Time for Health: Time as a social determinant of health & health inequity

In the modern world, time poverty and income poverty can be closely related, particularly for those without the financial resources to outsource tasks of daily living (cleaning,shopping, childcare). Celia Green reports on the impact of being 'time poor' on health.

“Time is money”, the famous quote from Benjamin Franklin in 1748 has not lost its resonance today. In the increasingly hectic market economy in which we live, time has become a valuable commodity which is counted and controlled. But if time is money, might we also be able to look at other dimensions of time and the idea that time is health? In February 2015 at Vic Health researchers Associate Professor Lyndall Strazdins, Dr Jane Dixon and Dr Gemma Carey, from the Australian National University, Centre for Epidemiology & Population Health presented a seminar on “Time as a social determinant of health & health inequity”.

A health promotion campaign designer in 2011 remarked:

“…in health terms, time is almost like a prescription…like two fruit, five veg…and thirty minutes of physical activity”

Health promotion professionals have long been aware that good nutrition and daily physical activity is the key to reducing modern health epidemics such as type 2 diabetes, obesity and heart disease. Interestingly research has shown that lack of time is the number one reason people report not exercising, not eating nutritious food and being reluctant to walk, cycle or use public transport. People are simply “too busy” to be healthy. Recently health researchers have begun to look at this emerging trend and to examine time as a social determinant of health.

Associate Professor, Lyndall Strazdins commented that the way in which resources in a society are distributed, from the material to the social, is central to how societies shape health. Widely accepted social determinants of health include variables such as income and income distribution, education, unemployment and job security, and employment and working conditions. Could time also be seen as a social determinant of health? If so we need to understand time scarcity, find ways to address time constraints and seek to address time inequities.

The Problem of Time

Australia was one of the first countries where workers petitioned for the right to an eight hour working day. A banner created for the movement in the 1800s exemplified the idea of 8 hours for work, rest and recreation, with proponents arguing that this was the best way to structure time to have a truly civil society. Since the 1800’s when these ideas were first introduced, society has undergone significant social change. Labour force participation between men and women has seen a dramatic shift of women into the workforce. In the 1970s most families were still single breadwinners with males working around 45 hours a week. In 2000 most families were dual-earners contributing approximately 75 hours of work into the market. We thus need to shift away from the idea that time is an individual concept and begin to see time a commodity which is traded and shared in households and families. With more women transferring their time into the labour market studies have shown that other time intensive activities such as unpaid domestic work are not correspondingly shifted away, instead they are “piled up” on top of paid work. This has led to an increasing percentage of women reporting that they “often” or “always” feel rushed or pressed for time.

What do people do when they perceive they have less time? “Saving” time by rushing, multi-tasking, eating fast food, and doing everything “quickly” are common responses. The researchers from ANU are investigating the limits of just how fast, and how much people can do and what are the implications for health. Thinking about time is complicated. As St Augustine said “What then is time? If no one asks me I know; if I wish to explain it to one who asks, I know not.” The experience and value of time is shaped by factors such as history, culture and the market. In our market economy with time as a valued commodity efficiency is the new virtue. As associate professor Lyndall Strazdins says “doing more in less time has become something we accept as an imperative, and essential for workplaces to keep a competitive advantage. But it also changes the value of time and how people are experiencing time”. A current study on time scarcity in Australian families using data from a large representative sample of Australian households has shown that time poverty (80 hours or more spent on work, care, commuting) increases the odds for physical inactivity, and that rushing/time pressure also correlates with greater physical inactivity and poor mental health. Additionally it was shown that increased inactivity and decreased consumption of fruit and vegetable was related to low income and rushing. So people who are “rushing” have actually been shown to be less physically active and eat less fruit and vegetables – a significant finding for health promotion.

Work time

Workplace case studies have also highlighted the link between time and health. In regards to health promotion in the workplace, financial costs were seen as much more acceptable than time costs. Employers reported that they would prefer to give their employees $100 than time off during a lunch break to pursue health activities. Work time scheduling also impacts health. In Australia over thirty percent of the workforce works some or all hours at night and in an average week individual employees may work different shifts, days of the week or split shifts. These types of fragmented work practices can mean that it is hard for people to achieve rhythm and routine in their lives. This asynchronicity can have flow on effects for health such as in the area of nutrition. Research shows that eating with others is preferable to solo eating as it helps slow down ones rate of food intake. Slow eating typically leads to lower calorie intake in comparison to fast eating. Planning meals rather than spur of the moment buying leads to healthier food purchases and cooking at home tends to produce food with less energy density than commercially prepared convenience foods. When people work irregular hours or at night normal social patterns such as eating meals as a household are disrupted.

Get with the Times?

If public health is to succeed and social determinants of health addressed there needs to be a conceptualisation of time as a health resource, and a resource that for some, is scarce. Future public health research must include time as a determinant of health and health promotion strategies include time as a factor for consideration in intervention design in their interventions. The challenge for policy makers will be to develop policies which address time barriers and acknowledge time inequalities. Time constraints linked to transport, work, care and health services must be incorporated into the public health framework if we are to achieve health equality.

Celia Green is a Phd student at the National Centre for Epidemiology and Public Health at ANU

Posted by Sarah Toohey