Author Archives: Chris Garrington

Who cares? Looking after mum and dad and links with work and relationships

Who are the ‘sandwich generation’ of people caring for parents while in mid-life? Anne McMunn and colleagues from the UCL Department of Epidemiology and Public Health, along with Age UK, asked whether our working lives and our relationships affect the likelihood that we will take on these roles. Their findings suggest the pool of available caregivers is likely to dwindle as work and relationships change.

Informal caring is a crucial component of social care in the UK – around seven million people care for someone in this way, and as the population ages this is expected to increase to more than 10 million by 2030. It’s been estimated that in a little more than a decade there could be a shortfall of around 160,000 such carers.

There’s been a major increase in the numbers of carers who are aged 50-64 and who are therefore likely to be working at the same time.

So we need to know what factors may make people more likely to become carers. Are those who have often been in part-time work in pole position to step in when the need arises? Are those people more likely to be in stable relationships or not? And to what extent does gender have an influence?

Are you caring for a parent?

We used data from the National Child Development Study, which follows more than 17,400 babies born in a single week in 1958 in Great Britain. They have been questioned throughout their lives on their economic, medical and social circumstances. At age 55 the participants were asked if they were caring for a parent or parent-in-law, providing shopping or transport, housework, financial support or personal care.

The responses were analysed alongside information on the participants’ work lives and relationship status.

We found significant differences between men and women when it came to the ways in which work patterns influenced their likelihood of becoming a carer. For men, those who had entered full-time work early and who had been in work for longer were the most likely group to become carers for the older generation of their family.

For women, longer periods spent in part-time employment were associated with a greater likelihood of caring for a parent at age 55.

But among both men and women, those in long marriages were more likely to be caring for parents or in-laws than those who had remained single or whose relationships had been less stable.

Family-oriented lives

It’s perhaps not surprising that women who spend fewer hours in paid work  are more likely to become carers for older relatives. But why would those who are married be more likely to take on the role than their single siblings? Perhaps those with stable relationships are seen as being more family-minded, or perhaps those who aren’t married tend to be in less family-friendly jobs?

We might also speculate that women who have spent long periods combining paid work with childcare find it ‘makes sense’ for them to look after other relatives. 

We were also surprised to find men with longer-term employment were more likely to provide care compared with men who’d spent fewer years in employment: perhaps these men are perceived within their families as successful and competent providers. And maybe those with long-term, full-time contracts are more able to get flexible working and leave entitlements which allow them to combine work and care. 

We know that women are spending more time in the labour market and in full-time work at the same time as the need for family caring is increasing. We also know that fewer people are in long-term marriages as partnerships become increasingly diverse and varied. 

What are the implications, then, for subsequent generations among whom family forms are more diverse and men’s and women’s working lives are more similar? 

Double-burden

This continued ‘double burden’ has potential implications for the longer-term health and well-being of family caregivers: evidence suggests combining full-time work and adult care is linked with worse health and earlier labour-market exits for women in particular.

Our results suggest the pool of informal caregivers is likely to shrink, just as the pool of potential care recipients is set to increase. And this has important implications for the provision of adult social care in the UK.

Demand for care services is already outstripping supply. This is an important area that should be considered as social care reforms announced in 2017 are rolled out.

Life course partnership and employment trajectories and parental caregiving at age 55: prospective findings from a British Birth Cohort Study, by Anne McMunn, Rebecca Lacey and Elizabeth Webb, is published in Longitudinal and Life Course Studies

Anne McMunn and Rebecca Lacey are at the ESRC International Centre for Lifecourse Studies at UCL’s Department of Epidemiology & Public Health, and Elizabeth Webb works for Age UK.

Older man

Retirement: is it good for your mental health?

Retirement has traditionally been seen as a stressful time, with disruption to routines bringing potential health hazards. Recently this assumption has been challenged – maybe retirement could actually be a relief to many people.  But the evidence so far has been mixed. Now a new study by Maria Fleischmann and colleagues from the renEWL project at UCL suggests there are mental health benefits to retirement – with the biggest gains for those retiring from stressful, unrewarding jobs.  

As working lives get longer and retirement ages rise, policymakers and employers are waking up to financial implications: if employees are less productive or often absent due to ill health as they near retirement, that costs money.

The debate about retirement has centred on whether it’s experienced with a sense of loss or of relief. But could the answer be in the types of jobs people do before they retire? Could that post-retirement dip or boost be dependent on whether those jobs were good, rewarding ones?

Does workers’ mental health in the run-up to retirement, and in the years afterwards, depend to some extent on the type of work they do, and the amount of stress they experience while at work? Surely those who do not enjoy their jobs will benefit more, in mental health terms, from retirement.

Whitehall II Study

We used data from the Whitehall II cohort study, which started in 1985–1988 and which followed more than 10,000 London-based civil servants who were then aged 35-55. They were questioned every two or three years about their working and personal lives, and at some points also had clinical examinations. This long follow-up period allowed us to observe changes in mental health over an exceptionally long period of time.

We looked at a sample of 4,700 people who had retired but who had not been forced to do so for health reasons; who had given information on their work status and who had answered multiple questions on mental health. Two thirds were men.

