Time scarcity: Another health inequity?

Considerable policy action has focused on the social patterning of health, especially the health risks associated with low income. More recent attention has turned to transport, food systems, workplaces, and location, and the way their intersections with social position and income create health inequalities. Time is another dimension that structures what people do; yet the way in which time contours health has been neglected. This paper explores (a) how time might influence health, and (b) the way in which time scarcity complicates current understandings of health inequalities. Alongside other meanings, time can be thought of as a health resource. People need time to access health services, build close relationships, exercise, work, play, care, and consume - all activities that are fundamental to health. There is evidence that the experience of time pressure is directly related to poorer mental health. Lack of time is also the main reason people give for not taking exercise or eating healthy food. Thus, another impact of time scarcity may be its prevention of activities and behaviours critical for good health. We investigate whether time scarcity, like financial pressure, is socially patterned, and thus likely to generate health inequality. The experience of time scarcity appears to be linked to variations in time devoted to employment or caring - activities closely bound to gender, status, and life course. One reason that time scarcity is socially patterned is because of the way in which caring is valued, allocated, and negotiated in households and the market. Adding paid employment to caring workloads is now normative,transforming the allocation of time within families. But caring requires a close interlocking with others' needs, which are often urgent and unpredictable, creating conflict with the linear, scheduled, and commodified approach to time required in the workplace. We review the evidence for the possibility that these time pressures are indeed contributing to socially patterned health inequalities among people caring for others. We also explore the potential for time scarcity to compound other sources of health inequality through interplays with income and space (urban form, transportation networks and place of residence). People who are both time and income poor, such as lone mothers, may face compounding barriers to good health, and the urban geography of time-scarce families represents the embedding of time -money- space trade-offs linked to physical location. In Australia and the US, poorer families are more likely to live in mid to outer suburbs, necessitating longer commutes to work. These suburbs have inferior public transport access, and can lack goods and services essential to health such as shops selling fresh foods. We conclude with a tentative framework for considering time and health in the context of policy actions. For example, social policy efforts to increase workforce participation may be economically necessary, but could have time-related consequences that alter health. Similarly, if cities are to be made livable, health promoting, and more equitable, urban designers need to understand time and time - income - space trade-offs. Indeed, many social policies and planning and health interventions involve time dimensions which, if they remain unacknowledged, could further compound time pressures and time-related health inequality.