Tag Archives: Health

Are permanently sick people less sick nowadays?

Brexit aside, there have few topics more hotly contested in recently years than who should get incapacity benefits. The steady rise in the incapacity benefits bill over several decades led some to question whether greater numbers of people could actually be sick and whether this group is actually healthier, with less serious health problems, than had been the case in decades past. But what does research evidence tell us? Bola Akinwale from Public Health England and colleagues at the ESRC International Centre for Lifecourse Studies have looked at 30 years’ worth of data to see.

In the last 30 years of the 20th century, life expectancy for those aged 65 increased more than it had in the previous 70 years. A job market that had been almost completely dominated by men became dramatically more diverse. By the turn of the century, very few men aged 60-64 were in paid work, although that number has since increased.

On the face of it, many of these changes represent good news, but they have also created new challenges around funding pensions and how to keep increasing numbers of older people healthy and active for longer.

Our research looked at the proportions of men and women around State Pension Age who were employed, unemployed, permanently sick (those we might expect to claim incapacity benefits) or retired. We went on to look at their health immediately after retirement age to see if they had died prematurely or had a limiting long-term illness or disability.

When we compared the labour market positions of 60-64 year-old men in 1971 compared with 2001, we saw some big changes:

  • Working – 78.4 percent v 47.5 percent
  • Retired – 7.2 percent v 24.7 percent
  • Permanently sick – 9 percent v 19.7 percent

By 2001, women were almost as likely as men to describe themselves as retired after State Pension Age and 12.4 percent of 55-59 year-old women described themselves as permanently sick in 2001 compared with 3.4 percent back in 1971.

So we see the proportions of permanently sick men doubling over 30 years and quadrupling for women.

Across the same time frame, the risk of dying just before State Pension Age decreased substantially – by more than 60 percent for men and by more than 50 percent for women, irrespective of whether they are in work or permanently sick. In other words, both groups benefited equally from these changes – staying healthier and living longer than their counterparts 30 years previously.

Are sick people less sick nowadays?

 The answer is no and yes – it depends on the comparator.

To try to get to the bottom of this idea that people who are permanently sick are less sick than their historical predecessors, we compared the likelihood of them dying prematurely with that of their working peers.

On the one hand, if they were less sick, we would expect to see the gap between the chances of dying prematurely for these two groups get smaller over the 30-year period. We don’t see that.

Permanently sick men aged 65-69 were three times more likely to die prematurely than their working peers in 2001 and this was an increase on the 1971 figure. For women, the figure was between four and five times over the period we looked at.

On the other hand, it’s clear that this 30 year period brought about some remarkable changes in the working lives and general health of older people, including among permanently sick group. Their life expectancy has increased in line with other people of their age.

But despite these improvements in life expectancy among permanently sick people, compared with employed people their likelihood of dying has, if anything, slightly increased and certainly not decreased.

So, taken together, our research does not support the argument that the permanently sick have less serious health conditions nowadays than they used to.

A key plank of the Government’s policies for people who are unable to work due to illness is to try to support them back to work wherever possible. Our research shows that achieving this aim, requires careful consideration of the types of jobs and working environments that might be suitable for people with chronic illnesses.

If we don’t create enough jobs that older people with chronic illness can sustain and thrive in, life expectancy gaps between those in work and those who leave the workforce prematurely due to ill-health may widen further.

Work, permanent sickness and mortality risk: a prospective cohort study of England and Wales, 1971-2006 is research by Bola Akinwale, Kevin Lynch, Richard Wiggins, Seeromanie Harding, Mel Bartley and David Blane. It made use of linked census and death records in the ONS Longitudinal Study.

Photo credit: ILO in Asia and the Pacific

Work and family – how it affects our health

How our working and family lives affect our health as we get older is of increasing interest to us all. Researchers at the ESRC International Centre for Lifecourse Studies have used the 1958 Cohort Study to look at levels of inflammation (indicators of being at risk of illnesses such as heart disease) and and how people combine their work and family lives to see if any patterns emerge that could tell us more.

In this episode of the ICLS Podcast, Dr Rebecca Lacey explains the background and context of the research and what the team has found.

You can also listen to a policy seminar talk about the research.

Working longer: is it good for your health?

Across Europe we are all living and working longer. Many of us in the UK are working past state pension retirement age. But what sorts of jobs do older workers opt for and why and what does all this mean for our health, especially in the context of changes to the age at which we can collect our state pension?  In this policy presentation from the ESRC International Centre for Lifecourse Studies at UCL, Professor David Blane looks at what these changes mean for our quality of life as we get older and the implications for those working in occupational health.

A full transcription of David Blane’s talk is also available on the ICLS website.

Photo credit: Scott Lewis

A question of inflammation

Inflammation can be good and bad for us. Find out more in this presentation from researcher Rebecca Lacey, who uses inflammatory markers in mid life to look at whether the way in which we combine our work and family lives early on affects our health later on.

The research,  presented at an ESRC International Centre for Lifecourse Studies policy seminar, concludes that homemakers and people who have children early, particularly teen parents, are at greater risk of poor health in mid life and recommends increased support and opportunities for young parents.

Listen to Rebecca’s presentation and view the slides below.

Work, family and health – a question of inflammation? from Chris Garrington on Vimeo.

