Merel Schuring

The effects of ill health on entering and maintaining paid employment: evidence in European countries

Objectives: To examine the effects of ill health on selection into paid employment in European countries. Methods: Five annual waves (1994–8) of the European Community Household Panel were used to select two populations: (1) 4446 subjects unemployed for at least 2 years, of which 1590 (36%) subjects found employment in the next year, and (2) 57 436 subjects employed for at least 2 years, of which 6191 (11%) subjects left the workforce in the next year because of unemployment, (early) retirement or having to take care of household. The influence of a perceived poor health and a chronic health problem on employment transitions was studied using logistic regression analysis. Results: An interaction between health and sex was observed, with women in poor health (odds ratio (OR) 0.4), men in poor health (OR 0.6) and women (OR 0.6) having less chance to enter paid employment than men in good health. Subjects with a poor health and low/intermediate education had the highest risks of unemployment or (early) retirement. Taking care of the household was only influenced by health among unmarried women. In most European countries, a poor health or a chronic health problem predicted staying or becoming unemployed and the effects of health were stronger with a lower national unemployment level. Conclusion: In most European countries, socioeconomic inequalities in ill health were an important determinant for entering and maintaining paid employment. In public health measures for health equity, it is of paramount importance to include people with poor health in the labour market.

Poor health, unhealthy behaviors, and unfavorable work characteristics influence pathways of exit from paid employment among older workers in Europe: a four year follow-up study

OBJECTIVES The aim of this study was to get insight into the role of poor health, unhealthy behaviors, and unfavorable work characteristics on exit from paid employment due to disability pension, unemployment, and early retirement among older workers. METHODS Respondents of the longitudinal Survey of Health, Ageing, and Retirement in Europe (SHARE) in 11 European countries were selected when (i) aged between 50 years and the country-specific retirement age, (ii) in paid employment at baseline, and (iii) having information on employment status during the 4-year follow-up period (N=4923). Self-perceived health, health behaviors, and physical and psychosocial work characteristics were measured by interview at baseline. Employment status was derived from follow-up interviews after two and four years. Cox proportional hazards regression analyses were used to identify determinants of unemployment, disability pension, and early retirement. RESULTS Poor health was a risk factor for disability pension [hazard ratio (HR) 3.90, 95% confidence interval (95% CI) 2.51-6.05], and a lack of physical activity was a risk factor for disability pension (HR 3.05, 95% CI 1.68-5.55) and unemployment (HR 1.84, 95% CI 1.13-3.01). A lack of job control was a risk factor for disability pension, unemployment, and early retirement (HR 1.30-1.77). CONCLUSIONS Poor health, a lack of physical activity, and a lack of job control played a role in exit from paid employment, but their relative importance differed by pathway of labor force exit. Primary preventive interventions focusing on promoting physical activity as well as increasing job control may contribute to reducing premature exit from paid employment.

The effect of ill health and socioeconomic status on labor force exit and re-employment: a prospective study with ten years follow-up in the Netherlands

OBJECTIVES The aim of this study was to investigate the effect of ill health and socioeconomic status on labor force exit due to unemployment, early retirement, disability pension, or becoming economically inactive. A secondary objective was to investigate the effect of ill health and socioeconomic status on return to work. METHODS A representative sample of the Dutch working population (N=15 152) was selected for a prospective study with ten years follow-up (93 917 person-years). Perceived health and individual and household characteristics were measured at baseline with the Permanent Quality of Life Survey (POLS) during 1999-2002. Statistics Netherlands ascertained employment status monthly from January 1999 to December 2008. Cox proportional hazards analyses were used to determine the factors that predicted labor force exit and return to work. RESULTS Ill health increased the likelihood of labor force exit into unemployment [hazard ratio (HR) 1.89], disability pension (HR 6.39), and early retirement (HR 1.20), but was not a determinant of becoming economically inactive (HR 1.07). Workers with low socioeconomic status were, even after adjusting for ill health, more likely to leave the labor force due to unemployment, disability pension, and economic inactivity. Workers with ill health at baseline were less likely to return to work after unemployment (HR 0.75) or disability pension (HR 0.62). Socioeconomic status did not influence re-employment. CONCLUSIONS Ill health is an important determinant for entering and maintaining paid employment. Workers with lower education were at increased risk for health-based selection out of paid employment. Policies to improve labor force participation, especially among low socioeconomic level workers, should protect workers with health problems against exclusion from the labor force.

