Tag Archives: Career

Being accommodating in the workplace: could it help close the disability employment gap? 

In 2020, 8.4 million people of working age (16-64) reported that they were disabled which is 20% of the working age population. 52 percent of disabled people aged 16-64 were in work compared with  81 percent of non-disabled people. It’s a gap the Department for Work and Pensions wants to tackle, but good research for evidence-based policy solutions in this area is thin on the ground. New research from Tarani Chandola and Patrick Rouxel suggests that ‘workplace accommodations’ such as flexible or part-time working, mentorship and training and support could help the Government achieve its 10 year ambition to halve the disability employment gap.

In its 2017 policy paper Improving lives: the future of work, health and disability, the DWP committed to seeing the number of  disabled work in work rise by 1 million from 3.5 to 4.5 million over the subsequent 10 years. 

When we talk about the disability employment gap we mean the difference between the number of people with a disability who are in work compared with those without a disability. The gap comes about through people having to leave work through ill-health or the onset of physical or mental health problems whilst working, together with the fact that if you’re disabled, you have considerably lower chances of getting a job in the first place. The large majority (83 percent) become disabled whilst they are in work and once they do the likelihood of them being in work a year later is much reduced.

There has been little research in this area, particularly when it comes to looking at all this in the round in order to get the bigger picture as it relates to all workers who use some sort of work place accommodation or adjustment to how, where and when they carry out the role. In order to make sound policy recommendations that work for disabled people and employers, the Government has been looking to develop a more comprehensive evidence base. 

Rather than starting with a person’s medical condition, we thought it could be useful to examine which workers (no matter the state of their health) are able to access e.g. a technical solution that means they can fulfil a role they otherwise wouldn’t be able to, as well as a range of flexible arrangements such as working hours, modified duties, being based at home, having access to a mentor. 

We wanted to try to establish who and how these arrangements and adaptations help to remain in work.

Barriers faced

We made use of information on more than 6,000 participants from the Life Opportunities Survey , which looks specifically at the barriers disabled people face in participating in various aspects of life including work. 

Around a third of the people we looked at who were in work reported some sort of impairment – a problem with their sight, hearing, mobility, pain, breathing, learning mental health or with a range of other conditions and disability-related issues. They were more likely to be out of work a year later than peers with no impairment, particularly if their impairments were to do with mobility or dexterity in which case they were three times more likely to be unemployed.

Workers with some sort of impairment or disability who had modified work duties or hours were more likely to remain economically active (in work or looking for work) than those who reported no such accommodations.

Modifications

A modified work area or equipment led to workers being twice as likely to stay in work. Indeed the more modifications reported, the more likely workers with an impairment were to be in work one year later.

Particularly noteworthy was how true this was for workers with mental impairments. Those who had no workplace accommodations were over 2/3rds (or 70 percent) less likely to remain in work than workers with no mental impairment.

This stark gap closed where two or more accommodations were reported. Also interesting was the fact that people with mental impairments were considerably less likely than those who reported physical pain to report an increase in their workplace accommodations. 

Looking at the wider picture of who accesses work accommodations and why, the main reason was not actually related to disability at all, but with having caring responsibilities.

The key things we learn from all this are that despite the evidence that workers with mental impairments could benefit considerably from workplace accommodations, they are less likely to have their workplace adjusted to take account of it.

This is something that could be a focus for policymakers and employers looking to close the disability employment gap. It should be especially helpful in informing managers and supervisors who have a crucial role in creating healthy and inclusive workplaces where all can thrive and progress. 

The role of workplace accommodations in explaining the disability employment gap in the UK is research by Tarani Chandola and Patrick Rouxel and is published in Social Science & Medicine.

Youth unemployment and later mental ill-health: who is at risk?

The pandemic has brought links between unemployment and mental health to the fore. With joblessness having risen across the globe, new research looking at the longer-term effects is particularly timely. Liam Wright and colleagues from UCL’s Department of Epidemiology and Public health describe new research which could motivate efforts to target vulnerable groups and use resources efficiently.

We have known for some time that unemployment has a detrimental effect on mental health. And we know, too, that these effects can last for many years. A large body of research tells us those who have a spell out of work when young are more likely to suffer from poor wellbeing, depression and anxiety even decades later. 

It’s particularly useful to study these effects through the lens of youth unemployment, for two main reasons. First, unemployment rates are higher for those under 25 and recessions have a disproportionate effect on them. Second, unemployment at this formative stage of life may have a greater impact than unemployment later on: it can affect the way young people see themselves and can set off ‘chains of risk.’

Negative experiences during youth can have a measurable impact on our responses to stress, and that this can have a lifelong effect on our physical and mental health.

But until now we don’t know much about the reasons behind these links, or about whether these impacts were experienced differently by different groups of people. By learning more about these things, we should be able to direct resources more effectively to those who are likely to need extra help.

We decided to look at whether unemployment had a stronger association with later mental health for some individuals than others using a statistical technique called quantile regression. We also looked at whether the association was stronger for those with longer unemployment spells, was larger in men or women, and whether later employment success (which is thought to explain the association) was associated with relatively better mental health.

Mental health

We used data from Next Steps, formerly the Longitudinal Study of Young People in England, which followed a cohort of English school children who were aged 13 and 14 in 2003-4. The group were followed up to the age of 25– by that stage, there were 7,700 in our sample.

The mental health of the participants was measured at age 25 using the General Health Questionnaire or GHQ-12, a screening tool which can pick up mood and anxiety disorders and which scores them on a 36-point scale of seriousness – with 36 the most serious. We also took account of whether the respondents had a disability, their mental health during adolescence, as well as how they saw their general physical health.