The participants had been scored on the General Health Questionnaire  mental health scale, which has 30 questions covering depression, anxiety, sleep disturbance and social functioning. They had also answered questions on the psychological and social demands of their jobs, their levels of skill and decision-making authority and how well they felt they were supported by colleagues and superiors.

Positive effects of retirement

For most, retirement brought improvements in mental health, especially in the first three years. Our findings showed a pattern in which there was a steep improvement immediately after retirement, with individuals then settling into a more stable phase.

But these improvements were more pronounced in those who retired from jobs with poorer working conditions. This was particularly the case for those who had stressful or alienating jobs. This was also true for those who lacked support from colleagues and who lacked control over decision-making in their working lives.

The mental health benefits of retirement were not strongly affected by the levels of authority people had at work, or by the breadth of skills they used in their jobs – though those with lower-skill jobs generally had worse mental health.

In our analysis we took into account other factors such as social and economic status, general health, health-related behaviour such as drinking and smoking, age at retirement, relationship status and occupational grade.

The average age of retirement was 60.5 years, and more than three quarters of our sample were married or cohabiting. Four out of 10 worked in the highest – administrative – grade and a similar proportion in the middle – professional or executive – grade. One third had left the civil service before retirement.

In general, these were healthy people – just two per cent took depression medication and 83 per cent had no chronic illness. Almost half had never smoked and less than 10 per cent were dependent on alcohol. Just under half had a normal or low body weight, and their psychological and social working conditions were generally good.

Good jobs are key

So, our study once again confirms that workers in “good jobs” have better mental health. Even though those in less good jobs benefit more from retirement with respect to mental health, this does not close the gap between the two groups.

We believe, on the basis of these results, that employers and policymakers can reduce health care costs through changes in the workplace. In short, if workers have good working conditions early in their careers,  they will reap the rewards later on.

Mental Health Before and After Retirement—Assessing the Relevance of Psychosocial Working Conditions: The Whitehall II Prospective Study of British Civil Servants, is research by Maria Fleischmann, Baowen Xue and Jenny Head, and is published in the Journals of Gerontology: Social Sciences; B Psychol Sci Soc Sci, 2019, Vol. XX, No. XX, 1–11, doi:10.1093/geronb/gbz042

Maria Fleischmann is at the Department of Health Sciences, Vrije Universiteit Amsterdam, De Boelelaan 1105, The Netherlands.

 

Constriction worker

Is temporary employment bad for your health?

How is the health of those in insecure jobs affected by their working lives? Rachel Sumner and colleagues* have discovered some types of work may be just as strongly linked with poor health as unemployment is.

It’s long been acknowledged that there’s a link between unemployment and poor health. A recent Government Green Paper put it starkly:

“People who are unemployed have higher rates of mortality and a lower quality of life. This is an injustice that we must address.”

But is any job really better than no job? Or could some types of employment actually be linked just as strongly to poor health?

We looked at the issue using data from the Understanding Society study, which took blood samples from more than 4500 people aged between 16 and 64 who were either working or unemployed in 2010 and 2011– we excluded those who were retired, homemaking, not working due to incapacity or in education.

Overall, 7.6 per cent of our sample were unemployed. Amongst the employed, 81.8 per cent were permanently employed, 5.3 per cent were temporarily employed and 12.9 per cent were self-employed.

Health indicators

These samples were used to show whether the study participants had raised levels of fibrinogen or C-reactive protein (CRP), both of which are inflammatory markers and are associated with increased risk of heart disease. Healthy lifestyles decrease CRP levels, while obesity, physical inactivity and smoking increase them.

We compared the levels of these markers in those who were unemployed, permanently employed, temporarily employed and self-employed. We took into account a range of individual, social and health factors which might also influence the levels of these markers.

We didn’t find links between employment status and levels of CRP – but we did find links with fibrinogen.

We looked at how the levels of fibrinogen in different types of employee compared with those who were unemployed. And while those in permanent jobs or self-employed had lower levels of this marker, those in temporary work had similar levels to the unemployed.

So, not all types of work are equally beneficial in health terms – and in particular, temporary work would seem to be linked with worse health than other types. Indeed, in health terms we may actually be just as well off being unemployed as we are in an insecure job.

Why does this matter? It matters because less stable types of employment have grown in recent decades, with many workers employed on fixed-term contracts and experiencing uncertain job conditions. This has already been shown to have negative psychological consequences.

And since the recent global recession, which happened just before our data was collected, both unemployment and temporary employment have expanded. The European Union has a higher temporary employment rate than the OECD average  – 14.2 per cent compared with 11.2 per cent in 2016.

Levels of temporary employment in the UK are lower than the EU average – just six per cent in 2017 and four per cent in 2019  – but temporary employment has become more common since the financial crisis, particularly among young people. The rate of young people in the UK going into precarious employment has already resulted in poorer mental health.

Lessons for policymakers

If temporary employment is associated with an increased risk of mortality then earlier research which has simply compared unemployment with employment has not captured the complexities of the situation.

In conclusion, our findings would suggest there is little difference between the health effects of temporary employment and unemployment, using these particular indicators.  And given the continuing rise of precarious modes of employment across developed countries, this has significant implications for public health. Policymakers should encourage employers to expand the use of permanent contracts.