The impact of ill health on exit from paid employment in Europe among older workers

Objective To determine the impact of ill health on exit from paid employment in Europe among older workers. Methods Participants of the Survey on Health and Ageing in Europe (SHARE) in 11 European countries in 2004 and 2006 were selected when 50–63 years old and in paid employment at baseline (n=4611). Data were collected on self-rated health, chronic diseases, mobility limitations, obesity, smoking, alcohol use, physical activity and work characteristics. Participants were classified into employed, retired, unemployed and disabled at the end of the 2-year follow-up. Multinomial logistic regression was used to estimate the effect of different measures of ill health on exit from paid employment. Results During the 2-year follow-up, 17% of employed workers left paid employment, mainly because of early retirement. Controlling for individual and work related characteristics, poor self-perceived health was strongly associated with exit from paid employment due to retirement, unemployment or disability (ORs from 1.32 to 4.24). Adjustment for working conditions and lifestyle reduced the significant associations between ill health and exit from paid employment by 0–18.7%. Low education, obesity, low job control and effort–reward imbalance were associated with measures of ill health, but also risk factors for exit from paid employment after adjustment for ill health. Conclusion Poor self-perceived health was strongly associated with exit from paid employment among European workers aged 50–63 years. This study suggests that the influence of ill health on exit from paid employment could be lessened by measures targeting obesity, problematic alcohol use, job control and effort–reward balance.

The influence of re-employment on quality of life and self-rated health, a longitudinal study among unemployed persons in the Netherlands

BackgroundUnemployed persons have a poorer health compared with employed persons and unemployment may cause ill health. The aim of this study was to investigate the effect of re-employment on quality of life and health among unemployed persons on social benefits.MethodsA prospective study with 18 months follow-up was conducted among unemployed persons (n=4,308) in the Netherlands, receiving either unemployment benefits or social security benefits. Quality of life, self-rated health, and employment status were measured at baseline and every 6 months of follow up with questionnaires. Generalized estimating equations (GEE) modeling was performed to study the influence of re-employment on change in self-rated health and quality of life over time.ResultsIn the study population 29% had a less than good quality of life and 17% had a poor self-rated health. Persons who started with paid employment during the follow-up period were more likely to improve towards a good quality of life (OR 1.76) and a good self-rated health (OR 2.88) compared with those persons who remained unemployed. Up to 6 months after re-employment, every month with paid employment, the likelihood of a good quality of life increased (OR 1.12).ConclusionsStarting with paid employment improves quality of life and self-rated health. This suggests that labour force participation should be considered as an important measure to improve health of unemployed persons. Improving possibilities for unemployed persons to find paid employment will reduce socioeconomic inequalities in health.

Effectiveness of a health promotion programme for long-term unemployed subjects with health problems: a randomised controlled trial

Background: Employment status is an important determinant of health inequalities. Among unemployed people, poor health decreases the likelihood of re-employment. Methods: A randomised controlled trial with 6 months’ follow-up among unemployed people with health complaints receiving social security benefits from the city of Rotterdam, The Netherlands. In total, 456 people were assigned to the control group and 465 people to the intervention group. The intervention consisted of three sessions weekly over 12 weeks. One session a week was focused on education to enhance the ability to cope with (health) problems, and two weekly sessions consisted of physical activities. The primary outcome measures were perceived health, measured by the Short Form 36 Health Survey, and psychological measures mastery, self-esteem and pain-related fear of movement. Secondary outcome measures were work values, job search activities and re-employment. Results: Enrolment in the intervention programme was 65%, and 72% completed the programme with over 70% attendance at all sessions. The intervention had a good reach among subjects with lower education, but had no effect on mental and physical health, mastery, self-esteem and pain-related fear of movement. Participation in the programme had no influence on work values, job search activities or re-employment. Conclusion: This intervention programme aimed at the promotion of physical and mental health in unemployed people with health complaints did not show beneficial effects. The lack of integration into regular vocational rehabilitation activities may have interfered with these findings. This particular health programme cannot be recommended for implementation.

Educational differences in trajectories of self-rated health before, during, and after entering or leaving paid employment in the European workforce

OBJECTIVES This study aimed to investigate (i) the influence of entering or leaving paid employment on self-rated health trajectories before, during, and after this transition and (ii) educational differences in these health trajectories. METHODS In this prospective study, we used yearly measurements of self-rated health from the European Community Household Panel (ECHP) to establish how health is affected by employment transitions in or out of the workforce due to early retirement, unemployment or economic inactivity. Trajectories of self-rated health were analyzed among 136 556 persons with low, intermediate, or high educational level by repeated-measures logistic regression with generalized estimating equations. RESULTS Among low-educated workers, ill-health partly prompted their voluntary labor force exit through early retirement and becoming economically inactive, but thereafter these exit routes seemed to prevent further deterioration of their health. In contrast, among higher educated workers, early retirement had an adverse effect on their self-rated health. Becoming unemployed had adverse effects on self-rated health among all educational levels. Entering paid employment was predetermined by self-rated health improvement in the preceding years among intermediate and high educated workers, whereas, among low-educated workers, self-rated health improved in the year of entering paid employed and continued to improve in the following years. CONCLUSIONS Prolonging working life may have both adverse and beneficial effects on self-rated health. Health inequalities may increase when every person, independent of educational level, must perform paid employment until the same age before being able to retire.

