Tag Archives: Occupational health

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/

A question of support: working longer and what works

As more of us work for longer, it’s important to recognise the needs of older workers: and that includes the fact that as we age we are more likely to suffer from long-term illnesses. To what extent do our working conditions affect our decisions about whether or not to continue in a job despite having a chronic disease? Maria Fleischmann, research associate in the Department of Epidemiology and Public Health at University College London, has been asking what might help to prolong working life for older people. Could factors such as having supportive colleagues and managers, or a clear understanding of who does what, make a difference?

There is strong evidence that people with long-term illnesses leave work early. While three quarters of healthy European 50-somethings have jobs, the figure from those with chronic disease is much lower. Among those with one condition such as diabetes or heart disease, the employment level is around 70 per cent – and for those with two or more that drops to around 50 per cent. Conversely, those who are able to stay well are significantly more likely to continue working beyond pensionable age.

As our working lives grow longer, it’s important to acknowledge that older workers with chronic diseases may have different needs from those who are well – they may not be able to work such long hours, for instance.

So, what are the factors that can make a difference? We know, for instance, that people are likely to remain in work for longer if they have a high level of control over their own hours. Shift workers, on the other hand, are more likely both to become unwell and to leave work early.

Deciding to stay on at work

But what about the factors that are harder to see? What about a worker’s sense of his or her own job stability, or of how harmonious the relationships are between co-workers? Does it help if an employee feels he or she generally knows who does what, or how to respond to a given situation? These types of factors – collectively known as ‘psychosocial factors’ – are also believed to affect peoples’ decisions about whether to stay on at work.

We used data from the Whitehall II study, which has been following the lives, work histories and health experiences of just over 10,000 London-based civil servants since the mid-1980s, when they were all aged 35-55. We looked at the participants in mid-life, around 14 years before retirement age, to see how factors such as levels of autonomy and of support from supervisors or co-workers might affect their decisions if they became ill with diabetes, coronary heart disease, stroke or malignant cancer.

And we found that while good ‘psycho-social’ working conditions were helpful generally in supporting workers to stay on in their jobs, they didn’t appear to make any extra difference for those who became ill.

The participants in the Whitehall II study were asked questions such as: ‘Do you have to do the same thing over and over again?’ and ‘Do you have a choice in deciding how to do your work?’ They were also asked whether they felt they had good support from colleagues and superiors and how demanding they felt their job was. They were also asked to describe their level of education, their mental health and whether they had a partner who worked.

We were able to use their answers to assess whether these factors made a difference when they developed illnesses later in life.

Chronic illness

We could see that six out of 10 participants left work between the first phase of the study in 1985 and the last one used for this study, in 2007-9. During the same period the proportion suffering from chronic illness had increased from less than two per cent to almost 30 per cent.

So why had they left, and how might those ‘psychosocial’ working conditions have affected those decisions?

Among the whole group of participants, we found clear evidence that those who felt they had reasons to be happy in their work were more likely to stay on. Specifically, those who felt they were using a wide range of job skills – known as skill discretion – and those who felt they had good social support at work were more likely to stay on for longer.

However, we did not find evidence that those ‘psychosocial’ factors would make more of a difference in whether or not a worker stayed on if he or she were chronically unwell. Or rather, good working conditions were equally important for workers both ill and well.

So, we know that good social and psychological conditions at work are likely to be helpful in keeping employees at work as their careers near their end. And we know that chronic illness is a major reason why people leave work early. But from our study, we cannot say that such good working practices will be a particular deciding factor for those who become unwell.

How and why people leave work

There were some interesting factors in our results: first, we were able to look at the different ways in which people left their jobs, and the reasons why they did so. So those who used a wide range of skills had a reduced risk of leaving work earlier through retirement or ill-health, but this was not related to the risk of leaving work earlier through unemployment; while those who had good social support had a reduced risk of leaving earlier through ill health or unemployment, but not so much when we looked at leaving earlier through retirement.

And while previous studies had tended to measure working conditions at the time of leaving, ours looked at those conditions several years beforehand.

There is certainly scope for more detailed research on this issue – and there is plenty of reason for both researchers and policy advisors to continue to focus on how employers can help chronically ill workers to stay in their jobs.

Can favourable psychosocial working conditions in midlife moderate the risk of work exit for chronically ill workers? A 20-year follow-up of the Whitehall II study is research by Maria Fleischmann, Ewan Carr, Stephen A Stansfeld, Baowen Xue and Jenny Head. It is published in the BMJ Journal of Occupational and Environmental Medicine and is part of the renEWL project on Extended Working Lives.

Could frailty screening help extend our working lives?

The Government’s Business Champion for Older Workers, Andy Briggs, has called for one million more older people to be in work by 2022. But to enjoy the benefits of working longer, we need to remain in good health. Professor Keith Palmer from the University of Southampton and colleagues investigated whether signs of frailty in mid-life can predict difficulties in continuing to work later on. Here he outlines their findings and makes the case for developing screening to identify those workers most in need of support.

