the

strong importance of illness on self-rated health status.

Concurrently, in this paper, we found that a married re-

spondent who indicated an illness was 0.12 times less

likely to report moderate-to-excellent health status. In

addition, the current study found that the mean age of

married persons who reported very good self-rated

health status was 43 years and the mean age increased as

the self-reported health status declined to very poor

health: the mean age for those with very poor health

status was 66 years and 59 years for those with moderate

health.

Married people are wealthier, older, with more finan-

cial resources at their disposal, and they have 1) more

choices; 2) more maturity; 3) more social support; and

these cushion the effect of economic hardship which is

likely to be experienced by unmarried and single people.

Income plays a critical role in determining the health

status of people [43] and married people have more of it

than unmarried people, which puts them in the advan-

tage category of the health status scale. Marmot [43]

opined that poverty translated into poor health from the

choice of nutrition, milieu and the choice of freedom,

and this helps in the explanation of the advantage that

income plays in aiding improvements in health status.

The current study concurs with Marmot and other stud-

ies in that income is correlated with good health status;

but disagrees that the correlation is a strong one. The

current work showed that income only accounted for 1%

of 44.4% explanatory power of good health status of

married Jamaicans. Although income opens access to

better physical milieu, choice of medical care, education,

freedom, general choices and entertainment options, it

cannot buy health and it plays a secondary role in im-

proving one’s moderate-to-excellent health status.

The next variable that is correlated with moderate and

beyond health status is age of respondents. The age of

respondents accounted for 10.2% of the variability in

health status in this study. The current study found a

correlation between poor health status and age of re-

spondents, and with 50% of the sample being 48 years;

25% being 39 years and 75% being 62 years and below,

the better health status is carried across the age cohorts

even into older ages for married Jamaicans. Thirty-five

percent of the sample recorded having diabetes mellitus

compared to 12% of the population; 34.5% had hyper-

tension compared to 22.4% of the population and 9.1%

had arthritis compared to 8.8% of the population; yet

still 71% indicated at least good health and 92% at least

moderate health status. This means that preventative care

is high among married respondents. It is this preventa-

tive mechanism which separates and accounts for some

of the health disparity between married and unmarried

people. Within the context of the health conditions

among married people, preventative lifestyle practice is

one of the measures that aid in the health inequality be-

tween this cohort and unmarried people, but it also is the

choice.

A study of 1,147 Jamaicans revealed that there was no

significant difference between the health statuses of the

sexes [11]. However, in the current study, married males

were 1.32 times more likely to report moder-

ate-to-excellent health status compared to married fe-

males. This begs the question, why life expectancy be-

tween the sexes has increased to 6 years since 2004?

Since 1988, females have been reporting more illnesses

than males, yet still they outlive males on an average by

6 years; it means therefore that marriage increases the

current health status of males. The findings of this study

revealed that 21 out of every 100 married men reported

an illness compared to 28 out of every 100 married

women and with the context that the latter group is out-

living the former, it can be extrapolated from this study

that men are either under-reporting their ill-health or that

P. A. Bourne / HEALTH 1 (2009) 332-341

339

women are more impaired by ill-health than men. A

study by Herzog [44] found that elderly women are more

impaired by their health problems than men, and that

men are more likely to die from them, which goes to the

crux of their under-reporting their illness and so they are

unable to receive adequate care before severity sets in.

Underscoring the under-reporting of ill-health of men,

Schoen et al. found [45] that men in general tend to be

more stressed and less healthy than females, and further

argued that men can use denial, distraction, alcoholism

and other social strategies to conceal their illness or dis-

abilities. It should be noted here that there was no sig-

nificant statistical difference between medical care

seeking behaviour of married men (65%) and women

(66%), which indicated that men benefit from marriage

which is accounted for in their choice to visit health care

practitioners (including healers): in 2007, 63% of the

male population visited a health care practitioner com-

pared to 68% of their female counterparts. Marriage

therefore benefits the health status of males.

