Work, Health & Well-being Symposium: Managing Health in the Workplace

2. Work, Health and Well-being: an interdisciplinary approach to managing health in the workplace • The Work, health and well-being network has been funded for a 10-month period to build new multi-disciplinary teams as part of the Lifelong Health and Wellbeing Project (LLHW). This is a major cross-council initiative supporting multi-disciplinary research addressing factors across the life course that influence healthy ageing and wellbeing in later life. The objectives of the LLHW initiative are to: • Target factors over the life course that may be major determinants of health and wellbeing in later life. • Identify and develop effective interventions that lead to improved health and quality of life in later life. • Inform policy and practice including the development of services and technologies to support independent living. • Increase capacity and capability in ageing-relevant research

3. Aims of the network • To develop an interdisciplinary network focusing upon health transitions in employment. • The project will have a particular focus on the management of two of the main reasons for work loss (stress and musculoskeletal conditions) occurring during the middle and later phases of working life. • The aim of the proposed network is to examine the influence of particular health conditions on work transitions at particular points of the life course. • The network will focus on the two most common health reasons for work loss in the United Kingdom: (1) mental health problems relating to stress in the workplace; and (2) musculoskeletal disorders. • This proposal brings together a range of disciplinary backgrounds to examine the influence of specific health conditions affecting work transitions in middle and later life.

4. Network website • http://www.keele.ac.uk/research/pchs/pcmrc/WHW_Network/index.htm

5. Symposium- Work, Health and Well-being: Older Workers Chris Phillipson and Ross Wilkie ‘Health and social issues in extending working life’ David Lain‘Measuring Ill-health and older workers: a comparison of the US and the UK’ Joanne Ross ‘Does an understanding of occupational identity help to explain vocational rehabilitation for older workers?’ Sarah Vickerstaff ‘Understanding the impact of health and health pessimism on the extending work life agenda’

6. Health and Social Issues in Extending Working LifeChris Phillipson and Ross Wilkie

7. Debates on older workers 50s/60s: Labour force retention 70s/80s: Labour market exit 90s/early 2000s: Extending work Late 2000s: Extension - Exclusion

8. Employment/Population Ratios and Activity: men and Women 55 - 64 Source: OECD Employment Outlook: 1998 and 2008

9. Factors behind increase in employment Policies less important than: Demand-side factors: economic growth Supply-side factors: impact of shift from DB to DC pensions on retirement behaviour Closure of early exit pathways: tightening of eligibility criteria for unemployment/disability benefits Bridging employment: expansion of self-employment among older workers

10. Is extending working life possible? Policy drivers Raising of pension ages (Pension Regulator, Turner: retirement at 70?) Age discrimination and equality at work (Employment Equality Age Regulations, 2006) Promotion of health and well-being in the workplace (Black, 2008, Working for a Healthier Tomorrow) Economic and social value of older workers (‘Building a Society for All Ages’, DWP, 2009)

11. Is extending working life possible? Policy Barriers - rise in unemployment with older workers targeted for redundancy; - uncertainty about ‘extended work’ agenda (Vickerstaff et al., 2008); - relationship to other events in the life course (Schmid, 2002).

12. Is extending life possible? What do we know of the key barriers in respect of health and workplace issues? Data sets: British Household Panel Survey English Longitudinal Survey of Ageing Labour Force Survey

13. Is extending working life possible? Key barriers Impact of transitions through work Impact of health issues in the workplace Impact of detachment from work

14. IMPACT OF TRANSITIONS

15. Work status of cohorts of men: Stable transitions

16. Occupational status of cohorts of men: Bridging transitions‏

17. Occupational status of cohorts of men:‏unemployment transitions

18. IMPACT OF HEALTH FACTORS

19. Main reason for early retirement

20. Main reason for early retirement

21. Percentage of individuals aged 50 to 65 in paid work in 2002-03 who stay in paid work or move out of paid work between 2002-03 and 2004-05, job type and self-reported health status in 2002-03 (men only)‏

22. Health problems (for those who report a problem) by gender (cell%)‏

23. Expected chances of returning to paid employment for economically inactive individuals below SPA

24. Reported desired changes to working situation among those reporting that they have health problems that limit their ability to work in their current job Source: English Longitudinal Study for Ageing, Wave 3 (Emmerson & Tetlow, 2004)‏

25. Proportion of men and women who had the opportunity to work past retirement age by previous occupational category Source: English Longitudinal Study of Ageing (ELSA), Wave 1 2002 (own calculations)‏

26. Proportion of employees who have attended a formal educational or training course during the past 12 months Source: English Longitudinal Study of Ageing (ELSA), Wave 1, 2002

27. Key messages on barriers Health status – especially major health changes - most important factor ‘pushing’ people out of work. Earlier the retirement the more it is driven by health. Men and women in lower social class social groups more likely to cite health factors. Working class groups more limited opportunities of working up to 65. Once out of work unlikely to return.

28. Problems in current policies Raising pension age reinforces health inequalities. Under-pensioned groups ‘forced’ to remain in labour market despite health problems (especially manual workers, ethnic minorities). ‘Triple jeopardy’ of poor health, lack of work training, inadequate pension provision. Failure to tackle poor working conditions and oppressive management styles both of which may be predictors of early retirement.

