Social resources, pension policy, and older adults’ mental, physical, and cognitive health: A cross-national comparison between China, England, Mexico, and the United States

Population aging is accelerating across the globe. A cross-national comparison
perspective is imperative and important because such comparison provides an opportunity to
contrast experiences of different countries and learn from each other. Promoting healthy aging is
one of the ultimate goals of social policies related to older adults. Guided by the integrative
theoretical framework based on the social ecological model and life course perspective, this
dissertation investigates the relationship of social resources with older adults’ physical, mental, and cognitive health in China, the United States, England, and Mexico using the Harmonized
Health and Retirement Study (HRS) dataset and its international sister studies. Four countries
were chosen primarily based on their geographic location, different level of economic
development, and availability in the Harmonized HRS dataset. The dissertation comprises three
projects.The first project explored the relationship between retirement/pension and depressive
symptoms of older adults across the life course. Regression models were estimated using
structural equation modelling. Results indicated that retirement was associated with higher levels
of depressive symptoms for the U.S. and with lower levels of depressive symptoms for Mexico
and England. Having a public pension was associated with lower levels of depressive symptoms
for Mexico and with higher levels of depressive symptoms for the U.S. and China. Having a
private pension was associated with lower levels of depressive symptoms for the U.S., China, and England. The study showed that continuity theory demonstrates cross-national variation in
explaining the association between retirement and depressive symptoms. The second project tested the cross-cultural applicability of the shared resource
hypothesis in explaining mental health concordance among older couples. Dyadic data were
analyzed to examine the actor and partner effects of demographic, health, and household
variables on depressive symptoms using both multilevel model and structural equation model. Results indicated both husbands’ and wives’ depressive symptoms were associated with their
own and the spouses’ social and health status. Most couple-level resources were nonsignificant
predictors for Chinese and Mexican couples’ concordance, but having more social and financial
resources was associated with higher concordance among British and American couples. It is
concluded that the shared resource hypothesis was more applicable to depressive symptom
concordance within couples in the U.S. and England, but not in China and Mexico. The third project examined health inequalities between genders and countries in the
context of cumulative dis/advantage (CDA) and welfare state theories. Regression models were
fitted to examine the moderation roles of country and gender. Health patterns across age groups
were cross-examined by linear regression models and negative binomial models. Results
indicated older Chinese and Mexican respondents had poorer health status than their British and
American counterparts consistently except for Mexicans’ memory. Cumulative health gaps
between developing and developed countries existed only for functional ability. However, there
is no evidence of gender gaps in health status across age groups. CDA explains the increasing
gaps of functional ability across age groups between countries. General health and mental health, however, may depend more on individuals’ intrinsic capacity and human agency. Findings from these interconnected projects corroborate the person-in-environment
perspective and suggest older adults’ health is influenced by multilevel factors including micro
demographic characteristics, meso household resources, and macro culture/policy contexts
across countries. The cross-national comparisons provide a unique perspective on variables
associated with older adults’ health in different societal contexts. Suggestions were
recommended for clinical practice to work with diverse aging population and for decision
makers to improve policy design, with the ultimate goal to promote healthy aging and reduce
health disparity in later life.