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 20^th 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.