Welcome to Work Life, a blog about the relationship between work and health and well-being of people, whether they are preparing for working life, managing their work / life balance or preparing for retirement and life beyond retirement.
As more of us work for longer, it’s important to recognise the needs of older workers: and that includes the fact that as we age we are more likely to suffer from long-term illnesses. To what extent do our working conditions affect our decisions about whether or not to continue in a job despite having a chronic disease? Maria Fleischmann, research associate in the Department of Epidemiology and Public Health at University College London, has been asking what might help to prolong working life for older people. Could factors such as having supportive colleagues and managers, or a clear understanding of who does what, make a difference?
There is strong evidence that people with long-term illnesses leave work early. While three quarters of healthy European 50-somethings have jobs, the figure from those with chronic disease is much lower. Among those with one condition such as diabetes or heart disease, the employment level is around 70 per cent – and for those with two or more that drops to around 50 per cent. Conversely, those who are able to stay well are significantly more likely to continue working beyond pensionable age.
As our working lives grow longer, it’s important to acknowledge that older workers with chronic diseases may have different needs from those who are well – they may not be able to work such long hours, for instance.
So, what are the factors that can make a difference? We know, for instance, that people are likely to remain in work for longer if they have a high level of control over their own hours. Shift workers, on the other hand, are more likely both to become unwell and to leave work early.
Deciding to stay on at work
But what about the factors that are harder to see? What about a worker’s sense of his or her own job stability, or of how harmonious the relationships are between co-workers? Does it help if an employee feels he or she generally knows who does what, or how to respond to a given situation? These types of factors – collectively known as ‘psychosocial factors’ – are also believed to affect peoples’ decisions about whether to stay on at work.
We used data from the Whitehall II study, which has been following the lives, work histories and health experiences of just over 10,000 London-based civil servants since the mid-1980s, when they were all aged 35-55. We looked at the participants in mid-life, around 14 years before retirement age, to see how factors such as levels of autonomy and of support from supervisors or co-workers might affect their decisions if they became ill with diabetes, coronary heart disease, stroke or malignant cancer.
And we found that while good ‘psycho-social’ working conditions were helpful generally in supporting workers to stay on in their jobs, they didn’t appear to make any extra difference for those who became ill.
The participants in the Whitehall II study were asked questions such as: ‘Do you have to do the same thing over and over again?’ and ‘Do you have a choice in deciding how to do your work?’ They were also asked whether they felt they had good support from colleagues and superiors and how demanding they felt their job was. They were also asked to describe their level of education, their mental health and whether they had a partner who worked.
We were able to use their answers to assess whether these factors made a difference when they developed illnesses later in life.
We could see that six out of 10 participants left work between the first phase of the study in 1985 and the last one used for this study, in 2007-9. During the same period the proportion suffering from chronic illness had increased from less than two per cent to almost 30 per cent.
So why had they left, and how might those ‘psychosocial’ working conditions have affected those decisions?
Among the whole group of participants, we found clear evidence that those who felt they had reasons to be happy in their work were more likely to stay on. Specifically, those who felt they were using a wide range of job skills – known as skill discretion – and those who felt they had good social support at work were more likely to stay on for longer.
However, we did not find evidence that those ‘psychosocial’ factors would make more of a difference in whether or not a worker stayed on if he or she were chronically unwell. Or rather, good working conditions were equally important for workers both ill and well.
So, we know that good social and psychological conditions at work are likely to be helpful in keeping employees at work as their careers near their end. And we know that chronic illness is a major reason why people leave work early. But from our study, we cannot say that such good working practices will be a particular deciding factor for those who become unwell.
How and why people leave work
There were some interesting factors in our results: first, we were able to look at the different ways in which people left their jobs, and the reasons why they did so. So those who used a wide range of skills had a reduced risk of leaving work earlier through retirement or ill-health, but this was not related to the risk of leaving work earlier through unemployment; while those who had good social support had a reduced risk of leaving earlier through ill health or unemployment, but not so much when we looked at leaving earlier through retirement.
And while previous studies had tended to measure working conditions at the time of leaving, ours looked at those conditions several years beforehand.
There is certainly scope for more detailed research on this issue – and there is plenty of reason for both researchers and policy advisors to continue to focus on how employers can help chronically ill workers to stay in their jobs.
“When I was sitting around at home I would just get grumpy. I’ve also lost five stone since working here. This is like a vitality camp for me.” Retired British Transport Police inspector Brendan McCambridge, 56, interviewed in The Telegraph, describes how his new role at Waitrose has improved his life. He is one of the one in four retired British people who return to paid work, a phenomenon called “unretirement”. New research, led by Dr Loretta G. Platts from Stockholm University’s Stress Research Institute, explores who ends up unretiring. In this blog post, she considers the implications for individuals, business and policy of retired older people returning to paid work.
Retirement can be an abrupt and one-way change marking the end of paid work and the start of a time of leisure. But people’s lives often don’t look like this. People may gradually retire over a period of time, or even unretire, returning to paid work after retiring. We found that around one in four retirees in the UK returns to paid work, mostly within five years of retiring.
Our information came from the longitudinal Understanding Society data and its predecessor the British Household Panel Survey. We followed more than 2000 50–69-year-olds through the 1990s and 2000s. Participants were defined as unretiring if they reported retiring and later returned to paid employment, or began full-time work following a period of semi-retirement.
While all sorts of people unretire, men are more likely to unretire than women, as are people in good health and those with post-16 qualifications. Unretirees are also more likely to have a partner in paid work. After ten years, a retiree’s chances of taking up paid work are low.
What motivates unretirement?
