Author Archives: Chris Garrington

Would reducing social inequality lead to more years of healthy life?

Across Europe, there’s good news for older people – life expectancy is on the rise and levels of disability among older people are falling. But there are concerns that a longer life may not be a better life for all. So who benefits from increased life expectancy?  Jenny Head and colleagues from the IDEAR network find those with a higher occupational status can expect the greatest number of years of healthy, disease-free life.

We know from lots of studies that there are big differences in life expectancy between different social groups. And we know that those in higher social positions tend to benefit more from that rise in healthy life expectancy.

But, given that many governments expect people to extend their working lives, we specifically need to know about the different expectations of people in different occupational positions – which is slightly different.

Together with colleagues in the IDEAR networK, we looked at what those from different occupational backgrounds might expect in later life – to be precise, how many years with good health can they expect to enjoy between the ages of 50 and 75?

The data came from four cohort studies in England, Finland, France and Sweden.

We were able to look at data from 9,213 people in the English Longitudinal Study of Ageing from 2002 onwards. We also had information on 42,978 people who took part in the Finnish Public Sector study between 1997 and 2013. In France, we used the GAZEL Cohort Study, which gathered information from 18,263 people working for the national utility company from 1989 onwards. And in Sweden, we looked at a sample of 8,186 people who responded to the Swedish Longitudinal Occupational Survey of Health between 2003 and 2014.

Health measures

We used two health measures: whether participants rated their own health as good or poor, and whether they had ever been diagnosed with heart disease, stroke, chronic lung disease, cancer or diabetes.

In all the cohorts, people in lower occupational positions could expect fewer years of life than those in higher occupational positions – and they could expect to spend fewer of those remaining years in good health.

So in England, both men and women in high-grade occupations could expect more than four years’ extra healthy life when compared with men and women in lower-grade occupations. In Finland that gap was wider, with those in high-grade jobs expecting at least six and a half years more good health. In France the difference was around two and a half years, while Sweden had the smallest gap of a little more than two years.

This pattern was consistent across the four countries and for both men and women. There were also socioeconomic inequalities in chronic disease-free life expectancy, although these differences were less marked than for self-rated health.

Better understanding

Why does this matter? A better understanding of the future health of older people is crucial to policy-makers because it affects public expenditure on income, health and long-term care. It also matters because governments want to extend working lives and increase State Pension ages, and in order to do that they need older workers to stay healthy.

Our results indicate that those in lower socioeconomic positions may be doubly disadvantaged because they have worse health but may also need to work longer for financial reasons. To achieve extended working lives for all, policy-makers will need to find ways of reducing those social class differences in health expectancies.

Socioeconomic differences in healthy and disease-free life expectancy between ages 50 and 75: a multi-cohort study, by  Jenny Head, Holendro Singh Chungkham , Martin Hyde, Paola Zaninotto, Kristina Alexanderson, Sari Stenholm, Paula Salo, Mika Kivimäki, Marcel Goldberg, Marie Zins, Jussi Vahtera and Hugo Westerlund, is published in the European Journal of Public Health.

 

Early retirement – can welfare systems help ease the transition?

The post-war baby boomgeneration in developed countries is reaching retirement age and this is placing strain on welfare systems. Sol Richardson and colleagues from the ESRC International Centre for Lifecourse Studies at UCL find the type of welfare system under which we live can affect our prospects of having a happy and fulfilled retirement.

We know stopping work can lead to changes in our sense of personal wellbeing both positive and negative. And we know this can be influenced by a range of factors, such as whether an individual has left work at the usual age or has stopped early.

There are other factors which can make a difference to how we fare after retirement, too: If we were dismissed, retired through illness or through unemployment, for instance, the change is more likely to hit us hard.  

But how much difference do the different types of welfare system which exist in different countries make to those who leave work early? Until now we havent had much clear evidence on this point.

Data

We looked at a sample of people from 16 countries, using data from the Study of Health, Ageing and Retirement in Europe (SHARE) between 2004 and 2013, and from the English Longitudinal Study of Ageing (ELSA) between 2002 and 2013 these are studies which revisit their participants over time.

Our subjects were aged 50 years and over and had been visited before and after they left work.

We looked at a total sample of 8037 respondents who had left work between 2002 and 2013 and for whom we had information not only on work history but also on personal wellbeing.

We categorised how people left work according to the type of benefit they received afterwards: Were they receiving disability benefit, unemployment benefit, sickness benefit, social assistance, early retirement pension, old age pension or none of those?

Retirement age is different in different countries it can depend on gender or on the number of years worked, and its been rising in many countries. So we defined retirement as the earliest age at which an individual can draw a full pension if he or she has been working since the age of 20.

And we looked at the wellbeing of our subjects, using a validated scale called CASP-12 (control, autonomy, self-realization and pleasure.)

