Tag Archives: Sickness

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/

Staying at work longer – a matter of geography?

There are lots of reasons why people end their working lives early, and the relationships between those reasons are complex. We know, for instance, that if you’re a carer for someone close to you, if you’re unwell yourself or if you don’t have higher level qualifications then you’re more likely to stop working sooner. But how does the area in which you live affect your prospects of working for longer? What if you live in an area of high unemployment, for instance? A new report by George Holley-Moore and colleagues at the International Longevity Centre – UK highlights how people in such areas are less likely to extend their working lives – even when those other factors are taken into account.

All too often the debate about how best to help people to work into later life stops at physical health. But research from the renEWL project suggests there is much more to be considered. In a new report, Working for Everyone – Addressing Barriers and Inequalities in the Working Lives Agenda, we look at these complex relationships – and we find there’s a great deal more policymakers could be doing to help.

Interlinking factors such as physical and mental health, working conditions, family life and lifestyle are all important. And it’s vital that regions should use their devolved powers to ensure that people in all parts of the population have the opportunity to extend their working lives.

The importance of geography

But how does where you live affect the length of your working life? We know older workers living in areas of high unemployment tend to leave work earlier: A study by Emily Murray and others looked at a one per cent sample of the population, aged between 40 and 69 and working in 2001, and at the same sample again 10 years later. Using local area statistics on unemployment, it mapped whether they left work, and their reasons for leaving, against the level of joblessness in their area.

It found that people who rated their health as poor in 2001 were almost six times more likely not to be in work 10 years later.

Thinking about this, it’s perhaps unsurprising that older workers in areas of high unemployment were less likely to be in work 10 years on – after all, if you live in an area with high unemployment you’re more likely to suffer from a long-term health issue. And that’s bound to affect your ability to work. Furthermore, if you have poor health earlier in life you are more likely to be sick or disabled later in life.

But was there a geographical factor even after these health inequalities were taken into account? Murray and colleagues found that even those in good health were more likely to be out of work a decade on if they lived in an area of high unemployment – that is to say, this economic factor operates separately from all those other things that can affect the length of a person’s working life. People in poor health were more likely to be out of work regardless of where they lived.

Evidence-based planning

It’s clear that there is a need for strong regional and national planning on these inter-related areas of work, health and geography. Creating policies tailored to the unique pressures faced by the local population will be necessary to address the scale of the problem:

National Government should focus infrastructure spending on areas of higher unemployment with a view to increasing job opportunities and making employment more accessible for older workers.

Regions need to use devolved power to tailor their own integrated strategies to enable fuller working lives.

Local authorities should be given power and funding to coordinate local partnerships that tackle employment challenges. These should include councils, businesses, health and social care providers and charities: supporting fuller working lives in at-risk areas would require a joined-up approach that targets the various at-risk groups.

Fundamentally, policy must move away from focusing exclusively on physical health conditions. We need a holistic approach which incorporates physical and psychological health, growing care needs and socio-economic disparity if we are to extend working life for everyone.

 

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