The social context of health selection: a longitudinal study of health and employment

https://doi.org/10.1016/S0277-9536(00)00318-XGet rights and content

Abstract

Health selection out of the labour force has received considerable attention by analysts attempting to disentangle the “true” biological dimensions of ill-health from its social meaning. Rejecting this dualistic separation, we argue that the effect of health on labour force participation is an inherently social process reflecting differential access to material and symbolic rewards that are structured by social position. Using longitudinal data from the US-based Panel Study of Income Dynamics, we examine the extent to which structural arrangements, including those designated by gender, race, education and age, differentially affect the risk of a labour market exit when health is compromised. Individuals employed at entry into the study (from 1984 – 1990) were followed for the duration of the study or until they left the labour force. Analyses were stratified by gender and age (25–39 and 40–61 years at baseline). We found suggestive evidence that the hazard of labour market exit in the context of perceived ill-health depended on gender, race and education, but in ways that were not constant across each of these social positions. For example, men may be more vulnerable to the labour market effects of poor health, but only in the younger group, black men were less likely to leave the labour force than white men, and education mattered, but only among younger women and older men. While these patterns may reflect differential access to disability pensions or other work-related benefits, we suggest that a more detailed analysis of trajectories of health and employment, as well as the meaning of health states, would be useful in further elucidating the social dimensions of health selection.

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.

References (38)

  • L.L. Belgrave et al.

    Gender and race differences in effects of health and pension on retirement before 65

    Comparative Gerontology B

    (1987)
  • M. Berkowitz et al.

    Health and labor force participation

    Journal of Human Resources

    (1974)
  • J. Bound

    Self-reported versus objective measures of health in retirement models

    Journal of Human Resources

    (1991)
  • J. Bound et al.

    Race differences in labor force attachment and disability status

    Gerontologist

    (1996)
  • J.A. Breslaw et al.

    The effect of health on the labor force behavior of elderly men in Canada

    Journal of Human Resources

    (1987)
  • D. Broad

    The casualization of the labour force

  • R.V. Burkhauser et al.

    Employment and economic well-being following the onset of a disability

  • P.S. Cain et al.

    The dictionary of occupational titles as a source of occupational data

    American Sociological Review

    (1981)
  • M. Farmer et al.

    Distress and perceived healthMechanisms of health decline

    Journal of Health and Social Behaviour

    (1997)
  • Cited by (96)

    • The relationship between employment and health for people from refugee and asylum-seeking backgrounds: A systematic review of quantitative studies

      2022, SSM - Population Health
      Citation Excerpt :

      Although the causation hypothesis, which asserts that employment influences health outcomes, has more evidence, research also supports the selection hypothesis which posits that health is a determinant of labour market participation (McDonough & Amick, 2001; Pelkowski & Berger, 2004; Schuring et al., 2007). For example, rates of unemployment are generally higher among people with disabilities or poor health (Schuring et al., 2007), and people with better health status have higher odds of obtaining and maintaining a job (McDonough & Amick, 2001; Pelkowski & Berger, 2004). The effects of mental health on employment have also been documented in several studies which found that mental ill-health is a risk factor for unemployment, while good mental health promotes employment (Frijters, Johnston, & Shields, 2014; Olesen et al., 2013).

    • The unequal impact of ill health: Earnings, employment, and mental health among breast cancer survivors in Finland

      2021, Labour Economics
      Citation Excerpt :

      However, such evidence is fundamental for understanding the underlying reasons for health and income inequalities and for a better design of social security, health care, and rehabilitation systems. The association between health and labor market outcomes is likely to defy generalizations, and therefore analyses should take into account social structures (McDonough and Amick III, 2001). This article studies the impact of breast cancer on earnings and employment among Finnish women of prime working age (35–55 years old).

    • The health impacts of eviction: Evidence from the national longitudinal study of adolescent to adult health

      2021, Social Science and Medicine
      Citation Excerpt :

      Supplementary analyses using alternative operationalizations of the self-rated health measure (including a binary measure indicating poor/fair health) yielded substantively similar results. Self-rated health is strongly and consistently associated with a variety of health outcomes, including markers of morbidity, biomarkers of physiological function, and mortality (Idler and Benyamini, 1997; Jylhä, 2009; Jylhä et al., 2006; McDonough and Amick, 2001). Importantly, unlike indicators of disease, disability, or mortality that are more prevalent among older age populations, depressive symptoms and self-rated health reflect continuous changes in well-being over time, making them particularly useful for estimating health trajectories among younger populations (Deaton and Paxson, 1998; B. A. Shaw and Krause, 2002).

    View all citing articles on Scopus
    View full text