And then we compared these findings according to the type of welfare regime the participants had in their home countries again using an internationally-recognised scheme that relates to how social benefits are granted and organized.

Negative effects

We found that those who left the labour market because of unemployment or disability and who left outside of the typical time-frame tended to experience negative effects on their personal wellbeing.

How much difference did country of residence make? We found this was significant, but that only a small proportion of the difference was down to the country itself. Almost two thirds of the wellbeing gaps we found between individuals in different countries could be accounted for, we found, by the type of welfare system they had.

Those living in Scandinavian social democratic welfare systems experienced the most positive transitions but this effect is unlikely to be down to expenditure alone. Other factors could be important for instance, employment rules guiding the ways people left work. Different finance mechanisms, the extent of benefit coverage and the eligibility regime for those benefits could also have an effect.  

When we looked at the different types of welfare system we found people in systems which could be described as Bismarckian,such as France or Germany, or  Scandinavian,such as Sweden or Denmark, did better than those in systems which could be categorised as Mediterranean,such as Italy or Greece.

As a generalisation, Scandinavian systems can be described as Social Democratic. They spend the most, they have high levels of cash benefits and a strong emphasis on services.

Bismarckian countries emphasise earnings-related cash benefits like pensions and they provide reasonable services, but not at the level of Social Democratic countries.

In Mediterranean countries, the pensions system is fragmented and services are rudimentary. People living in Mediterranean systems are more likely to rely on family and the voluntary sector for support.

Policy implications

What lessons should policy-makers draw from our study? We found that higher expenditure per head, particularly expenditure on non-healthcare services such as home help, did help our participants to feel better after they left paid work.

And our results have important implications for welfare policy: They underscore the importance of welfare services as greater numbers of workers approach retirement age and leave the labour market.

Country-level welfare-state measures and change in wellbeing following work exit in early old age: evidence from 16 European countries, by Sol Richardson, Ewan Carr, Gopalakrishnan Netuveli and Amanda Sacker, is published in the International Journal of Epidemiology, 2018, 113.

Working with a long-term illness – does employment status make a difference?

Across the developed world, a growing share of the population suffers from chronic disease such as diabetes, arthritis or heart problems – in the EU, around 45 per cent of those aged 55-64 had such a disease in 2015. And that affects their ability to work: just half of those with chronic illnesses are employed, compared to three quarters of those without. But how do the self-employed cope with such conditions, when compared with those in employment? Maria Fleischmann and colleagues from the RenEWL project find these differences in work status can make a major difference.

We know that when people become chronically ill, changes in their working conditions can help them to continue working. And we also know that good working conditions – being able to control how you use your time and how you do your job, whether you make the decisions and whether you feel valued, for instance – can help all of us to stay in paid work for longer.

And of course, if you become ill you’re more likely to feel the need to take time off or maybe to give up work altogether. We wanted to compare how the employed and the self-employed adjust their working conditions when facing a diagnosis of chronic disease.

Existing research tells us that many older people work for employers, and have to ask for their approval when it comes to making adjustments to their working conditions. The self-employed, meanwhile, are much more able to make their own decisions and tend to feel they have more control over their working lives.

We looked at people’s ability to control their work: physical demands, working hours, psychological demands such as how fast they had to work, and social aspects such as whether they felt valued.

And we had a great source of data for this – the English Longitudinal Study of Ageing (ELSA), which has followed a total of almost 9,000 over-50s since 2002.

From that group we were able to find and study 1389 participants who reported no chronic diseases when they were interviewed in 2004-5 – the second wave of interviews – and who were in work.  We were then able to look at what happened to them before the seventh wave of interviews, in 2013-14.

A little over 40 per cent of our sample were in managerial or professional occupations, a quarter in intermediate occupations, and almost 30 per cent in routine and manual occupations.

After diagnosis

At each interview, respondents were asked whether they had been diagnosed by a doctor with lung disease, asthma, arthritis, cancer, high blood pressure, diabetes or high blood sugar, stroke or heart problems.

During the study period 510 of the 1389 sample members were newly diagnosed with one of those conditions. We were able to look at how they fared at work for four years after that, and we found some striking differences between how the employed and the self-employed seemed to have been treated.

The physical demands of our participants’ jobs were pretty similar before their diagnosis, for instance. But afterwards significant numbers of those who were employed said that those demands had actually increased when they were diagnosed. The self-employed, meanwhile, told us the opposite had happened to them – they reported significantly lower physical demands at work immediately after diagnosis. This effect continued for some time, though it grew less pronounced.

How could that be? We think maybe the increase in physical demands among the employed could be due to perception – similar demands might be perceived as more strenuous by the chronically ill. The self-employed, meanwhile, have more freedom to adjust those demands when they feel they need to.

