Category Archives: Research report

Health and place: How levelling up health can keep older workers working

As part of its levelling up agenda, the UK Government has set itself an ambitious target to add five additional healthy years to the average UK lifespan by 2035. In this blog Dr Emily Murray from the Department of Epidemiology and Public Health at University College London highlights lessons from the Health in Older People in Places project (HOPE), which she leads. HOPE uses data from the ONS Longitudinal Study to showing the link between levels of employment and health in a place.

We know place matters when working to extend healthy life expectancy (HLE) – there are large inequalities in older people’s health, depending on where they live. The Government recognises this and has set target of narrowing the gap between those living in the ‘healthiest’ and ‘unhealthiest’ local authority areas by 2030.

There are strong links, too, between the health of the population in a local area and levels of employment. So if we want people to be able to stay healthy and to work for longer, narrowing these gaps can make a real difference.

Staying in work

If the UK had achieved the current levelling up agenda goal of reducing the HLE gap by five years between 2001 and 2011, older people’s participation in the labour market would have increased by 3.7 per cent between 2001 and 2011. That would have meant 250,000 additional older people in paid employment. The HOPE project used Disability-Free Life Expectancy (DFLE) g as a proxy for HLE, as HLE data for local authorities was not available in 2001.

While disability-free life expectancy (DFLE) improved overall in the UK from 1991 to 2011, there was still a significant gap between the local authority areas considered the ‘healthiest’ and the ‘unhealthiest’. In 2011, DFLE at age 50 varied from 13.8 to 25.0 years – that’s a gap of 11.3 years between the healthiest and unhealthiest areas, which widened during the study period.

Unfortunately, over a decade later, the conversation hasn’t moved on much further. Health Equity in England: The Marmot Review 10 Years On, the 2020 follow-up to Sir Michael Marmot’s landmark study, found that the health gap between wealthy and deprived areas had continued to grow.

The HOPE project has built on this research by using Census data for England and Wales to show the link between levels of employment and health in a place.

It finds:

  • The higher the proportion of older people with poor health in a place, the less likely it is that any adults in that place will be in paid work. For example:
      • Older workers from the unhealthiest areas were 60 per cent more likely to be out of work than those who live in the ‘healthiest’ areas
      • Women aged 50-74 living in the ‘healthiest’ areas re 5.6 per cent more likely to be in paid work than those living in the ‘unhealthiest’ areas.
      • Men aged 50-74 living in the ‘healthiest’ areas were 7.1 per cent more likely to be in paid work than those living in the ‘unhealthiest’.

  • How we measure health in a place matters: links between health in a place and employment are stronger for self-rated health measures, compared with life expectancy figures or mortality indicators.
  • Historically disadvantaged areas continue to struggle: areas where people left paid work at a younger age due to poor health in 1991 were much more likely to experience this trend in 2011 as well.
  • This disproportionately affects people in manual occupations: they’re much more likely to experience ill health, and they can expect four fewer years of healthy life beyond age 50, compared with workers in administrative or professional roles.
  • There’s a correlation between health in a place and younger people being in paid employment: for example, the probability of a woman aged 16 to 49 not being in paid work was 33.7 per cent in the ‘unhealthiest’ areas compared with 26.3 per cent in the ‘healthiest’ areas.
  • Those working in professional occupations were more likely to be in work 10 years later than those working in elementary occupations or doing repetitive manual labour: this gap in employment outcomes was most marked for people living in ‘unhealthy’ areas.

The fallout from the COVID-19 pandemic and the current cost of living crisis are likely to widen existing inequalities. So it’s unclear how the Government intends to achieve its ambitious goals to increase healthy life expectancy and to narrow the gap between those in the ‘healthiest’ and ‘unhealthiest’ areas, especially given its recent decision to abandon the promised white paper on health disparities. 

We recommend that The Government should: 

• Increase spending on preventative health programmes to at least 6 per cent of the national health budget. This is in line with Canada, who currently invest the most in prevention across the G20 and continue to raise this proportion in accordance with the rise in preventable diseases. 

• Earmark part of the £4.8 billion levelling up infrastructure fund for projects that will create jobs suitable for older workers in the ‘unhealthiest’ local authority areas, especially in those where a high proportion of employment is in manual work. 

• Collect, monitor and publish data every year on health in a place, in particular self-rated health measures and labour market participation for people over the age of 50. 

• Confirm that there will be another census in 2031 and add detailed questions about health and labour market participation for people aged over 50. 

• Improve access to medical services to allow older people in poor health to remain in work. This includes reducing wait times to see a GP and for referrals, treatments and A&E. 

• Provide support, including career training and advice, to help older workers transition to less physically demanding roles, especially those in manual roles. 

Local authorities should: 

• Develop a five-year strategy to increase employment rates for people aged over 50 in the ‘unhealthiest’ communities, in partnership with business. This strategy should recognise that older women often face additional barriers to employment apart from health barriers. 