Despite the strong influence of culture on men’s social

behaviour, the current study highlights that men’s un-

willingness to seek medical care can be reversed. In the

general population women outnumber men by 5%; but

while married, no statistical difference was found be-

tween visits to medical care facilities by the sexes. This

suggests that during marriage men will disregard to

some degree the culture for the family, as they see their

health and longevity as an important family success.

Although this study did not examine the psychological

status of men and women during marriage, we can ex-

trapolate that some aspect of this changes for men, and

we see them attending medical care facilities in milieu,

which signals weakness and lowered masculinity. Young

males are socialized to be strong, masculine and brave,

and they are taught to shun the appearance of weakness.

One such case is illness. The male child therefore as a

part of his socialization is supposed to accept that illness

is correlated with weakness, and that he must not be

willing to participate in health care seeking behaviour

unless it is unavoidable. This definition of unavoidable

is embedded into severity, and being unable to rectify the

complaint outside of health care practitioners. This gen-

der role of the sexes is not limited to Jamaica or the

Caribbean, but a study carried out by Ali and de Muynck

[46] on street children in Pakistan found a similar gender

stereotype. A descriptive cross-sectional study carried

out during September and October 2000, of 40

school-aged street children (8-14 years) revealed sever-

ity of illnesses, and only when ill-health threatened fi-

nancial opportunities, males sought medical care. How-

ever, married men will utilize health care facilities more

than other men, and this is one of the ways in which they

are able to have better health status, as they would be

more likely to rectify ailments before severity sets in and

premature death results. Recognition of the illness at that

time is difficult to cure or averted.

Another aspect is the psychological component. It can

be deduced from the current findings that marriage pro-

vides positive psychological benefits to both parties that

are embedded in mortality and suicide data. A study by

Kposowa [47] found that divorced and separated people

have a greater rate of suicide than married people; and

that divorced and separated men are 2.4 times more

likely to commit suicide than their female counterparts.

One study found that premature mortality from pneumo-

nia was 7 times higher for divorced men than married

men [48]. Lynch [48] found that divorced or separated

men underwent inpatient or outpatient psychiatric care

10 times more often than married men. In Jamaica, the

suicide rate disparity between the sexes was 9 times

more for men than for women [49]; and while this was

not disaggregated by sex from the literature it can be

extrapolated that marriage provides psychological bene-

fits to men that aid in their better health status, and in-

crease the likelihood of their decision to seek medical

care, unlike their unmarried counterparts. Like men,

marriage provides women with psychological benefits.

A study by Stroup & Pollock [50] found that divorced

women experienced a 30% decline in income compared

to a 10% reduction for their male counterparts. Divorce

therefore sees a financial separation from particular life-

style choices by the women, which also means that the

children as well as the divorced women must now alter

their choices owing to this new reality. The financial

instability which accompanies divorce denotes that

women will be more pressured to carry out some of the

roles that previously were left to their husbands. Hence,

this role, coupled with the financial challenge of the

separation from the man’s resources, demonstrates why

divorced women experience more depressive bouts than

their married counterparts [51]. For women, the benefits

of marriage are more financial, as the literature showed

that women, on separation or divorce, experienced

greater levels of depression [52-54]. Marriage therefore

benefits both sexes. However, like Smith & Waitzman’s

[3], and Lillard & Panis [2], this study concurs that the

health gains from marriage for men were greater than

those for women, and the financial benefits greater for

women than men. The financial gains for women from

marriage were also documented in a study by Prause et

al. [55] which found that married women had higher

economic wellbeing than divorced females, and this in-

dicates the gains that marriage affords them.

5. CONCLUSIONS

Marriage provides greater access to more socioeconomic

resources for its participants, as well as increasing men’s

P. A. Bourne / HEALTH 1 (2009) 332-341

340

unwillingness to visit medical care practitioners. Al-

though married people have greater health status, the

benefits are different based on the sex of the individual.

For men the health gains from marriage are greater than

for women; while women benefit more from the finan-

cial access to resources.

6. CONFLICT OF INTEREST

The author has no conflict of interest to disclose.

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