The self-employed reported that their working hours dropped by an average of 2.8 hours per week on diagnosis, while those who were employed did not see a change. This effect was not statistically significant, though.

Employees found that their level of autonomy at work also dropped marginally, while for the self-employed there was no significant change. We did not find any major changes in psychological or social conditions in either group.

So, what did we learn? Essentially, that improvements in working conditions after diagnosis of chronic illness were restricted to the self-employed. So employers may need to ask themselves some hard questions – do they want to hold on to workers who become unwell? If they do, then they should consider the levels of flexibility they offer, and they should think about making adjustments for those workers if they don’t want to lose them.

In an ageing society, older people are expected to work ever longer and therefore to remain at work even when they begin to suffer from health problems. Our findings should also encourage policy-makers and governments to think about how chronically ill older adults are treated at work.

Changes in autonomy, job demands and working hours after diagnosis of chronic disease: a comparison of employed and self-employed older persons using the English Longitudinal Study of Ageing (ELSA)by Maria Fleischmann, Ewan Carr, Baowen Xue, Paola Zaninotto, Stephen A Stansfeld, Mai Stafford and Jenny Head, is published in the Journal of Epidemiology and Community Health.

 

Being a carer: a sizeable problem

Millions of people combine work with caring responsibilities – looking after an older relative, a disabled child or a partner, for example. But what are the effects on the health of those who do this? Rebecca Lacey and colleagues from the ESRC International Centre for Lifecourse Studies at UCL have found that younger women and those who juggle working and caring are at higher risk of being obese.

The number of people who care for others without pay is huge – and it’s growing. In the United Kingdom there are more than seven million such carers – around one in five adults. About six in 10 of them are women.

We know from existing studies that becoming a carer can mean having to stop work – but an ageing society, extended working lives and cuts in social care funding mean those doing this unpaid caring are also increasingly often juggling their caring responsibilities and paid work.

Caring is linked to behaviour which leads to health risks, as well as to poorer health. Carers can suffer from the deterioration of their relationships with those they care for – particularly when the person needing to be cared for has dementia. They have to juggle caring and other responsibilities, resulting in little time for themselves: this means they may have less time to exercise and to eat healthily. They can also suffer additional financial burdens. All this can lead to measurably higher levels of stress – for example, research has shown that carers have higher levels of cortisol, which can cause the body to lay down fat. We wanted to know more about whether particular groups of carers were at increased risk of being obese.

We were able to use a major study, Understanding Society, which has followed a representative sample of 40,000 UK households since 2009 and which is also linked to another study, the British Household Panel Survey, which first started in 1991.

This enabled us, for the first time, to look at obesity amongst UK carers from the age of 16 onwards: previous studies had only looked at older carers or carers of those with specific conditions such as dementia.

We had information on 9,421 participants who had also been visited by nurses for health checks between 2009 and 2012, of whom 1,282 were carers. We were able to look at factors such as Body Mass Index (BMI) alongside whether participants had an illness or disability, their education, occupation, household income, socioeconomic position, partnership status and whether they were parents. We looked at how many people they cared for, and for how many hours in the week. And we also looked at whether they were also doing paid work, and if this was full or part-time.

Nurse visits were used to measure participants’ weight, percentage of body fat and BMI.

Women as carers

Roughly in line with national figures, we found women were more likely to be carers and to put in more hours of care each week. Female carers were more likely than their male counterparts to have children at home and also to be working outside the home – this may be because male carers tend to be older.

When we looked at whether men’s caring was linked to obesity, we did find an association – men who were carers had higher BMIs and larger waists. However, once we had taken differences in age into account we didn’t find this statistically significant.

But when we looked at women, the story was rather different. In contrast to men, women who were carers were significantly more likely to have larger waists or a higher percentage of body fat. And there was a particularly strong effect when it came to women who combined caring with full-time work: amongst young women aged 16-44 who were in full time work, those who were carers had waists 4cm larger, on average, than those who were not carers. Those who were caring and working beyond the age of 65 were also larger, with higher proportions of body fat and bigger waists.

Why is this? Why would women’s health potentially suffer a greater adverse effect than men’s from being a carer? It seems the strains on them may be greater – younger women may be working outside the home and may also be caring for children, for instance. They may lose touch with friends who have more freedom to enjoy leisure time. Carers are likely to have less time to spend exercising or to prepare healthy and nutritious meals – and those combining several caring roles with working life are likely to be particularly hard-hit.

This matters, not least because the scale of the issue is so great – and because the UK relies so heavily on its citizens to look after their own – carers have been estimated to save the UK economy £132 billion per year. We need to make this largely hidden army of unpaid carers a public health priority.