29. Policy Options New emphasis on tackling health inequalities in the workplace (but note problems of SMEs). Workplace as setting for improving health and well-being (but globalization increasing pressures on workers). Focus upon occupational health in middle-life (though services being cut in many places). Specialist support for migrant workers (given complex work histories). Support for those balancing caring and working roles. Different needs short and long-term unemployed. Focus on key groups such as line managers whose attitudes towards older workers may be crucial.

30. WORK, HEALTH AND WELL-BEING: RESEARCH NETWORK Some research questions: What is the role of line managers as gatekeepers facilitating return to work? What variations can be identified in terms of the impact of their in respect of mental health and musculo-skeletal issues? What role is played by different work environments in assisting return to work/retention etc? What forms of collaboration can be identified between health organisations and employers? What is the role of self-care? How can its effectiveness be enhanced within the workplace?

31. Acknowledgements Rowntree Foundation and Department of Work and Pensions for funding for data analysis of sections of the paper. Dr. Jim Ogg (Young Foundation, UK) for work on the British Household Panel Survey and English Longitudinal Survey on Ageing.

32. References Banks, J. and Tetlow, G. Extending Working Lives. In Living in the 21st Century. In: The 2006 English Longitudinal Study of Ageing (Wave 3). Institute for Fiscal Studies, 2008. Cappellari, L. et al. Labour market transitions among the over-50s. Department for Work and Pensions, 2005. Emmerson, C. and Tetlow, G. Labour Market Transitions. In: The 2004 English Longitudinal Study of Ageing. Institute for Fiscal Studies, 2006. Loretto, ed The Future for older workers. Policy Press, 2007 Phillipson, C. Transitions from work to retirement. Policy Press, 2002

33. Selected references Phillipson, C and Smith, A. Extending Working life: a review of the research literature. Department for Work and Pensions, 2005. Phillipson, C. Extending Working Life: problems and prospects for social and public policy. In Bauld, L. et al. Social Policy Review Policy Press, 2006 Smeaton, D. and Vegaris, S. (2009) Older people inside and outside the labour market. Research Report No. 22. EHRC Schmid, G.Towards a theory of transitional labour markets. In Schmid, G and Gazier (eds) The dynamics of full employment. Edward Elgar, 2002. Vickerstaff, S. et al. Encouraging labour market activity among 60-64 year olds. Department of Work and Employment, 2008.

34. Measuring Ill-health and older workers: a comparison of the US and the UK David Lain University of Brighton, UK d.lain@brighton.ac.uk

35. Health and employment past 65 in the US and England • Previous research indicates health is an important influence on employment past age 65. However, hard to measure / compare. • More needs to be known about how the influence of health on employment is mediated through other known influences, such as education and wealth. • Using English Longitudinal Study of Ageing 2002 and US Health and Retirement Study 2002, I will examine: • How can we compare health using these surveys? • How does health interact with wealth and education to influence employment past 65? • How does this vary between the countries?

36. Diagnoses reported by over 65s

37. Difficulties reported by over 65s

38. Employment by number of health difficulties

39. Employment Ratio: low : medium/high education

40. Employment Ratio: Bottom 2 wealth quintiles : Top 3 quintiles

41. Employment past 65 by wealth quintile, 2002 Source: Analysis of the English Longitudinal Study of Ageing and Health and Retirement Study

42. Influence of wealth on employment past age 65: Odds ratios from logistic regression analysis Note:*** = p<0.001, ** = p<0.01, * = p<0.05.

43. Conclusions • Comparative research can help us understand what is specific to the English situation. • In both countries: Employment declines as health worsens (but employment higher at all health levels in US). • In both countries: Education increases the likelihood of working for people with health difficulties. • In England: Low levels of wealth reduce likelihood of working (except for the very healthy ‘poor’); • Institutional explanation: means-tested benefits. • Adopted ‘difficulties’ measure of health; need to consider the social construction of health measures.

44. Does an understanding of occupational identity help to explain vocational rehabilitation outcomes for older workers? Dr Joanne Ross NHS Eastern and Coastal Kent

45. Vocational rehabilitation • “a process whereby those disadvantaged by illness or disability can be enabled to access, return to, or remain in, employment, or other useful occupation.” (British Society of Rehabilitation Medicine 2003 p1)

46. Current perspectives in vocational rehabilitation

47. Lifespan perspective • Younger worker: • accessing employment • Older worker: • returning to and remaining in employment

48. A condition-focused perspective • A ‘medical model’ approach seeks to understand: • the disease process • the nature and aetiology • the impairment or disability • the anticipated course • management of the condition.

49. A functional perspective • A functional approach seeks to understand: • the functional implications of a medical diagnosis • physiological • physical • psychological status • the functional capacity of the worker (Ross J 2007)

50. A bio-psychosocial perspective • The bio-psychosocial model seeks to understand: • the nature of the disability or condition • psychological factors • social contextual factors – eg. family influences, environmental barriers (Waddell G, Burton KA, Kendall N 2008)