Unemployment, employment precarity, and inflammation, by Rachel C. Sumner, Rachel Bennett, Ann-Marie Creaven and Stephen Gallagher, is published in Brain, Behavior and Immunity.

Rachel Sumner and Rachel Bennett are based at the School of Natural & Social Sciences, University of Gloucestershire, United Kingdom; Ann-Marie Creaven and Stephen Gallagher are at the Health Research Institute, Department of Psychology, University of Limerick, Ireland.

Young woman sat by window

Are some types of job bad for your mental health? And how can employers ensure poor mental health does not lead to early retirement?

Mental illness is a major cause of early retirement – but do those who are forced to leave work early for this reason get better afterwards? What is the relationship between work stress and mental health? A new study of public sector workers in Finland suggests there is a link – and there are important lessons for employers. Tarani Chandola from the ESRC International Centre for Lifecourse Studies was among the authors of the study.

One way in which we can track the prevalence and level of mental illness is by looking at the use of psychotropic medication – that is, medication which can alter one’s mental state. This group of drugs includes common antidepressants, anti-anxiety drugs and antipsychotic medication. 

If there is a link between work stress and mental illness, then we should expect those forced to leave work for this reason to get better after retirement. So by tracking the levels of psychotropic medication among a group of workers before and after retirement, we could find out the extent to which there was such a link.

We were able to use data from a long-term study of Finnish public sector workers to examine the issue more closely. 

It matters because previous studies have shown an increase in the use of this group of drugs among all those who take disability retirement, particularly those whose retirement was due to mental ill health. Those from higher social classes saw the biggest drop in medication use after retirement, suggesting there are social factors at play here, too.

Global issues

The effect does seem to vary around the globe, though – some studies from Asia found an increase, rather than a decrease, in mental health problems after leaving work. But in Europe, retirement has often been found to be followed by an improvement in both mental and physical health. Retirees have reported sleeping better, feeling less tired and generally feeling a greater sense of wellbeing. 

We were able to use data from the Finnish Public Sector study cohort study, which followed all employees working in one of 10 towns and six hospital districts between 1991 and 2005. The study included participants from a wide range of occupations including administrative staff, cleaners, cleaners and doctors, and they were followed up at four-year intervals regardless of whether they were still in the same jobs. Their survey responses were linked to a register of medication purchases for at least two years before retirement and two years after.

We had information on 2,766 participants who took retirement because of disability. Uniquely, the data included both participants’ use of medication and their perceived levels of work stress. So we were able to ask whether there were differences in this pre and post-retirement effect between those in low and high-stress jobs.

Specifically, we looked at something called effort-reward imbalance – that is, when workers put in too much effort at work but get few rewards in compensation: according to a recent review, this carries an increased risk of depressive illness. 

If our theories were correct, we would see a decline in the use of psychotropic medication after disability retirement, and it would be greatest among those with high levels of effort-reward imbalance. Along with mental illness the other major cause of disability retirement in Finland is musculoskeletal disease, so we categorised our sample in three groups – mental illness, musculoskeletal disease and ‘other.’ Eight out of 10 in the sample were women, and three out of 10 reported high effort-reward imbalance before retirement.

Unsurprisingly, those who retired due to a mental disorder had the greatest increase in psychotropic drug use before retirement. And those who were in high-stress, low-reward jobs had higher levels of medication use than those who were not. But after retirement, there was no difference in psychotropic drug use between those with high vs low effort-reward imbalance. It looked as though stopping work in high stress jobs reduced the need for higher psychotropic medication use among those workers who exited the labour market for mental health reasons.  

Retirement because of musculoskeletal disease or other causes was not associated with any similar link between stress level and psychotropic medication.

Lessons for employers

Our study showed that among people retiring due to mental disorders, those in high-stress, low-reward jobs benefited most from retirement. So it’s likely that they could benefit from the alleviation of work-related stress before retirement, too.

In conclusion, if employers could find ways of reducing the levels of stress suffered by employees suffering from mental ill-health, their early exit from paid employment might be prevented and their working lives might be extended. 

Psychotropic medication before and after disability retirement by pre-retirement perceived work-related stress was published in the European Journal of Public Health, Vol. 0, No. 0, 1–6. 

The other authors were Jaana Halonen, Taina Leinonen, Ville Aalto, Tuula Oksanen, Mika Kivimäki and Tea Lallukka of the Finnish Institute of Occupational Health; Hugo Westerlund and Marianna Virtanen of the Stress Research Institute, Stockholm University; Martin Hyde of the Centre for Innovative Ageing, Swansea University; Jaana Pentti, Sari Stenholm and Jussi Vahtera of the Department of Public Health, University of Turku; Minna Mänty of the Department of Public Health, University of Helsinki; Mikko Laaksonen of the Research Department, Finnish Center for Pension.

These authors also have the following additional affiliations: Jaana Halonen; Stress Research Institute, Stockholm University; Jaana Pentti; Department of Public Health, University of Turku; Minna Mänty; Statistics and Research, City of Vantaa, Finland; Mika Kivimäki, Department of Public Health, University of Helsinki and Department of Epidemiology and Public Health, University College London; Marianna Virtanen, School of Educational Sciences and Psychology, University of Eastern Finland, Joensuu; Tea Lallukka, Department of Public Health, University of Helsinki.