Informal caregiving and markers of adiposity in the UK Household Longitudinal Study is research by Rebecca Lacey, Anne McMunn and Elizabeth Webb of the ESRC International Centre for Lifecourse Studies, University College London.

Work stress and ill health – what’s the link?

Lots of studies have suggested stress can be a cause of ill health – and that leads to people ceasing to work before they reach retirement age. But most have offered only a snapshot on the issue. Now a new analysis of data from a major panel study by José Ignacio CuitúnCoronado and Tarani Chandola from the University of Manchester has shed new light on how work stress can affect an employee’s health over a longer period.

Many animals have the ability to adapt to environmental changes and pressures so that they’re better prepared the next time they happen. Bears can put on fat as winter approaches, for instance, to help them stave off hunger and stay warm.

And human beings can do this too. Stressful situations trigger chemical responses which can help to give us extra resources when things are tough. Our neuroendocrine systems, for instance, trigger hormonal responses which enhance our physical performance when we need it most.

But these valuable systems can have a downside. In our research, we wanted to look at how repeated exposure to stressful situations might contribute to health problems, particularly in people nearing the end of their working lives. We call this stress-induced effect ‘Allostatic Load’ – the wear and tear” on the body that accumulates as an individual is exposed to repeated or chronic stress because of fluctuating hormonal responses.

Given that many governments are looking for ways to extend working lives, there’s particular interest in finding out how stress can affect the health of older workers.We were able to tap into a rich source of information – the English Longitudinal Study of Ageing (ELSA), which has followed a representative sample of almost 10,000 over50s since 2002.

These participants have been interviewed regularly and one of the things they’ve been asked to report is whether they’ve experienced a sense of imbalance between the effort they put into their jobs and the rewards they get out.

Health testing

This gave us a sample of 2663 older adults, all over 50 and living in England, who’d reported these feelings at least once and who’d been assessed as having had an adverse reaction to them. We wanted to know whether repeated episodes had a bigger effect than just one, and whether the effect would be just as strong for past episodes as it was for more recent ones.

Between 2004-5 and 2014-16 the group were asked about stress at work, but they also underwent physical tests to see how the various systems in their bodies were bearing up.

They were visited by nurses who carried out a battery of tests including taking hair samples to assess levels of the stress-related hormone cortisol, carrying out blood pressure checks to provide information on their cardio-vascular systems, white blood cell counts to assess their immune systems and cholesterol checks on their metabolic systems. Participants also had measurements taken of their waist to height ratios – a good indicator of coronary heart disease risk factors.

Overall, we found the more occasions of work-stress a participant had reported, the greater their ‘Allostatic Load’ index – that is, the greater the amount of biological wear and tear. Moreover, the evidence suggests that employees who had experienced stress more recently (towards the end of their working career)had higher levels of health risk when compared to those who had experienced it earlier in their careers.

This suggests there is an association between repeated reports of stress at work and biological stress mechanisms, which in turn could lead to stress-related disorders such as coronary heart disease, type-2 diabetes or depression. This also suggests that previous cross-sectional studies which reported small or inconsistent associations may have suffered because they were only measuring one effect at one time.

Work-related stress is one of the reasons for labour market exit – and our findings would suggest that earlier, snapshot studies may have underestimated the true effect of work-related stress on health over a lifetime.

As this is an observational study, it is not possible tomake any causal claims. Also, there may be other factors that we have not taken into account that may explain the association between stress and disease risk. For example, sleep problems may be relevant – though they may also be part of the journey from stress to ill-health.

But equally it is possible that cumulative exposure to work stress is resulting in damage to employees’ physical health, which is then leading to disability and an early exit from the world of work. So, if we want to extend working lives then reducing work-related stress could be one of the keys to achieving that goal.

Allostatic Load and Effort-Reward Imbalance: Associations over the Working-Career, by José Ignacio Cuitún Coronado, Tarani Chandola and Andrew Steptoe, is published in the International Journal of
Environmental Reasearch and Public Health
.

Use it or lose it: fact or fiction?

We’ve probably all heard the phrase: “Use it or lose it” –  the belief that if we don’t keep our brains active, particularly as we grow older, our mental abilities will fade. Or that, conversely, if we stay mentally active we can hold back the inevitable decline that comes with ageing. But is that really true, and how might we differ from one another in this respect? A new study by Baowen Xue and colleagues from the RenEWL project at UCL tests the hypothesis.

If, as the theory goes, a lack of mentally challenging activity can lead to a loss of ability, then retirement might increase that risk. And previous studies suggest that may be the case – we know that those who retire later have better cognitive function and a lower risk of dementia.

In our study we set out to learn whether the sorts of activities we all do at work could benefit older peoples’ memories, and whether certain factors could help to preserve their abilities.  There’s a theory that some of us build up ‘reserves’ which can provide us with a buffer against later decline: if we have lots of mental stimulation as children, for instance, or if we have mentally demanding jobs as adults.

