Exploring the impacts of social determinants of health over the life-course on well-being in widowhood for older Greek migrants in urban and rural South Australia

Author: Georgia Panagiotopoulos

Panagiotopoulos, Georgia, 2016 Exploring the impacts of social determinants of health over the life-course on well-being in widowhood for older Greek migrants in urban and rural South Australia, Flinders University, School of Medicine

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This thesis examines the impact of widowhood on health and well-being among older first-generation Greeks in Australia. A life-course and social determinants of health perspective informed this qualitative study. In-depth interviews (n=41), mostly conducted in Greek, allowed for inclusion of those less proficient in English, enabling the Greek speaking, Greek background researcher to employ insider linguistic and cultural knowledge to gain rich accounts of widowhood and its effect on health. Social determinants considered in this study were ethnicity, gender, residential location, socio-economic status, social support and capital, and social inclusion and exclusion. The findings are reported in the following main areas: demographics, social inclusion and exclusion and social support, the widowhood experience, and health and well-being. The study built upon limited existing literature to provide a nuanced and timely exploration of older Greek migrants’ widowhood experiences and later-life well-being.

The study found that most interviewees felt socially excluded from mainstream English-speaking Australian society. Interviewees were generally included in their Greek communities, which had implications for their later-life sense of identity, notions of safety and homeland, and socialising in widowhood. This thesis describes how processes of life-course exclusion across different areas of life and communities influenced older widowed Greek migrants. Continuous efforts to maintain ‘Greekness’ were often not conducive to wider societal inclusion, and many simply did not have opportunities to amass language and capital to facilitate social mobility in the wider English-speaking Australian community. Exclusion represented an added form of life-course disadvantage, compounding factors such as earlier experiences of poverty, lower familial socio-economic status and educational attainment, migration, and often adverse work conditions in Australia. For most interviewees, ageing and widowhood exacerbated their sense of exclusion.

Interviewees’ social capital and support was largely bonded and reciprocal, confined to their families and Greek communities. Family units are vital in Greek culture, resulting in considerable expectations of informal support in later life. Children were also central to interviewees’ social networks. Familial emotional and instrumental support enhanced interviewees’ sense of belonging, coping and overall well-being, contributing to their ability to reside independently in their community in widowhood, a time at which interviewees had typically lost their primary confidant and associated support.

Cultural background influences widowhood experiences. The impact of ethnicity and earlier life-course experiences on marriage and widowhood were evident among this group of Greek migrants. Interviewees valued marriage and viewed widowhood rather fatalistically as an all-encompassing experience to be endured in older age, with mostly negative implications for their later-life identity, daily life and socialising. Most subscribed to notions of how widowhood was performed in Greek culture (e.g. mourning rituals, memorial services, continued bonds and spousal relationships), which in their wider Australian context were largely non-normative and enhanced a sense of ‘otherness’.

Regarding well-being, this thesis found that experiences of ageing, migration and widowhood had resulted in unique struggles over the life-course, and had influenced interviewees’ lay understandings pertaining to their current physical and psychological well-being in older age. Although most interviewees acknowledged the importance of remaining healthy and independent as they aged, their accounts reaffirmed that their personal notions of happiness and life satisfaction appeared more collectivist and familial (rather than individualist) in nature, highlighting the importance of familial happiness and well-being.

Overall, this thesis concludes that for this group of older widowed Greek migrants ‘ageing in a foreign land’, many life-course experiences (including migration and widowhood) have affected their later-life conceptions of health and well-being. For many among this group, jeopardies over the life-course and especially in older age, which may impact their current health and well-being include migrant status, being older, and female, and the widowhood experience. This thesis has numerous practical implications for policy.

Keywords: widowhood, health, well-being, Greek, Greeks, migrant, migration, Greek migrant, widow, widower, culture, support, qualitative, ageing, social inclusion, social exclusion, foreign land,

Subject: Public Health thesis

Thesis type: Doctor of Philosophy
Completed: 2016
School: School of Medicine
Supervisor: Prof. Fran Baum