Are universal state pensions discriminating against those in lower-skilled jobs?

With the state pension age likely to rise further in coming years, are policymakers right to link pension eligibility to average life expectancy? In a one-size-fits-all system, which social groups will lose out? Dr Emily Murray and colleagues* used census data to look at who lives longest after leaving work.

In most industrialised countries, the eligibility age for state pensions is being increased. Between 2011 and 2018, the United Kingdom government raised the State Pension Age for women from age 60 to 65, to match that for men, and a further increase to age 67 for both genders is planned by 2028. A further increase to age 68 by 2039 has been mooted.

Yet our state pension system ignores some very basic facts – it doesn’t take into account the wide disparities in health and life expectancy between different social classes. Those in professional occupations can expect to live longer and to enjoy good health for longer than those in manual jobs. For example, the average 50 year-old man in a professional job can expect to enjoy a further 25 years of good health, while a man the same age in a manual occupation can only expect 18: a seven-year difference. That is why lower social class groups are more likely to find themselves on disability benefit.

We wanted to look more closely at these occupational social class differences in the amount of time older adults live after they stop work, and in particular at the extent to which these differences are due to health.

We used the Office for National Statistics Longitudinal Study, a one per cent representative sample of respondents to the English and Welsh censuses since 1971.  For our analysis, we included respondents who were aged 50-75 at the time of the 2001 census and who had stopped work by 2011 – the average age of stopping was 58 for women and 60.2 for men. These workers were born in 1951 or earlier, so men would have been eligible for state pension at 65 and women at 60.

That gave us a sample of 76,485 people, and over the next 10 years we were able to monitor deaths  – by 2011 14.6 per cent of the women and 25.1 per cent of the men had died.

We could see that for both genders, those in lower social classes tended to die younger – professional women lived two years longer than unskilled women, and professional men three years longer than unskilled men.

We estimated professional women in good health would live five years longer than unskilled women in poor health, while for men the gap would be five and a half years.

But despite these longevity gaps, those from lower social groups were facing more years between leaving work and being able to draw their state pensions – because they left work earlier.

We estimated that if two women were 65 in 2001, the woman who had worked in an unskilled occupation would live five years longer after leaving work than the professional woman with good health – because the unskilled woman would have left at a younger age. Two men in the same circumstances would live on average 25.0 and 19.5 years from stopping work to death.

The most likely explanation is that poor health has a greater impact on the ability of manual workers to continue working than it does on non-manual workers.  It is however important to note that associations between social class and post-work years were not entirely explained by health, and we feel more research is needed on this.

Poor health

But the conclusion is clear: our results show that a uniform state pension age disproportionately affects the poorest among us, because on average they must wait longer between stopping work and qualifying for their state pension, at a time when they are likely to be in poor health. This is despite the fact that they are likely to have started work younger and therefore to have worked and paid contributions for just as many years as their better-off peers.

The solution to this inequality is not straightforward. The preferred strategy for UK policymakers is to support individuals to stay in work for longer, and there is evidence that the average age of leaving work exit is increasing.  However, over half of women and two-fifths of men  still fall out of the labour market before state pension age.

Some researchers have suggested that pension ages should directly reflect life expectancy differences.  Alternatively the age requirement could be dropped and pension eligibility could be based solely on the number of years in work.

We believe a two-year earlier pension age may be more appropriate for individuals who work in manual occupations, given that they leave work earlier than professional workers not in good health.  With rises in pension age already in law, and evidence of stalling life expectancy, it is vital that researchers and policy-makers assess how these rises will influence financial security and health for the most vulnerable in society.

Inequalities in time from stopping paid work to death: findings from the ONS Longitudinal Study, 2001 to 2011 is by Emily T Murray,  Ewan Carr, Paola Zaninotto, Jenny Head, Baowen Xue, Stephen Stansfeld, Brian Beach and  Nicola Shelton.

*Emily T Murray, Ewan Carr, Paola Zaninotto, Jenny Head, Nicola Shelton and Baowen Xue are based at the Department of Epidemiology and Public Health, University College London.

Ewan Carr is also based at the department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London.

Stephen Stansfeld is based at Queen Mary University of London, Wolfson Institute of Preventive Medicine, Centre for Psychiatry, London, EC1M 6BQ, UK

Brian Beach is based at the International Longevity Centre – UK, SW1P 3QB, London, UK.

Does caring for others damage your mental health?

This blog is dedicated to the memory of the paper’s lead author, the luminary Allison Milner, whose recent death has left the world a poorer place.

Health work and caring make up a significant proportion of jobs in high-income countries – but how does the mental health of people in those jobs compare with others? And how does the mental health of those in higher-status medical jobs compare with that of those in lower-skilled and lower-paid caring jobs? Tania King and colleagues* at the University of Melbourne turned to a major Australian longitudinal study for answers.

The health and social care workforce is very diverse, encompassing both those with the highest levels of skill and salary and those with some of the lowest. Yet all those workers have one thing in common: they work primarily in jobs which involve caring for others.