We wanted to test the ‘use it or lose it’ theory, and also to find out whether those who work in high-grade jobs might be at lower risk of cognitive decline after retirement.

The subjects for our research were 3433 people who participated in the Whitehall II Study, which followed a cohort of civil servants for more than 30 years, beginning when they were aged between 35 and 55.

Cognitive ability tests

We were able to look at measurements of the participants’ cognitive abilities from up to 14 years before they retired and for up to 14 years afterwards.

The participants were tested on four different measures. Their verbal memory was assessed through a test in which they listened to a list of words and were then given two minutes to write down as many as possible. Verbal fluency was judged in two ways – participants were asked to write as many words beginning with ‘S’ as they could within one minute – ‘phonemic’ fluency – and also to recall as many animal names as possible within the same time – ‘semantic’ fluency. Finally, abstract reasoning – the ability to identify patterns and rules in data and to use them to solve problems – was measured through a four-part test known as AH4.

We found that participants’ abilities decreased over time on all four measures.  But the decline in verbal memory scores was 38 per cent faster after retirement than it was before, even after taking account of that age-related deterioration. Those who worked in higher-grade jobs also had some protection while they were still working, but this effect was lost when they retired.

Trajectories of verbal memory by employment grade

However, while retirement had a significant impact on verbal memory, particularly for those in more senior jobs, it did not make a difference when it came to the other tests we looked at – verbal fluency and abstract reasoning. Nor were there any significant differences in verbal memory decline between men and women in our sample.

Our findings are consistent with the theory of ‘mental retirement’ – suggesting that the work environment can be more mentally stimulating than the leisure environment as a retiree. As well as losing the direct stimulation they get from work, retirees may also suffer from indirect effects – from losing the need for self-discipline and organisation, for example, as well as from having fewer opportunities to communicate and collaborate with others. For instance, social networks could be more extensive during employment than they are later in life.

The finding that employees in high grade jobs suffer smaller declines before retirement also points to a wider significance – all of us can benefit, in terms of memory, from mentally stimulating activities.

So, do our findings support the ‘use it or lose it’ theory? Yes, they do. They suggest that failing to keep mentally active may lead to faster cognitive decline after retirement.

Effect of retirement on cognitive function: the Whitehall II cohort study, by Baowen Xue, Dorina Cadar, Maria Fleischmann, Stephen Stansfeld, Ewan Carr,Mika Kivimäki, Anne McMunn and Jenny Head, is published in the European Journal of Epidemiology.

Does education and job status affect the length of our working lives?

Who is most at risk of leaving work due to poor health? In a major international research project, Ewan Carr from the renEWL team has worked with colleagues at UCL, King’s College and Queen Mary University of London in the UK, INSERM and Paris Descartes University in France and the University of Turku in Finland to find out more about social inequalities and extended working life. Based on information from nearly 100,000 employees from seven studies in four countries, the research found employees with low levels of education or low occupational grade (e.g. unskilled or manual jobs) to be more likely to leave work for health reasons. While past studies have shown there is socioeconomic inequality in the ways that working lives come to an end, few have compared these trends across different countries.

Across Europe, ageing populations have forced governments to look at ways of extending working lives. As people stay healthier for longer, raising the state pension age has become a priority in a number of countries – in the UK this reform has already been implemented.

But this change is likely to be particularly challenging for those from lower socioeconomic backgrounds, who are known to lose both physical and mental ability more quickly as they age.

Planning for later life

There’s a double-bind here for this group. They’re more likely to be unable, through ill health, to continue to work in later life. But they’re also less likely to have the resources they need to keep them out of poverty in retirement.

People from lower socioeconomic backgrounds may have contributed less to their pension funds, and so may have to work even if they don’t want to, or if their health makes it difficult for them to do so.

Meanwhile those from higher socioeconomic backgrounds are likely to have bigger pension pots but also to have better health, which allows them to work for longer. They have a further advantage in that they are likely to have jobs they enjoy and which have more security – so they’re less likely to be forced into retirement or unemployment.

We wanted to find out more about this: would similar levels of poor health have a disproportionate effect on those who were less well educated, or who had lower-status jobs? If two people had the same health issues but had different social status, would one be more likely than the other to stay in work for longer?

Other studies have looked at these issues, but they had limitations. They tended to focus on single countries – or in some cases on the Nordic countries as a group – and weren’t necessarily applicable elsewhere. They often used things like disability benefit as a measure of work exit, and again these weren’t always the same from one country to another.

Work exit

Previous studies found people at both ends of the occupational ladder were more likely than those in the middle to extend their working lives, but for different reasons. Put bluntly, those at the top chose to continue working; those at the bottom were forced to do so.