We were able to compare these health scores with the employment status of the young people, focusing on those who had been unemployed for six months or more around the ages of 18 to 20 – this took place between 2008-10 and coincided with the global financial crisis, after which youth unemployment rose significantly.

We took account of a range of other factors such as gender, ethnicity, neighbourhood deprivation, educational attainment at age 25 and risk-taking behaviours such as drug-taking, alcohol, smoking and anti-social behaviour.

The results supported our key hypothesis that the association between youth unemployment and later mental health was driven by a relatively small proportion of formerly unemployed individuals who had very poor levels of mental health. Our model suggested that among a set of hypothetical individuals with average characteristics, more than 30 per cent of those who had been unemployed more than six months would have GHQ scores over 15 on the 36-point GHQ scale; 10 percentage points more than those who had not.

These effects could be seen even among those who were employed by age 25, and there was some evidence that the association was greater for men than for women.

Who’s at risk?

Our findings support and extend our existing knowledge, and they also pose questions: who are the individuals most at risk? We know men are more vulnerable in this respect than women, though this may be in part due to the greater likelihood that they are seeking work as opposed to looking after children, for example. But do men suffer more in economic, as opposed to mental health, terms?

We might also look at whether certain personality traits can help or hinder the wellbeing of those who find themselves unemployed while young. For example, does it help to feel that one has control over one’s own destiny, rather than taking a more fatalistic approach?

And we might look, too, at the mechanisms through which scarring takes place. Could unemployment while young affect people’s neuro-behavioural development? Or should we focus more on the ways in which an early spell of unemployment can cause problems later in the jobs market?

The answers to these questions could help us to identify vulnerable groups more accurately, and to point towards policy solutions which could potentially reduce these scarring effects in the future.

Heterogeneity in the Association Between Youth Unemployment and Mental Health Later in Life: A Quantile Regression Analysis of Longitudinal Data from English Schoolchildren, is research by  Liam Wright, Jenny Head and Stephen Jivraj of the Department of Epidemiology and Public Health, University College London, and is published in BMJ Open (http://dx.doi.org/10.1136/bmjopen-2020-047997).

Could having a psychologically demanding job actually be good for you?

Recent research has highlighted that those in psychologically demanding jobs which don’t offer possibility of control are more likely to become ill or to leave the labour market early. But a new study carried out in Sweden suggests the picture may be more complex than previously thought – for some workers, having a demanding job can be associated with good outcomes. Kristin Farrants from the Karolinska Institutet outlines what she and colleagues found and what it might mean for extending people’s working lives.

Governments across the developed world are interested in exploring how people can be enabled to extend their working lives. And a key part of that discussion has focused on how working conditions affect the likelihood that workers will stay on longer.

We know from earlier research that the working environment can affect how people feel about working into later life – if they are in jobs which are demanding but which don’t give them much control, they tend to want to leave. But until now we didn’t know much about what actually happened – do those intentions turn into reality? And what is the relationship between the demands of the job and the amount of control the worker has, when it comes to working after the usual retirement age?

We used nationwide register data from Statistics Sweden, to study all the 55-64 year-olds living and working in Sweden in December 2001. We followed up the same individuals 11 years later, in 2012, to see whether they were still working.

As predicted, we found that those who were in jobs with low levels of control in 2001 were less likely to be in paid work in 2012, while the reverse was true for those with a high level of control over their work tasks.

But when it came to how demanding the job was, the picture was more nuanced. Overall, those with more demanding jobs were less likely to have old-age pension, sick-leave benefits, or social assistance, 11 years on, than those with less demanding jobs, while those with low-demand, low-control jobs were less likely than others to carry on working.

Women and men

But there were significant differences between women and men. We found that when it came to control at work, women who had a high level of control over their work tasks were more likely to stay on in paid work, even if their jobs were not very demanding. For men, this was only the case if their jobs were both high-demand and high-control.

A possible explanation for these gender differences is that the jobs market in Sweden is highly gendered: perhaps the difference is in the type of jobs men and women do, rather than in the level of control or stress they have. It could also be due to differences in other factors, such as family needs, income or health.

Our findings support the underlying theory, which was first proposed in the 1970s by Robert Karasek. His Job Demand Control Model suggests it is high demands in combination with low control that leads to stress which can be bad for our health. Karasek’s model suggests that it is not stress, per se, which makes us ill – it is the mismatch between being asked to do a lot and yet not feeling in control of how we do it. So if our jobs are very demanding yet we feel we are in the driving seat, that makes a big difference to us.

Staying in paid work

Why does this matter? Across the developed world we have falling birth rates and increasing life expectancy – so it’s important to governments that people stay in jobs rather than retiring early. And if workers can stay healthy, this will be easier to achieve.

We already know that low levels of control are associated with high levels of disease, disability and sick leave. But the evidence about the role of job demands has been more equivocal.

Our research adds new depth to the picture. High-stress jobs are not necessarily bad; in fact a demanding job can be a positive factor in older people’s lives. Jobs which stretch and challenge us can keep us moving on in the labour market – and as well help us stay healthy.

Associations between combinations of job demands and job control among 616,818 people aged 55-64 in paid work with their labour market status 11 years later: a prospective cohort study, by Kristin Farrants, Jenny Head, Elisabeth Framke, Reiner Rugulies and Kristina Alexanderson, is published in International Archives of Occupational and Environmental Health .

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.

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.

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.