This means the emotional demands of the job are high: these workers often experience threats of or actual violence, for instance, and tend to have low levels of control over their work. This has been shown to lead to burnout, high levels of sickness absence and high job turnover.

We used the Household, Income and Labour Dynamics in Australia (HILDA) survey, a nationally representative study which has collected information from more than 13,000 people each year since 2001, to look at three questions:

  • Are job conditions in health and care more stressful than those in other sectors?
  • Do job stressors affect the health of health and care workers more than they affect others?
  • If health and care workers do suffer more than others, is that linked to the type of people who tend to go into that type of work and how they react to stress?

On the first question, we found that overall the working conditions of those in caring and support work jobs – the lower-paid, lower-skilled end of the sector – were worse than those in higher-status medical jobs, with care workers reporting a higher number of stress factors such as high demands, lack of control, job insecurity and perceived unfairness of pay.

Then we looked at workers’ mental health, using a widely recognised scale which assesses respondents’ symptoms of depression and anxiety in the past four weeks, along with more positive feelings such as calmness and happiness.

We found carers and support workers had poorer mental health scores than health workers. They also scored worse when compared to other workers who were not in health, care or other people-facing roles.

Other human service workers, such as hospitality workers, sales staff and personal assistants had worse mental health than those in roles which involved less personal contact. Of the four groups – carers, health workers, human service workers and others – carers had the worst mental health and health workers had the best.

Mental health effects

What were the biggest stress factors for the different groups? We found job insecurity had the greatest effect on all of them. But there were differences, too: In human service jobs, fairness of pay was the second-biggest factor, while in health care professions low control was associated with the second largest decline in mental health.

But we also found differences in the ways in which different groups reacted to stress: When carers and support workers reported three or more different stress factors, that resulted in a three-point decline on the mental health scale when compared to those reporting none. But when health care workers reported three or more stress factors that was associated with a lower, 2.65 point, decline in mental health.

Low-skilled is high-stress?

Our results suggest – perhaps surprisingly, given popular narratives about the stress suffered by senior executives – that lower skilled carers and support workers are more likely to be exposed to stress at work than higher skilled health workers such as doctors and nurses. They also have poorer mental health and a greater adverse reaction to stress.

There is other evidence to show low-income, less-educated workers suffer more from work stress. But our analysis adds another factor – the care workforce we looked at are mainly women with lower incomes and less education than either health workers or our reference group of other workers.

And even when this largely-female, low-status group of carers reports no stress factors at work, its mental health is worse than that of other workers – we found a three-point difference on the mental health scale between carers and either health staff or our reference category of non-health, non-people-facing staff.

Hence, people with lower levels of mental health face an accumulation of health hazards. They are likely to find themselves in stressful jobs which propel them into even worse mental health.

And so to our final question – is the poor mental health of care workers somehow intrinsic to them as people? Our methods enabled us to control for stable (time-invariant) characteristics such as gender, personality or country of birth (called within person effects), as well as things which might change over time, such as age, income and type of employment. The results showed that even after controlling for within person effects, as well as these other factors such as age and income, being exposed to these stress factors had a negative effect on the mental health of care workers.

We concluded that – while it’s important to note that health workers, too, experienced stress and poor mental health – low-quality working environments has a clear effect on the poorer outcomes of carers and support workers.

The impact of these environments does not stop with those who work in them:  this may also have knock-on effects on the quality of care provided. Earlier studieshave shown factors such as anxiety, stress and burnout  among healthcare workers are linked with poorer patient safety, too.

There is a dire need for more investigation into working conditions among health and human service workers. Such research could be critical in informing workplace design, particularly as the number of people employed as health and human service continues to grow. For that workforce to be sustainable, jobs need to be structured to promote health and productivity as well as a high quality of care.

The mental health impacts of health and human service work: Longitudinal evidence about differential exposure and susceptibility using 16 waves of cohort data, by Allison Milner, Tania L. King and Anne Kavanagh, was published in Preventive Medicine Reports, vol 14, June 2019.

Woman doing housework

Domestic work – why do women still do the lion’s share?

A recent international report suggests men need to increase their time spent doing unpaid care work by a minimum of 50 minutes per day in order to do 50 per cent of the work. The report calls for bold measures to help all men do their fair share of this work by 2030 and thus promote gender equality. So what do we know about how modern couples in the UK divide unpaid domestic work and the drivers behind that? A new study from Anne McMunn at the ESRC International Centre for Lifecourse Studies at University College London investigates why greater workplace equality has not yet been matched by a more equitable division of labour at home.

Some studies suggest education is the key to equality within the home – that women with better education, and therefore greater earning power, are in a stronger negotiating position when it comes to housework.

But that theory doesn’t entirely hold water – it’s clear that even when women are better educated than their partners, they’re still likely to bear the heaviest burden when it comes to domestic labour.

Similarly, it’s been suggested that domestic work is divided according to time available – so when a male partner works longer hours, the female does more housework. But again, the reverse doesn’t hold true and women who work more hours outside the home still do more housework too.

Longitudinal study

We used the UK Household Longitudinal Study, which has surveyed around 40,000 households since 2010, to examine a number of hypotheses about why greater workplace equality hasn’t been matched by a more equitable division of labour at home.