• Include local targets to improve population health in line with the national average for people aged 50 to 74 as part of their annual planning exercise. 

• Increase support for older workers in manual occupations to stay in employment. For example, training and financial support, either through the benefits system or apprenticeship schemes, can help older workers transition to less physically demanding jobs as they age. 

• Strengthen local tailoring of prevention programmes to ensure that services fully cater to local population health requirements. 

• Address ageism at a local level, by educating and informing people on how to receive the best care to prevent or manage health conditions, regardless of age. The aim is to challenge the perception that long-term conditions are an inevitable consequence of old age when many are preventable. Local authorities should also work with businesses to challenge employer perceptions that older people’s health is a barrier to their participation in the labour market.

Although the prevalent narrative is often that individual health is an individual problem rather than a societal one, the whole community is affected by poor health. It’s not just about helping people live longer, healthier lives but supporting local economies and economic growth.

The levelling up agenda is more important now than ever, and it’s vital it is not sidelined. 

The Health of Older People in Places (HOPE) project is a multidisciplinary research project funded by the Health Foundation under the Social and Economic Value of Health in a Place (SEVHP) programme. The research team includes scientists from the Department of Epidemiology and Public Health at University College London (UCL) and the School of Geography at the University of Leeds. The full report, Health and place: How levelling up health can keep older workers working, is available here. The report was written and published by the International Longevity Centre, UK.

The work was launched on October 19, 2022, at an event whose keynote speakers included Lord James Bethell, Parliamentary Under Secretary of State at the Department of Health and Social Care. Slides from the event are available here: https://ilcuk.org.uk/hope-project-report/

Dr Murray discuss the work further along with Dr Brian Beach in this Linking our Lives podcast.

Out of work again? The psychological impacts of repeated unemployment

Being unemployed is bad for our mental well-being, but if we lose our job more than once does the psychological blow lessen in some way? Researchers Cara Booker from the University of Essex and Amanda Sacker at the International Centre for Lifecourse Studies at UCL used the long-running British Household Panel Survey to examine the psychological well-being of people who have repeatedly lost their jobs. Their findings show that our employment history makes a difference and could have implications for welfare to work initiatives from Governments looking to get people back to work.

Continuous employment may be what is best for us, but of course life is not always that straightforward and, at any given time, a significant proportion of the population will be out of work. This could be because we choose to take time out to undertake training or to have a family. We may fall ill or be made redundant.

The world of work is also becoming more flexible. Fewer people are staying with the same firm for long periods of time and more people are moving from contract to contract or job to job, sometimes with spells of unemployment in between.

At the same time, the Government wants to get more people off benefits and into work and is looking to make its Work Programme more effective.

Using 17 years of data collected from the participants in the British Household Panel Survey (1991-2008), we looked at any individual who had reported at least one spell of unemployment. Of these 1,642 participants, 82 per cent were unemployed once, 15 per cent twice and 3 per cent three or more times.

Mental health score

Participants were asked a range of questions about their mental health and answers to these were used to allot a score with 0-11 indicating good psychological health and 12 or more indicating stress or anxiety that could lead to ill health. The time periods before and after a spell of unemployment were also taken into account because job loss isn’t generally something that happens suddenly and there can be weeks or months building up to it.

Looking at the group as a whole, we found their psychological well-being was generally poorer during all spells of unemployment compared with when they were not unemployed, but there was no evidence of a lowering or increasing of the effect from one spell of unemployment to the next.

When we dug deeper into participants’ prior work history, however, we saw some differences between those people who had previously been ‘economically inactive’ (voluntarily not working e.g. to look after family or study) and those who had been working.

Those who prior to being employed had been ‘voluntarily’ not working suffered poorer psychological well-being after they went on to lose their job but became notably worse in the third spell of unemployment.

The previously employed group’s psychological well-being also took a knock after losing a job once and then again, but, by the third time there was no change, a possible indication that the individual is somehow adapting or getting used to dealing with the ‘shock’ of becoming unemployed.

When we compared levels of psychological well-being between these two groups, they were notably lower among the previously employed at unemployment spells one and two, but this was reversed at spell three.

Employment history matters

So only when we took into consideration being economically inactive as opposed to employed, did a slightly clearer picture emerge around this question of whether people adapt to the ‘shock’ of unemployment, with those previously employed seeming to adapt and those previously economically inactive becoming increasingly sensitive to it. These findings were given further weight when we looked at retrospective employment histories before the BHPS began.

One explanation for this is that those who come from an employed background tend to find work again after each unemployment spell they experience, so they become less anxious about finding another job. The economically inactive, meanwhile, seem to find it harder to enter and re-enter the job market which could account for increased anxiety with more attempts to sign up as ‘unemployed and seeking work’.

Household income also played a role with those who were economically inactive on higher than average incomes experiencing worse psychological well-being than their less off counterparts when making an unsuccessful attempt to enter employment.