By 2020 the over-50s will comprise almost one third of the UK’s working age population, and more recent Government policies, including changes to the age at which we can claim our State Pension, have been focused on extending our working lives.

But, according to the Centre for Ageing Better, the single biggest reason for people leaving the workforce before retirement age is health, and nearly half of all people between ages 50 and 64 have a long-term health condition. The charitable foundation has been highlighting the need for more support to allow older people to continue to work.

For people with poor health, previous studies have shown that extending their working lives may not be in their best interests. Our research is the first to measure frailty and symptoms of pre-frailty in people aged 50-65 and determine whether and how it is associated with employment difficulties. The idea was to see if there is a way to identify early those people most likely to find it difficult to continue working.

We used information about more than 8,000 people collected through the Health and Employment After Fifty (HEAF) Study, which involves patients from 24 geographically-dispersed GP practices in England.

They answered a range of questions about whether they suffered from exhaustion, had a slow walking speed, a weak grip (determined by whether they had problems opening new jars), low levels of physical activity and whether they had unintentional weight loss in the past year.

People with more than three of the above symptoms were classed as ‘frail’, while those with one or two symptoms were classed as ‘pre-frail’.

They were also asked employment-related questions: were they currently working and, if not, had their previous job ended for health reasons?

Those in work were asked:

  • their total sickness absence over the past 12 months
  • had they needed to cut down at work because of their health?
  • were they coping with the physical and mental demands of their work?
  • Did they expect to be able to do the same work in two years’ time?
  • Was their job secure?
  • Did their work affect their sleep?

Information about their well-being, including back and other pain, was also collected, and participants’ jobs were classified as higher managerial, intermediate or routine/manual.

Health problems

More than one third of the women, and 27 per cent of the men studied were no longer working. Of these, around one third of both sexes said they had left their job because of a health problem.

Disorders or pain affecting movement, such as bone, joint or nerve problems, and mental illness, were the most common reasons for stopping work.

Many of those still working reported difficulties with their jobs, with between 6 and 7 per cent having taken 20 or more days’ sick leave in the last year. Around one third reported problems coping with work’s physical demands, and 20 per cent said their job was insecure.

Four per cent of the group studied were classed as ‘frail’ and, within this group, more than three-quarters reported low physical activity, weak grip and slow walking speed, with women more likely to report symptoms. Nearly one third of the participants were classed as ‘pre-frail’.

When work situations were taken into account, we found three quarters of those classified as ‘frail’ were no longer working, with 60 per cent of these leaving their job for a health reason. Only a quarter of the ‘non-frail’ participants had stopped working.

The odds of not being in paid work were more than ten times higher for frail compared with non-frail participants, while the likelihood of leaving work for health reasons was higher still (up 30-fold). In frail people who were in work, the odds of prolonged sick leave, cutting down a lot at work and struggling with work’s physical demands were about 11 to 17 times greater than for non-frail workers.

‘Pre-frail’ subjects also had more work problems, although not to the same extent as frail subjects. For example, their odds of health-related job loss were up 3.7-fold, and their odds of having prolonged sick leave or having to cut down a lot at work in the past year were up 2.5 to 3-fold.

Frailty effect

The impact of frailty on not being in work, taking more sick leave, and not coping with work demands was about 2–3 times greater among those from poorer backgrounds. However, we found ‘frailty’ was strongly associated with poor work outcomes even for those in higher managerial positions.

Looking at the frailty symptoms individually, we found most of the work problems to be most strongly linked with slow walking speed. Strong links were also found with poor grip strength and exhaustion.

Our findings showed strong associations between certain symptoms, for example those with slow-walking speed also tended to be exhausted or have a weak grip. Similarly, there were links between weak grip and exhaustion, and slow walking speed and low physical activity.

Strong associations

While our findings need further follow up, assessing the same group of patients over time to confirm the links between different physical symptoms and future work problems, our large sample size has confirmed frailty symptoms are common in people aged 50-65.

As the first study linking frailty and pre-frailty symptoms to work outcomes, we have shown strong associations with worklessness, health-related job loss, sickness absence and not coping at work.

Through further study, these symptoms could be refined to form the basis for simple screening tests for older workers, and spearhead the development of targeted support to improve physical function in those most at risk.

To realise the call of the Government’s older workers’ champion for one million more older people to be in work in five years’ time, identifying those most likely to struggle to remain in the workplace will be crucial.

The Government, NHS and employers will need to heed the call from the Centre for Ageing Better to develop workplace adaptations and age-friendly practices, and extend occupational health support and targeted preventive approaches that help people stay in work and stay well.

Further information

Frailty, prefrailty and employment outcomes in Health and Employment After Fifty (HEAF) Study is research by Keith Palmer, Stefania D’Angelo, Clare Harris, Cathy Linaker, Catharine Gale, Maria Evandrou, Holly Syddall, Cyrus Cooper, Avan Sayer, David Coggon and Karen Walker-Bone of the University of Southampton and Tjeerd van Staa of the University of Manchester. It is published in Occupational and Environmental Medicine.

Photo credit: Roberto Trombetta

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