Does a shared belief in equality make a difference? As men are often asked, in the modern world, to do more domestic labour, are their beliefs a driving factor? What is the role of education, if any, in how couples divide up these tasks? If one partner is resistant to sharing the work, is the other empowered by having a higher level of education?

Using opposite-sex couples in the study who were aged 16-65 and had answered the relevant questions, gave us a sample of 8,513 couples. We looked at four types of work to give us a full picture of the labour those couples did: housework, paid employment, childcare and adult care – for instance, caring for an older relative.We used a technique that allowed us to see what groups emerged from the data to see how contemporary British couples share or divide these different types of work.

We also categorized our couples according to their answers to a series of ideological questions – were they both similarly traditional, egalitarian or middling, or was one partner more egalitarian while the other was more traditional?

Education levels

Then we looked at their levels of education – were both equally educated, was the woman more highly educated or was the man more highly educated?

Very few of the couples shared work equally. In just six per cent of couples, the woman was the main earner while domestic tasks were shared quite evenly. These women were likely to be more highly-educated than their partners. In a further one per cent of couples  the man remained at home and did more than 20 hours’ domestic labour. Even in those cases, around two thirds of the women also did some domestic work.

However, these stay-at-home men were quite likely to be caring for an adult – four out of ten of them provided more than 20 hours’ care per week. Only 30 per cent of female-earner couples had children under 16 living at home, and of those just a quarter of men had the main responsibility for childcare. Men in this group did more housework than in some other groups, but they still did less than their partners.

Almost half (49 per cent) of couples were dual-earner couples in which both members of the couple tended to be employed full-time but these couples were less likely than traditional couples to have children at home.

Traditional divisions of labour

About 30 per cent of couples were traditional in the division of work with men working full-time and women not employed or working short hours. These couples tended to have dependent children at home and women in this couples did large amounts of housework, and in a small minority of women in these couples doing over 20 hours of housework per week.

A small group of couples (two per cent) also emerged in which women worked part-time and men worked very long hours at 60 hours per week or more. These women had more responsibility for care, and more for housework.

The third most common group, at 13 per cent, was a slightly older group of couples in their fifties or early sixties, in which neither were working full-time and there was little or no care responsibility. Women in these couples did relatively high levels of housework, suggesting that these couples may have previously followed a traditional gender division of work.

Those couples who didn’t have shared egalitarian beliefs – either both had traditional views or one did but the other didn’t – were more likely to fall into a more traditional work pattern.

What about education?

Men who were better-educated than their partners were more likely to fall into the traditional working patterns, and men with lower educational qualifications than their partners were more likely to stay at home. And these traditional patterns were even more likely to pertain when the man was more highly-educated and both shared traditional views.

So, education makes a difference, and so does a shared ideology. But it is important to note that very few men, in any category, did longer hours of domestic work than their female partner. So when it comes to housework and caring, gender equality remains rare and gender norms remain strong. 

Our beliefs may form a starting point for shaping our behavior, but that’s only a starting point, and not a solution. The ‘bold’ 50 minutes for 50 percent suggestion in the State of the World’s Fathers report, certainly seems to be grabbing the bull by the horns and, like our research, points clearly to the need for urgent change in terms of who does the daily care work in our homes. That is if we genuinely want a significant shift in power relations between men and women and to bring about gender equality.

Gender divisions of paid and unpaid work in contemporary UK couples is research by Anne McMunn, Lauren Webb, Elizabeth Webb and Amanda Sacker is published in the journal, Work, Employment and Society.

 

Job prospects: does it matter where we live when we are young?

What are the influences on our employment prospects across our working lives? Could where we live when we’re young be important when we’re older – regardless of our social class or level of education? A new study by Emily Murray and colleagues from UCL, King’s College, London and Queen Mary, University of London, finds if we live in an area of high unemployment when we’re young, we’re more likely to leave the labour market at a younger age.

Which factors can help improve our prospects of employment – and of good health – in mid-life? One reason the question is important is that if we can stay healthy longer and work longer, we are less dependent on the state. And the cost of our ageing society is a major issue for governments and individuals across the developed world.

In the UK the state pension age will be raised to age 67 by 2028, but in fact most employees leave work well before they reach that stage. For some that’s a positive thing, but for others it’s forced upon them by unemployment or poor health – and that contributes to social inequality among older people.

Who is at risk? We know older workers in areas of high unemployment are more likely to be on disability benefits. And older people are more likely to leave work for non-health reasons, too – if they are made redundant, they find it harder than their younger colleagues to find another job.

But until now we didn’t know much about how unemployment and other factors experienced by the young might affect their prospects of being in work as they approach the state retirement age.

‘Scarring effect’

There are good reasons to suspect there might be an effect –research has shown that periods of unemployment in young adulthood can have a ‘scarring’ effect – so it stands to reason that early work experiences could set some people on good trajectories and others on less positive ones.

Higher-level job opportunities aren’t evenly distributed, and so we might speculate, for example, that workers in the north – where access to careers in finance, for instance, would be poorer than in the south – would be less likely to start out on one of those ‘good’ pathways.