We looked at data from seven independent studies in Finland, France, the UK and the USA. Some of these were drawn from representative samples of the whole population, while others looked at specific groups – for instance, the Whitehall II study in the UK followed a large group of civil servants over several decades. All the studies were based on people who were in paid work at around the age of 50. In total, our study covered almost 100,000 people.

We considered two measures of social status – level of education, and level of occupation. We assessed retirement age and route (i.e. whether it was for health reasons or not) using respondents’ own reports of their retirement as well as company and administrative records and benefits information.

Overall,wefound those with lower levels of education were more likely to leave work for health reasons – this effect could be seen for men in all the studies and for women in most. Lower occupational grades were also strongly linked to leaving work for health reasons.

These findings have important implications for policymakers, who usually calculate retirement age by sex but who don’t take into account factors such as family circumstances or social status. Policies which seek to extend working lives for all are likely to place those with lower socioeconomic status at a disadvantage – especially in countries where the benefits system doesn’t do much to help those who must leave because of ill-health. This study underlines a need both for greater flexibility in polices that extend working life and for greater recognition of the barriers faced by those from less privileged backgrounds.

Further information

Occupational and educational inequalities in exit from employment at older ages: evidence from seven prospective cohortsis research by Ewan Carr, Maria Fleischmann, Marcel Goldberg, Diana Kuh, Emily T Murray, Mai Stafford, Stephen Stansfield, Jussi Vahtera, Bowen Xue, Paola Zaninotto, Marie Zins and Jenny Head. It was first published in the journalOccupational & Environmental Medicine on March 12, 2018.

The studies used in the research were:

British Household Panel Survey https://www.iser.essex.ac.uk/bhps

English Longitudinal Study of Ageing http://www.elsa-project.ac.uk/

1946 National Survey of Health and Development http://www.nshd.mrc.ac.uk/

Whitehall II study http://www.ucl.ac.uk/iehc/research/epidemiology-public-health/research/whitehallII

Finnish Public Sector study, Finnish Institute of Occupational Health https://www.ttl.fi/en/

GAZEL cohort http://www.gazel.inserm.fr/en/

Health and Retirement Study http://hrsonline.isr.umich.edu/

Having a family – how might the decision affect the length of your working life?

Across the developed world, people are living longer. In response to this, governments are looking for ways to encourage people to work for longer. In the UK, the State Pension age is being raised and future generations will have little choice but to work. But how will the decisions they made earlier in life – whether and when to have a family – affect their later employment prospects? A new study from the RenEWL project by Dr Mai Stafford and colleagues at UCL and Queen Mary University of London has some answers.

Many of the post-war baby boom generation retired before the State Pension age began to rise. But subsequent generations must plan for longer working lives, and government policy needs to find ways to facilitate that.

We know more people are living longer, and we know that our decisions about having a family can affect the likelihood of us staying in work for longer. But we wanted to get a more nuanced view of how family and working lives can interact.

Would those who delayed starting a family until their thirties be more likely to work into their late sixties? How would those who never had children differ from those who did? And how would the prospects of women who took time out of the workplace be affected by that decision as they neared State Pension age?

We looked at data from the MRC National Survey of Health and Development (NSHD) which has followed the lives of more than 5,000 people born within a single week in 1946. Participants have been studied 24 times during their lives from birth, through childhood and adulthood, and most recently when they were aged 68-69 – at which point more than 2,700 people responded. The men in the study reached state pension age at 65; the women at 60.

We found that almost half the men had been continuously married with children and in full-time work since their early twenties. Women’s lives tended to vary more, with the largest group working full-time until their early twenties then taking time out to raise a family before working part-time and then returning to full-time work in their late thirties.

In their early sixties, just over two thirds of women and a third of men were not in paid work.

Women who did work at this age were more likely to be in part-time work, while men were more likely to be in full-time work. By the age of 68-69, just one in five men and one in 10 women were still in paid work.

 Work and family

Those who became fathers in their early twenties and who had jobs were more likely to be in full-time work at age 60-64 than men who remained single and childless. They were also more likely to be in work at age 68-69 than men who had partners and jobs but no children.

When we looked at how the age at which participants had their children affected their later employment, we found this made no difference for men. But women who had children later were more likely to be in full-time work at age 60-64 than those who had them earlier.

Having children early then returning to full-time work after a break, rather than continuous work through the childrearing years, made no difference to women’s later employment prospects.

We considered whether these differences might be driven by earlier health and socioeconomic circumstances that result in different kinds of family-work patterns. The links between work-family patterns and later life work participation remained when we statistically controlled for childhood health, educational attainment and childhood socioeconomic factors.

Why did the age of family formation make a difference? Women who have their children later may still be providing financial support to them in their sixties – though if so we would expect that men who had children later would also be more likely to be in paid employment, and this was not the case.