Photo credit: Fixers

Can unemployment kill – Podcast

Our first blog showcased recent research from the team at ESRC International Centre for Lifecourse Studies about the links between long term unemployment and stress markers linked to killer diseases. If you were interested in that, you can also listen on Soundcloud to researcher Amanda Hughes discussing the research for the ICLS Podcast.

Can unemployment kill?

At the height of the recent recession around 2.7 million people were unemployed, and youth unemployment accounted for nearly 40 per cent of that total. Given growing evidence that unemployment is linked to long term illness and increased mortality, we can expect health implications for those affected. In a week when unemployment rose for the first time in over a year, Amanda Hughes presents new evidence from the ESRC International Centre for Lifecourse Studies on the links between unemployment and killer diseases such as heart disease.

In 1984 a study was published which had linked census data to mortality records and found that men unemployed in the week of the 1971 census were 36 per cent more likely to have since died than men of the same age who had been in work. Accounting for differences in social background only explained part of the excess, raising the question: can unemployment kill, and if so how?

That unemployment might damage health was not a new idea. Marie Jahoda’s research on unemployment in the 1930s had shown that the non-financial benefits of work, such as defining aspects of status and identity and providing regular social contact, are for many people crucial to mental wellbeing. And since job loss usually brings a sharp drop in income, it is intuitive that unemployment could affect physical health by reducing quality of diet or opportunities for exercise.

But there tends to be more scepticism as to whether serious physical illness or mortality could be causally influenced by the undoubtedly stressful experience of unemployment. Might those unemployed men have developed serious illness when employed, lost their jobs as a result, and then died from their illness? Or might their increased mortality simply be caused by unemployed people smoking and drinking more? In neither case could it be claimed that unemployment itself has caused any deaths.

New approach

Since the 1980s, the tools available to scientists researching the health impacts of social conditions have moved on considerably. One new approach involves molecules called ‘inflammatory markers’ which circulate in the bloodstream and appear to be influenced by stressful experiences.

Elevated concentrations have been found in the recently bereaved and caregivers; inflammatory markers are also typically higher for people of disadvantaged socioeconomic position as measured by income or occupational social class. Crucially, raised concentrations of these molecules are linked to atherosclerosis and predict heart disease, presenting a possible causal pathway between a stressful social environment and increased mortality.

It was for this reason that we wanted to see if two inflammatory markers – C-reactive protein and fibrinogen – were elevated in jobseekers compared to employed counterparts.

We used the Health Survey for England and Scottish Health Survey, annual government surveys used to track changes in the health of both countries’ populations. To isolate elevations in these molecules due to unemployment-related stress, we considered a number of additional factors beyond participants’ age and gender.

To rule out elevations due to serious illness predating job loss, we considered whether participants had a long-term illness of any type. To rule out elevations caused by disadvantaged socioeconomic position more generally, we took into account housing tenure and occupational social class from current or most recent job.

Finally, to test whether elevations might be explained by worse health-related behaviours of jobseekers, we took into account participants’ smoking, alcohol consumption and body mass index.

Stress markers

In our sample of over 23,000 men and women of working age, unemployed people had elevated circulating levels of both molecules even after consideration of these factors. These differences were moreover clinically relevant, since unemployed participants were 40 per cent more likely to have C-reactive protein over 3mg/L, the level at which cardiovascular risk becomes elevated.

Effects were not uniform across the population. Firstly, older jobseekers (48-64) were more affected than younger jobseekers. This might indicate that unemployment is more stressful for jobseekers facing age discrimination, or equipped with outdated skills.

Since older jobseekers will have accumulated more unemployment over their lifetimes than younger counterparts, it could alternatively indicate that long-term or repeated unemployment is especially damaging to this aspect of health.

Secondly, we found substantial differences in results by country, with much greater elevations in both molecules for jobseekers in Scotland than in England. Data from the Labour Force Survey and the British Household Panel Study show that during the years of data collection (1998-2010) unemployment was higher in Scotland than England, and unemployment spells on average longer, which suggests two possible explanations.

Firstly, the jobseekers in Scotland may have been unemployed for longer, or had more recent unemployment spells, than English counterparts. Secondly, unemployment could be more stressful in times and places where the background rate is higher, since jobseekers will rationally perceive their prospects for re-employment as worse.

Since these surveys only collect information from people at one point in time, it was not possible in this analysis to investigate effects in the context of people’s employment histories. But unpicking these explanations will be crucial if we are to better understand the conditions under which unemployment is most likely to damage health, and which groups are most at risk.

Crucially, given last week’s news of a 21,000 rise in unemployment for the first time in a year  to 1.7 million people, policy makers interested in the long term health of the population should not divert their gaze from its wider consequences.

Photo credit: Kate Hiscock

Further information

Amanda Hughes is a Senior Research Officer at the Institute for Social and Economic Research at the University of Essex.

Elevated inflammatory biomarkers during unemployment: modification by age and country in the UK is research by Amanda Hughes, Anne McMunn, Mel Bartley and Meena Kumari and is published in the Journal of Epidemiology and Community Health.

References

Unemployment and mortality in the OPCS Longitudinal study is research by K.A Moser, A.J Fox, and D.R. Jones, and is published in the Lancet.

Unemployment durations: evidence from the British Household Panel Survey is research by K. Long and is published in Economic & Labour Market Review.