Educational Inequalities in Exit from Paid Employment among Dutch Workers: The Influence of Health, Lifestyle and Work

Background Individuals with lower socioeconomic status are at increased risk of involuntary exit from paid employment. To give sound advice for primary prevention in the workforce, insight is needed into the role of mediating factors between socioeconomic status and labour force participation. Therefore, it is aimed to investigate the influence of health status, lifestyle-related factors and work characteristics on educational differences in exit from paid employment. Methods 14,708 Dutch employees participated in a ten-year follow-up study during 1999–2008. At baseline, education, self-perceived health, lifestyle (smoking, alcohol, sports, BMI) and psychosocial (demands, control, rewards) and physical work characteristics were measured by questionnaire. Employment status was ascertained monthly based on tax records. The relation between education, health, lifestyle, work-characteristics and exit from paid employment through disability benefits, unemployment, early retirement and economic inactivity was investigated by competing risks regression analyses. The mediating effects of these factors on educational differences in exit from paid employment were tested using a stepwise approach. Results Lower educated workers were more likely to exit paid employment through disability benefits (SHR:1.84), unemployment (SHR:1.74), and economic inactivity (SHR:1.53) but not due to early retirement (SHR:0.92). Poor or moderate health, an unhealthy lifestyle, and unfavourable work characteristics were associated with disability benefits and unemployment, and an unhealthy lifestyle with economic inactivity. Educational differences in disability benefits were explained for 40% by health, 31% by lifestyle, and 12% by work characteristics. For economic inactivity and unemployment, up to 14% and 21% of the educational differences could be explained, particularly by lifestyle-related factors. Conclusions There are educational differences in exit from paid employment, which are partly mediated by health, lifestyle and work characteristics, particularly for disability benefits. Health promotion and improving working conditions seem important measures to maintain a productive workforce, particularly among workers with a low education.

Work as treatment? The effectiveness of re-employment programmes for unemployed persons with severe mental health problems on health and quality of life: a systematic review and meta-analysis

Given the importance of unemployment in health inequalities, re-employment of unemployed persons into paid employment may be a powerful intervention to increase population health. It is suggested that integrated programmes of vocational reintegration with health promotion may improve the likelihood of entering paid employment of long-term unemployed persons with severe mental health problems. However, the current evidence regarding whether entering paid employment of this population will contribute to a reduction in health problems remains unambiguous. This systematic review and meta-analysis aimed to assess the effects of re-employment programmes with regard to health and quality of life. Three electronic databases were searched (up to March 2015). Two reviewers independently selected articles and assessed the risk of bias on prespecified criteria. Measures of effects were pooled and random effect meta-analysis of randomised controlled trials was conducted, where possible. Sixteen studies were included. Nine studies described functioning as an outcome measure. Five studies with six comparisons provided enough information to calculate a pooled effect size of −0.01 (95% CI −0.13 to 0.11). Fifteen studies presented mental health as an outcome measure of which six with comparable psychiatric symptoms resulted in a pooled effect size of 0.20 (95% CI −0.23 to 0.62). Thirteen studies described quality of life as an outcome measure. Seven of these studies, describing eight comparisons, provided enough information to calculate a pooled effect size of 0.28 (95% CI 0.04 to 0.52). Re-employment programmes have a modest positive effect on the quality of life. No evidence was found for any effect of these re-employment programmes on functioning and mental health.

Poor Health as Cause and Consequence of Prolonged Unemployment: Mechanisms, Interventions, and Policy Recommendations

Unemployment is associated strongly with poor health. This chapter discusses the underlying mechanisms of associations between unemployment and poor health: the selection hypothesis states that poor health will increase the probability of unemployment, whereas the causation hypothesis proposes that unemployment may cause poor health. Both patterns largely explain why unemployment is a major determinant of socio-economic health disparities in many countries. Unemployed persons in poor health need tailored return to work programmes. Specific interventions have been developed to support unemployed persons with health problems to re-enter paid employment. Adequacy of policies to protect workers with health problems against exclusion from the labour market will be discussed.