In its recent Welfare-to-Work report, the Work and Pensions Committee pointed out that key to the programme’s success was providing unemployed people with “the right help at the right time” and a better understanding of the barriers and characteristics that prevent a swift return to work. A better understanding of the impacts of repeated spells of unemployment on people’s well-being would seem to resonate here.

It is also clear that good quality, secure employment opportunities with long term prospects are key to people’s health and happiness.

Psychological well-being and reactions to multiple unemployment events: adaptation or sensitisation? is research by Cara Booker and Amanda Sacker and is publishes in the Journal of Epidemiology and Community Health

Photo credit: Kathryn Decker

 

Having a baby early? It might not be good for you later

Being employed is generally good for your health. That’s what a large body of research has shown over the years. But what about when you put having a family into the mix? That’s a question that Dr Anne McMunn at the ESRC International Centre for Lifecourse Studies at UCL has been asking in a series of studies looking at the interplay between work-family life and health in middle age. Here she outlines her findings and explains why having children early may not be good for you.

When couples think about starting a family, they may make decisions around a host of concerns. Finances, careers, childcare all spring readily to mind as things that could crop up in discussions about when it might be best to have a child. Not many people will stop and think about how and when having a child might affect their health later on in life – but maybe they should.

Research to date has shown that combining paid work with family responsibilities is usually linked with better health outcomes, although existing research has a number of shortcomings: men are often excluded, health measures have tended to be self-reported rather than objective, few studies take account of the role health plays in whether or not people work, get married and have children in the first place, and, crucially, few studies look across the lifecourse at the timings of entry into parenthood.

Combining work and family life

Using the National Child Development Study, which is following the lives of 17 thousand people born in 1958, our research has looked at how they combined their work and family lives between the ages of 16 and 42 and what that meant for their health in their mid 40s.

The thinking behind the research was that those people with more stressful work-family lives (often characterised by having children very young, being unemployed, and not marrying or forming a long-term partnership) would go on to have physical signs or indicators of poor health such as high cholesterol and blood pressure, being overweight etc.

All the men and women in the study were ascribed one of 12 lifecourse types e.g. ‘Work, Later family’, ‘Later family, Work break’, ‘Teen parent’.

Table 1-1

Almost all men were in a group characterised by long-term full-time employment, with most (34%) entering family life later (the ‘Work, Later family’ group), with nearly as many entering family life earlier (the ‘Work, Earlier family’ group at 32%). Conversely fewer than half of women (47%) were in a group characterised by long-term full-time employment. The ‘Part-time work, Earlier Family’ was the most common group (18%) for women.

Similar proportions of men and women were in the ‘Work, Cohabitation, Later Parent’ group (7% and 5%, respectively), the ‘Work, Marriage, Non-Parent’ group (8% of men, 9% of women) and the ‘Work, No Family’ group (13% of men, 10% of women). Only 4% of women were in the ‘No Paid Work, Earlier Family’ group, and few men or women were in groups characterised by marital dissolution, teen parenthood or weak ties to work or family.

Early parenthood – poorer health

As we expected, those men and women who were in full-time long-term employment, were married and had children later on enjoyed better health. Early parenthood, especially teen parenthood was clearly linked to poorer health, regardless of whether they were in paid work or in a stable long-term marriage.

For example, the waist circumference of teen parents was four inches larger, on average, than those who were in full-time long-term employment, were married and had children later (fat accumulated around the waistline is known to be particularly risky for health). Groups who entered parenthood earlier had 10-18% more fat circulating in the blood and 2-8% less of the ‘good’ HDL cholesterol than those who were in full-time long-term employment, were married and had children later.

Teen parents tended to be less well educated, which accounted for some of the link. However, even those who had stable employment and marriages, but had children early, had poorer health.

It seems that for both men and women, having children early is linked with poor health later on, possibly as a result of chronic stress from parenting in straitened circumstances with fewer financial and emotional resources.

Less human and social capital

Authors of other studies showing links between early parenthood and health problems such as depression, heart disease and long term illnesses, speculate that younger parents have accumulated less human and social capital to cope with the stresses of parenting. It is also possible that those who are older when they become parents have had time to establish healthier behaviours such as exercise and healthy eating prior to starting their families, making it easier to maintain those behaviours through the busy parenting years.

There is need for further evidence on how timing of parenthood influences health and we are currently replicating this study with participants from the 1970 birth cohort.

In the meantime, perhaps those family planning discussions around finances, careers and childcare should incorporate an extra question? If we have a child now rather than later, how might it affect our health later on? It’s a question that will be of interest not just to prospective parents, but to all those concerned with improving the long term health and well-being of our society.

Work-family life courses and metabolic markers in mid-life: evidence from the British National Child Development Study is research by Anne McMunn, Rebecca E Lacey, Meena Kumari, Diana Worts, Peggy McDonough and Amanda Sacker.

Photo credit: Darren Johnson