Elsevier

Public Health

Volume 127, Issue 1, January 2013, Pages 46-52
Public Health

Original Research
Health status and health behaviour as predictors of the occurrence of unemployment and prolonged unemployment

https://doi.org/10.1016/j.puhe.2012.10.016Get rights and content

Summary

Objectives

Earlier research on health-related selection into unemployment has been based on relatively severe health problems, leaves questions unanswered about particular problems, follow-up times have been short and the measurement of unemployment utilised has been crude. The present study explores the effects of suboptimal health on employment in the long term, with statistics that enable assessment of the occurrence and extent of unemployment.

Study design

Employment status of a population cohort (n = 1083) was measured half-yearly from 18 to 42 years of age with four follow-up surveys.

Methods

Health status at 30 years of age was assessed with nine indicators. Their associations with the occurrence of a period of unemployment during the subsequent 12 years were analysed with Cox proportional hazard models, and generalized linear models were applied in assessing their associations with prolonged unemployment.

Results

Suboptimal self-rated health and suboptimal mood were the most robust predictors of both occurrence of unemployment {hazard rates 1.48 [95% confidence interval (CI) 1.13–1.94] and 1.59 (95% CI 1.19–2.12), respectively} and prolonged unemployment [risk ratios 1.95 (95% CI 1.66–2.29) and 1.44 (95% CI 1.24–1.67), respectively]. Significant associations, particularly with prolonged unemployment, were also seen for musculoskeletal pain, suboptimal sense functions and sleep quality, and smoking and risky alcohol intake.

Conclusions

There is health-related selection into unemployment in early middle age, irrespective of unemployment earlier in the life course. High risk ratios for prolonged unemployment suggest that selection takes place, in particular, at re-employment. The findings indicate the need for policies to prevent those with a history of health problems being at a disadvantage in terms of future employment.

Introduction

Theoretical reasoning indicates that unemployment and health problems are intertwined in a continuously ongoing process in which deterioration of health is accelerated by the stress and the psychosocial and socio-economic disadvantages of unemployment, and marginalization in the labour market is accelerated by health-related selection.1, 2 Correspondingly, studies aiming to show the effects of unemployment on health need to treat selection as a confounding phenomenon, and studies following up the consequences of poor health on the labour market position cannot omit the ‘scars’ caused by unemployment.30

The standpoint of the present study is health selection, which can be defined as ‘…the influence of physical and mental health on the statuses and attainments of individuals, or what we refer to as reverse causation’.3 Regarding the selection that takes place in the labour market, several studies analysing physical and mental health and health behaviour as predictors of unemployment have been published.4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16 They revealed numerous significant associations between poor health and subsequent unemployment, although there were also non-significant findings. For example, Leino-Arjas et al.7 studied health-related lifestyle [smoking, alcohol consumption, physical exercise, body mass index (BMI)], symptoms (stress, musculoskeletal complaints) and 10 disease classes (cardiovascular, musculoskeletal, respiratory, gastrointestinal, urogenital, skin, neoplastic, neurological, sensory, mental), and found evidence for selection to long-term unemployment (>24 months over 4 years of follow-up) with frequent stress symptoms, mental disorders, skin diseases, smoking, high alcohol consumption and high BMI. A study of random population samples from 11 European countries12 found that poor self-rated general health and ‘chronic problems in physical or mental health’ increased the risk of becoming unemployed among the initially employed, and reduced the chances of re-entering paid employment among the initially unemployed, when measured as a change of employment status at 1-year follow-up. Previous studies have tended to test the risk of unemployment in terms of relatively severe health problems, such as diagnosed diseases,5, 6, 7, 12, 14, 16 hospitalization13 or limited functional capacity.5, 8, 9 Less is known about less severe health problems or suboptimal health as predictors of unemployment.

Unemployment is a strong and independent predictor of future unemployment,17 but analyses of health selection either have omitted this fact8, 11, 16 or have used variables that inadequately capture the severity and timing of previous unemployment. In measuring unemployment during the follow-up period, most earlier studies have added together the periods of unemployment and classified the total into two or three categories, while some studies have measured time until unemployment,5, 14, 16 or analysed whether baseline health predicts a change in labour market status at a fixed point in time.11, 12 In this study, unemployment was measured using a questionnaire that yields indicators of both the occurrence and extent of unemployment.

This study was undertaken in Sweden, which can be characterized as the prototype of the Scandinavian welfare state with generous social security systems. Citizens perceive their labour market status as unemployed, and are formally entitled to this status, in frames of national regulations about daily allowances and related benefits and obligations. For instance, parents of children under 18 years of age receive 150 extra days of unemployment benefits per year.

This study aimed to shed light on both empirical and methodological issues that have been addressed inadequately in earlier research. In addition to applying indicators of suboptimal health, this study focused on the measurement of unemployment, which has received insufficient attention in earlier studies. A novel method for measuring unemployment was used, and survival analysis and generalized linear models were combined to analyse whether suboptimal health, including risky health behaviours, is predictive of future unemployment.

Section snippets

Data sources

The data come from a follow-up study of all pupils who attended the last year of compulsory school (aged 16 years) in a medium-sized industrial town (Luleå) in the north of Sweden in 1981. After baseline investigations at school, survey data were collected at 21, 30 and 42 years of age at class reunions, and questionnaires were posted to participants who were unable to attend the reunions. In cases of missing or incomplete data, the participants were contacted by telephone for supplementary

Results

Regarding the background variables, 52% of the participants were men, 82% had one or more children, 42% were classified as upper white-collar employees, 14% were classified as lower white-collar employees, 35% were classified as blue-collar employees and 9% were classified as self-employed. The proportion of participants with no history of unemployment was 47%.

Seven percent of respondents assessed their health as optimal, 39% assessed their mood as optimal, 67% assessed their sleep quality as

Discussion

This follow-up study of a population cohort from 16 to 42 years of age demonstrated health-related selection into unemployment during early middle age (31–42 years), irrespective of unemployment earlier in the life course. Using a two-tier statistical approach, this study showed that suboptimal health status and health behaviour predicted both the occurrence of unemployment and, in particular, prolonged unemployment.

According to survival analyses, optimal health status protects against an

Ethical approval

This study was approved by the Regional Ethical Review Board in Umeå [no. 07-057].

Funding

This work was partially supported by the Umeå Centre for Global Health Research, with support from FAS, the Swedish Council for Working Life and Social Research (Grant No. 2006-1512) and by Academy of Finland (Grant No. 132668).

Competing interests

None declared.

References (30)

  • S. Montgomery et al.

    Health and social precursors of unemployment in young men in Great Britain

    J Epidemiol Community Health

    (1996)
  • A. Mastekaasa

    Unemployment and health: selection effects

    J Community Appl Soc Psychol

    (1996)
  • P. Leino Arjas et al.

    Predictors and consequences of unemployment among construction workers: prospective cohort study

    BMJ

    (1999)
  • B. Claussen

    Health and re-employment in a five-year follow-up of long-term unemployed

    Scand J Public Health

    (1999)
  • C. Bildt et al.

    Occupational conditions exceed the importance of non-occupational conditions and ill health in explaining future unemployment among women and men

    Arch Women’s Ment Health

    (2003)
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