And education might make a difference, too. We know those growing up in poorer areas are likely to end up with fewer qualifications, and therefore to be disadvantaged in the jobs market. That, too, could continue to affect them throughout their lives.

So health, employment status, occupational class and education might all influence the length of our working lives and lead to unequal retirement outcomes.

Survey of health and development

We used the Medical Research Council National Survey of Health and Development (NSHD), a sample of all births in one week in March 1946 across England, Scotland, and Wales, to test our theories.

This group of people have been questioned 24 times throughout their lives, most recently in 2014 when they were aged 68. We used data from when they were aged four, 26, 53, 60-64 and 68 – a total sample of 2526 people, all of whom had given information on their retirement age or were still in work at age 68 years.

We found there was a correlation between increased unemployment rates in the area a person lived in mid-life and the likelihood of an individual retiring earlier.  However, this relationship was explained by where people lived earlier in life.

For example, cohort members who lived in an area with higher unemployment when they were 26 were more likely to be outside the labour market at age 53. Compared to those who worked full-time, those who were unemployed at aged 53 retired on average 4.7 years earlier.

Similarly, mid-life health problems were more common among those who had lived in areas with high unemployment at age 26, even when taking account of age 26 health status.

We did not find a direct link between educational achievement by age 26 and retirement age. We did, however, find indirect links: for example, those who did not obtain any educational qualifications by age 26 were more likely to live in areas of high unemployment than those who gained degrees. There was no association between area unemployment at age 4 and educational achievement at age 26.

Adulthood is key

Our findings show for the first time that early adulthood is a key life stage at which local labour market conditions can affect our eventual retirement age. We found this happened through two interlinked factors – high area unemployment and worse health status at age 26.

So, there are clear messages for governments: strategies to extend the working lives of future generations will be most effective if they address youth unemployment rather than focusing on older workers in areas with high unemployment.

Policies to extend working life should focus not just on individuals but also on the wider labour market context in which those individuals reside. Maintaining employment and good health in mid-life are key to ensuring that individuals can work longer. And large-scale interventions that create new jobs in areas with high youth unemployment could bring long-term positive consequences for future generations’ extended working lives.

Linking local labour market conditions across the life course to retirement age: Pathways of health, employment status, occupational class and educational achievement, using 60 years of the 1946 British Birth Cohort, is published in Social Science & Medicine.

Emily T. Murray,  Paola Zaninotto, Maria Fleischmann, Nicola Shelton  and Jenny Head are based at the University College London Department of Epidemiology and Public Health.

Mai Stafford and Diana Kuh were based at the Medical Research Council Unit for Lifelong Health and Ageing at University College London when this paper was written. 

Ewan Carr is also based at the Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King’s College London

Stephen Stansfield is based at the Queen Mary University of London, Wolfson Institute of Preventive Medicine, Centre for Psychiatry.

Retirement: good or bad for your heart?

Across the globe, more people are spending more time in retirement than ever before. So staying healthy in later life is critical. Yet political debates on ageing tend to ignore a growing body of research on how retirement can affect our health. Baowen Xue and colleagues from the Department of Epidemiology and Public Health at UCL looked at links between retirement and cardio-vascular disease – and found unexplained differences between Europe and the US.

Is retirement good for your heart, or bad for it? The question is an important one because cardio-vascular disease (CVD) is the biggest cause of death globally and costs health services a huge amount of money.

Some studies have shown retired people have a higher risk of being diagnosed with CVD than those who are still working. But until now the evidence has been unclear.

We set out to review evidence from across the world, so that we could help to build a more accurate picture of whether, and how, retirement might affect our cardio-vascular health. As CVD is linked to our lifestyle, diet and other behaviour, there are lots of ways in which changes that take place in retirement might have an effect – both negative or positive.

Longitudinal studies

We looked for longitudinal studies that could help answer our questions, and found 82 which measured risk factors for CVD and 14 which looked at actual incidence of CVD. The second set of 14 papers provided the answer to our first question – does retirement affect our cardio-vascular health?

The answer revealed a major difference between the USA and Europe. Studies conducted in the US showed no significant effect, good or bad, on retirees’ cardio-vascular health. In Europe, meanwhile – with the exception of France – studies consistently showed a link between retirement and an increase in CVD.

Data from the British Regional Heart Study, for instance, showed that healthy men who retired before the age of 60 were more likely than others to die from circulatory disease within five and a half years. Fatal and non-fatal CVD was also more common among retirees in Denmark, Greece, Italy and the Netherlands.

Why might this be? Could there be cultural or lifestyle differences between Europe and the US which might cause this difference? We took a systematic look at the risk factors.

Weight gain

First, we looked at weight gain. If Americans were less likely to put on weight after retirement compared to Europeans, that might help to explain the difference. But when we looked at this, we found that body mass index (BMI) actually increased after retirement in the USA – and also Japan -but did not change in England, Denmark, France, Germany, Switzerland or Korea. While those who do physically demanding jobs are likely to put on weight after they retire, most people aren’t.

Could it be that retired people generally do less exercise – another risk factor – in Europe? The studies suggest that’s not the reason. While many retirees did more physical activities, they also spent more time sitting still – so the effect was a balanced one. For instance, a retiree might play more golf, but also watch more television.