Women who became mothers later may also have started working later – possibly because they stayed in education longer – and therefore might have accrued less pension entitlement by age 60-64, though we do not think this fully explains the difference because we controlled for educational attainment.

British baby-boomers

So, what can this cohort of British baby-boomers tell us about how family decisions affect later working lives? We found that the timing of having children was related to women’s but not men’s employment in later life.

Both men and women who remained childless, regardless of whether they had a partner, were less likely to be in paid work in their sixties than those who had children.

And both men and women who worked full-time and neither had children nor a partner were also less likely than their peers to be still in paid work after the age of 60, though women in this group who were still working were more likely than men to be working part-time.

Mothers who returned to work were more likely to be in work in their sixties, while becoming a father made no difference to a man’s prospects.

It’s important for policymakers who have an interest in extending our working lives to consider these results. Mothers, and parents more generally, may stay in the work-force in later life if they have access to jobs which allow them to combine family and work. Our study underlines the need for both part-time jobs and flexible working to be available to parents.

Work–family life course patterns and work participation in later life is research by Mai Stafford, Rebecca Lacey, Emily Murray, Ewan Carr, Maria Fleischmann, Stephen Stansfeld, Baowen Xue, Paola Zaninotto, Jenny Head, Diana Kuh and Anne McMunn and is published in the European Journal of Ageing.

Working after retirement age: who benefits?

Recent reforms have made it unlawful for employers to force their workers to retire. So what are the reasons why some people stay on after state pension age while others choose to leave? How do those decisions affect quality of life for those who stay, and for those who go? A study by Giorgio Di Gessa and colleagues at King’s College London and the University of Manchester sheds new light on the issue.

We know that more of us are working after we reach retirement age – but until now we haven’t known much about how people make that decision, or about what effect it has on their sense of wellbeing afterwards.

In our research, we used English data from a panel study of older people to find out more about who chooses to stay on in work and why. We then went on to ask whether those who chose to work felt differently about their lives when compared with those who felt they had to work.

We took a representative sample of 2,500 men aged 65 to 74 and women aged 60 to 69 who had previously been in work, and we found one fifth of them still had paid jobs. Of those, two thirds had chosen to continue to work because they enjoyed their jobs or because they wanted to keep fit and active. The other third said they worked for financial reasons: either they couldn’t afford to retire or they wanted to improve their pension provision for later.

We placed the retired respondents into three groups: Those who had had a ‘normal’ retirement when they became eligible for a state pension (28 per cent), those who felt they had to retire because of ill-health or redundancy (2 per cent); and those who retired voluntarily – because they could afford to do so or because they wanted to spend more time with their family, for instance (28 per cent).

Quality of life

On average, those who had retired experienced a lower quality of life, when measured on the CASP-19 scale for older people. The highest quality of life was reported by those who had stayed in work voluntarily, while the lowest was reported by those who had retired involuntarily. The gap in quality of life between these two groups is similar to the one observed between respondents who said they had a long-standing illness and those who did not. As expected, respondents who were financially better off also had higher quality of life scores.

When we considered changes in these CASP-19 scores over time, we found that on average people experienced a drop in their quality of life over a six-year period between two ‘waves’ of the study: about a quarter experienced a decrease of 5 points or more whereas just over 16% experienced an improvement of 5 or more points. Those working voluntarily experienced a slight increase in their quality of life when they eventually retired. On the other hand, the wellbeing of those who were working out of necessity did not improve after retirement.

Health benefits

As one might expect, the scores improved among those whose health got better after retirement, and worsened among those whose health deteriorated.

It’s worth noting that our study sample is skewed towards the more advantaged – the proportion with no qualifications is significantly lower than in the census. It is therefore likely that our study underestimates the percentage of people who work out of financial necessity.

What does our study tell us about working after retirement age? In particular, it reminds us how important it is for people to feel they have control over these key decisions about their lives. Those who continue working because they have to have lower quality of life than those who continue working because they want to – and even once those people have retired, this wellbeing gap is likely to persist.

We know that people who experience a higher quality of life tend to be healthier and to live longer.

Government initiatives aimed at helping workers maintain control over their decisions are worthwhile – but policymakers should also consider how people might be given more support throughout their lives to protect their financial and personal wellbeing if they do have to work for longer.

Further information

The decision to work after State Pension Age and how it affects Quality of Life: Evidence from a 6-year English panel study is a research paper by Giorgio Di Gessa of King’s College London, Laurie Corna of King’s College London, Debora Price of the University of Manchester and Karen Glaser of King’s College London. It is published in the journal Age & Ageing.

