The social context of health selection: a longitudinal study of health and employment
Introduction
A well-known debate concerns the relationship between socioeconomic position and health. At issue are two seemingly contrasting explanations of increasing health disadvantage as one “descends” the socioeconomic hierarchy. One, the social causation hypothesis, is that compromised social and economic conditions damage health. The other, the health selection hypothesis, is that poor health selects individuals into unemployment, low income and other disadvantaged states. For some time, researchers argued over the primacy of these apparently mutually exclusive pathways but, in recent years, a rapprochement that recognizes their interrelationship has emerged.
One issue that has received less attention in the health selection – social causation debate, however, is the structured nature of health selection. Specifically, if we think of health selection as a social process (West, 1991) and, in particular, one that reflects the embodiment of social inequality, we are led to ask whether and how we might apprehend such interactions. This paper investigates whether health selection out of employment depends on social location defined by age, gender, race and labour market resources. To the extent that individuals’ locations within these positions signify varying levels of “desirable” attributes in the labour market (e.g., work experience, skill level), differential access to disability pensions, health care insurance and workplace resources that permit accommodations of poor health (e.g., opportunity to create flexible work arrangements), and different demands in relation to family roles (e.g., breadwinner/caring for family), they may structure the health selection process. That is, individuals’ labour market fates in the context of health problems may be contingent on material and symbolic rewards whose distribution is structured systematically in the distinctive experiences of social groups.
Section snippets
Health and labour force participation
The negative relationship between poor health and labour force participation is well-documented (Haveman, Wolfe, Kreider & Stone, 1994; Stern, 1989; Ruhm, 1992; Bound, 1991; Bazzoli, 1985; Kolstad & Olsen, 1999). In trying to interpret this association, analysts focus on separating some “true” element of health from a presumed universal proclivity to malinger. Fundamentally, answers to survey questions about health and disability are suspect in the context of labour market withdrawal that is
Data
Our data come from the 1984–1991 waves of the PSID, an on-going study of a representative sample of men, women and children living in the United States and of the family units in which they reside (Hill, 1992). Starting with a national sample of nearly 5000 households in 1968, individuals were interviewed annually through the study period. The sharpest annual sample loss occurred between 1968 and 1969 when 12% of the sample left the study, but annual attrition rates since then are between 2.5
Sample description
Table 1 presents descriptive statistics for the person-years sample by age group and gender. Younger women reported slightly higher levels of fair or poor health than men (5.7% compared with 4.8%). More women identified themselves as African-American, while education differences revealed a slight male advantage. Younger women's employment and work conditions were, generally, less favourable than those of younger men. For example, women's average labour income was almost one-half of men's
Discussion
This paper was centrally concerned with the social structuring of health selection. It was argued that the effects of ill-health on labour supply would depend on gender, race, education and age by virtue of the varied access to material and symbolic social rewards implied by one's location within these social designations. What is most striking about our findings is the extent to which they defy generalizations about health and social experiences. Among those in the younger cohort, men appeared
Acknowledgements
This study was supported by a grant from the National Institute of Aging and the National Institute for Occupational Safety and Health (Benjamin Amick, PI, grant R01-AG13-36-02 ). We thank Greg Duncan for his comment on our study design and Hong Chang for his assistance with data analysis.
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