Do retired people perhaps smoke more, we asked? Again, there were contradictory results but 12 out of 14 studies either showed no effect or showed retirement led to people smoking less.

Perhaps retired people in Europe drink more, then? Again, this couldn’t be identified as the reason. Studies in Australia, the UK, Japan and the USA suggested there was no association between retirement and alcohol consumption.

Diet is another possible cause of CVD, but again, there was no clear pattern of between retirement and diet emerged from reviewed studies.

No benefits

So the picture isn’t straightforward, and we don’t have answers as to why retirement might put Europeans at risk but not Americans. What we can say, though, is that none of the studies we looked at found any beneficial effects of retirement on CVD.

Apart from a decrease in smoking, there wasn’t evidence of any general ‘relief’ effect of retirement on people’s cardio-vascular health – so the supposition that working could be bad for our health and therefore retirement better for it doesn’t necessarily hold true.

However, studies that showed retirement brought negative health effects should be interpreted with caution. Many assessed the health effects of retirement by comparing retired people with employed people – and we know people who stay in the labour market are generally healthier than retirees. We do know people who have CVD, diabetes or hypertension are more likely to retire.

What our review has done is to reveal the complex nature of the underlying mechanism through which retirement might impact on the risk factors for CVD. Different people react differently to retirement, depending on their life experiences and the cultural and policy environments in which they live. So there isn’t one global solution to any of this – each country needs to plan its citizens’ retirement according to their individual needs.

The impact of retirement on cardiovascular disease and its risk factors: A systematic review of longitudinal studies, by Baowen Xue, Jenny Head and Anne McMunn, is published by The Gerontologist.

Is working flexibly good for your health?

Flexible working is considered good practice – and in England, most workers have the right to apply to work flexibly after they’ve been in their job six months. But what do we know about the benefits? A new study by Tarani Chandola and colleagues used biological measures to look at differences in stress markers among workers with reduced hours and those without.

In recent years many employees have been able to alter their work patterns to fit in with childcare and other responsibilities. Typically, this can mean working part-time, job-sharing, only working during school term-times or working from home some of the time.

It’s assumed this should help to relieve stress. But until now, we didn’t know whether this was necessarily the case. After all, there could be down-sides – for example working at home can mean a blurring of the boundaries between work and family time, part-time working can be a barrier to promotion and job-sharing can bring its own tensions.

Until recently we had to rely on workers’ own reports of how they felt in order to judge this interplay between work, family life and stress. But now a number of social surveys have begun collecting samples which allow us to measure biological changes which can indicate stress, too.

This is known as ‘allostatic load’ – when we’re repeatedly subjected to stress or trauma, this can lead to chronically heightened levels of stress hormones. And that is associated with all sorts of long-term health problems, such as heart disease, type-2 diabetes and depression.

We were able to use data from participants in the Understanding Society study, which began in 2009 and which follows more than 60,000 adults in 40,000 households. As well as responding to detailed questionnaires, many of them have been visited by nurses who have taken physical measurements and blood samples.

Blood-based markers

As well as blood-based markers such as insulin growth factor 1 and cholesterol, their pulse rate, blood pressure and waist-to height ratio were also measured.

After taking out those who weren’t employed, who didn’t have the nurse visits or for whom some measurements were missing, we had a sample of a little over 6,000 people.

All those people had been asked whether flexible working arrangements were available at their workplace, how many hours they worked and whether they were the primary carer for their children.

We categorised working hours into three groups, with different levels for men and women because they tend to have very different working patterns. So women were grouped into those working less than 24 hours per week, more than 25 hours and more than 37 hours; while men were grouped into those working less than 37 hours, 37-40 hours and more than 40 hours.

Unsurprisingly, we found more women than men had made use of flexible working  arrangements – almost no men in our sample were the main carers for two or more children.

Chronic stress

There were particularly high levels of biological chronic stress markers among women with childcare responsibilities who worked more than 37 hours per week. Those with similar childcare responsibilities but working fewer than 25 hours per week didn’t have any measurable effect on their stress levels.

Both men and women who had access to, and made use of, reduced-hours flexible working had lower levels of biological stress markers than those who didn’t have flexible working.

We found these types of reduced-hours arrangement were more common among those in lower-paid occupations, especially among men, and among older workers of both genders.

Other types of flexible working arrangements, such as working from home, were more common among those from more advantaged social groups. But we didn’t find any association between these types of working and lowered levels of stress.

So, what has our study told us? We’ve learned a good deal about the complex relationships between social and biological factors in our lives. And, crucially for policymakers, we can see that it’s particularly important for women with childcare responsibilities to be able to access shorter working hours when they need to. For employers, this isn’t just a matter of logistics and of ensuring a stable and happy workforce – it’s also a major factor in ensuring that workers live longer and healthier lives.

Are Flexible Work Arrangements Associated with Lower Levels of Chronic Stress-Related Biomarkers? A Study of 6025 Employees in the UK Household Longitudinal Study, is research by Tarani Chandola (University of Manchester and UCL), Cara Booker, Meena Kumari and Michaela Benzeval (University of Essex) and is published in Sociology.