Never too early to intervene to get us working longer

Working for longer is something we are all having to get our heads around. It’s certainly a priority for the Government, which wants to encourage more older people into satisfying jobs that will help them stay happy and healthy as they age. For older people already in good jobs that they enjoy, who have been fit and active for most or all their life, this could be a great opportunity for them and their families. Of course that’s not the case for everyone. Dr Charlotte Clark has been looking at what having poor mental health as a child could mean for our working life in our mid fifties. Here she explains why policy makers and businesses need to pay close attention to the mental wellbeing of the nation if they want to extend people’s working lives successfully.

Working beyond traditional retirement age has been the focus of much attention in recent years as policy makers, businesses and working people across the UK get used to the idea that more of us need to work for longer to take account of the fact that more and more of us are living longer and that this reality comes at a cost.

As things stand, by their mid fifties, many people are not in work because of early retirement, long-term sickness or disability, being or becoming unemployed or because they are long term homemakers. So the onus for working longer tends to fall on those who stay employed through all or most of their lives. But could more be done to encourage and support those most likely not to be working at 55 to do so and then to continue to do so?

Looking right across people’s lives to track what may have influenced a person to leave or not be working at 55 provides us with a much clearer and more nuanced picture than a simple snapshot in time. We wanted to see whether having poor mental health as a child or as an adult might be an important part of that picture and give us some ideas for interventions that could extend the working lives of this group of people in a way that would benefit them and society more widely.

Increasing psychological support

It’s fair to say that the Government’s ambitions to get more people working for longer have been laid out quite clearly already, as has their commitment to putting people’s physical and mental health on an equal footing. Saying that, their commitment has been called into question recently in a report from The King’s Fund, which says parity is a long way off.

When it comes to specific groups not working, the Department for Work and Pensions has tended to focus its attention on benefit claimants rather than other groups who, for one reason or another may choose not to work – housewives and husbands for example.

Government initiatives to try to help people with mental health problems find work have included the ‘Improving Access to Psychosocial Therapies’ (IAPT) programme, which has increased provision of therapies for benefit claimants with depressive and anxiety disorders.

Evaluations of IAPT suggest that ‘Nationally, of [adult] people that finished a course of treatment in IAPT, 45% recover. . . and a further 16% show reliable improvement’. Encouraging results that have led to modest increases in employment, and it’s hoped there will be more positive news on this front.

However, things don’t look quite so encouraging when it comes to younger people with mental health problems and that’s what our research is shining a spotlight on. It’s also an area we believe should be a focus for policy makers and those working with young people including parents and schools. After all, successfully extending people’s working lives can only be done once they successfully enter and then remain in employment. This is less likely for youngsters with poor mental health.

55-year survey

We used information from the National Child Development Study which has followed the lives of thousands of people born in 1958, and collected detailed information about their lives and circumstances.

This included their employment situation and, first and foremost, we were able to see that, at age 55, nearly 19 per cent of the 9,000 participants in the study were not working: 2.8 per cent were unemployed, 5.2 per cent were permanently sick, 3.3 per cent were retired and 7.5 per cent were homemaker/other.

From a very young age, the study also collected information on whether the individuals in the study exhibited signs of depression or worry, whether they were hostile, disobedient or aggressive.

Even when we took account of a wide range of other things such as whether they suffered poor mental health as young or older adults, numbers of other children in the household, whether their partner was employed, qualifications etc. the association with problems as a child were still really strong.

Drilling down into whether those mental health issues were ‘internalized’ or ‘externalized’, we were able to see that those who were depressed or anxious as children were about one and a half times more likely to be unemployed or permanently sick as their peers without problems.

It was a similar story for those who had shown externalised signs such as aggression. They were more than twice as likely to be unemployed or permanently sick, and also more likely to fall into the homemakers/other category too.

Interestingly there was no strong link between poor mental health in childhood and taking early retirement or being employed part-time.

Children’s mental health

Of course there is a lot more at play in children’s lives than we have taken account of in this study. Nevertheless, it is clear from our research that addressing the mental health problems of the very youngest in society could and should be an area for focus and schools, together with parents and those with a responsibility for the wellbeing of young children have key roles to play here.

It seems it is never too early to intervene proactively to try to help young people get and stay on a healthy happy path that will lead to them a productive and satisfying working life that extends well beyond the age of 55. Equally, given that people identifying themselves as ‘homemakers’ rather than unemployed are the largest group not working at age 55, policy makers could consider ways to get this economically inactive group into the workplace, in tandem with its efforts to support the mental health of those people on benefits.

There is also a message here for policy makers about just how important it is to make those promises about parity of esteem between mental and physical health a reality sooner rather than later.

Impact of childhood and adulthood psychological health on labour force participation and exit in later life is research by Charlotte Clark and colleagues and is published in Psychological Medicine. The research is part of the ESRC funded Research on Extended Working Lives (RenEWL) programme at UCL.