Unretirement was a positive experience for Brendan McCambridge. Having a job helps to stay mentally and physically active, provides a meaningful activity, and unretirees often appreciate the social side of paid work. Some may appreciate the extra money earned which supplements a pension and provides funds for little extras. For others, earning money is an important part of the decision to unretire.
Our findings suggest that financial factors play a role in the decision to return to paid work. Retirees paying off a mortgage are more likely to unretire than those who already own their home outright. Unretirees may wish to prepare financially for retirement or to supplement a pension. With a basic state pension of £122.30 per week for people who retired before 6th April 2016, some people may have found a new job because they could not afford to retire.
Former Pensions Minister Steve Webb, now director of policy at Royal London, contends that some retirees may have little other option than to get a job. In an interview for People Management, Webb noted that although many of those heading back to work after retirement do so because they “miss the stimulation and social contact”, there is a “real danger” that a whole generation of people will be unable to retire in the first place because they have not managed to save a big enough pension pot.
He says: “If employers do not address this issue they could find themselves with an unhappy older workforce that does not want to work but cannot afford to stop.”
Why retire and then unretire?
Some people may unretire as a result of finding out that they like being retired a lot less than they thought they would. Researchers call this a “retirement shock”, in which recent retirees, just like Brendan McCambridge, discover that they do not like their new lifestyle.
Others may have known all along that they wanted to remain in paid work, but were unable to. More than one million people over 50 are out of work for reasons beyond their control and would like to be in paid work if the appropriate opportunities were available. Some people may be forced out of work directly or indirectly as a result of age-based stereotypes, in particular through not being offered training programmes to learn new skills, or from their updated skills being undervalued.
In their second Missing Million report, Business in the Community has argued that far too many older people are being denied the chance to enjoy meaningful employment in later life and calls for stronger age discrimination legislation to tackle this.
Employers of older people also often deny them the flexibility they require to stay in paid work. Workers aged between 50 and 69 years are more likely than other age groups to want to work fewer hours than they currently do, even if this were for less pay. Around 8 per cent of workers in their 50s are working more than 45 hours per week while also being in ill health. Such older workers, locked into working long hours, may retire from jobs because they do not offer sufficient flexibility of working times.
Retirees may then take a more suitable job if it comes up, or negotiate more suitable working times later on if their former employer asks them to come back. Dr Jill Miller, diversity and inclusion adviser at the Chartered Institute for Professional Development believes that simple adjustments to working times or job roles could be the key to employers attracting and retaining a “significant talent pool” of older workers who can contribute to the success of the organisation.
Does everybody get to unretire if they want to?
While people in financial straits may be wanting to unretire, we found they did not necessarily manage to. People who were struggling to make ends meet were not more likely to unretire than people in a more comfortable financial situation.
Similarly, those who had lower earnings before retirement were not more likely to unretire. The reason is probably that it is harder for people in a precarious financial situation to find a suitable or good quality job.
These findings are worrying in terms of the broader picture of inequalities in later life. If those retirees who most need to supplement their incomes in later life are not able to find suitable paid work, unretirement may be part of processes that increase inequalities in income between older people.
The findings are also worrying in the context of skills shortages currently faced by British industry, which are predicted to be exacerbated over the coming years. By 2022, the skills gap is expected to reach 7.5 million vacancies. Government and business should not forget about the experience and skills of recently retired workers who are often ready and keen to be re-engaged in the workforce. These workers may need more support and legislation to protect and promote their rights to work more flexibly to take into account their preferences and also the fact that they may be caring for grandchildren and other family members.
Specifically, the government could improve flexible working legislation by providing employees with the right to request flexible working from the start of the job application process, rather than waiting 26 weeks from the beginning of employment. Since older employees are less likely to be offered training, and are less likely to take it up, employers could monitor access to training and development by age as well as proactively offering training to employees and being open to additional training requests.
Where older people manage to find new jobs, it is a result of their own efforts and networks, and not because they accessed effective support. Older people reported in focus groups that Job Centres in particular provided poor guidance and assistance. Government could consider how to develop age-appropriate support services and guidance in Job Centres. Both government and employers could offer mid-life career reviews.
In the long term, we need to work towards a society in which unretirement becomes a positive story for all. Business and wider society stand to benefit from the ambition, experience and skills older people bring to the labour market. For financial and other reasons, many older people want to be in paid work. Currently, they are all too often left out.
Making it easier for women to get back to work after having children has been the ambition of successive UK Governments. A £5m career break returner scheme was launched in the budget just a few weeks ago, with the Prime Minister telling the parenting website Mumsnet that it was neither fair nor did it make economic sense, for women trying to get back into the workplace to find the doors closed to them. At the same time, the Government has acknowledged the considerable benefits to babies and mums of being breastfed. So what does this drive to get mums back to work mean for them, particularly if their job isn’t a standard 9-5 Monday to Friday affair? Afshin Zilanawala from the ESRC International Centre for Lifecourse Studies has been looking at what working evenings, nights or weekends might mean for mums and children when it comes to breastfeeding to see if this should be factored into our thinking around helping women back to work.
In the last 50 years or so, many more women with children have gone back to work after having their children. The same time period has seen a huge growth in the service sector and it is these two economic changes, which have been credited to the growing phenomenon of nonstandard work i.e working evenings, nights, or weekend shifts. A 2008 report showed that nearly a third of UK employees work evening, night or rotating shifts and that 1/5 work on the weekends. About a quarter of employed mothers work evenings, nights, or rotating shifts and about 18% of these mothers work on the weekends.
In that time, anecdotal information around the benefits and importance of breastfeeding to a child’s early development and mother’s mental and physical health have been supported by an ever growing and increasingly compelling body of evidence. In short, children who are breastfed develop physically and mentally more quickly and are less likely to develop infections or be obese, whilst mums are less likely to suffer post natal depression or develop breast/ovarian cancer.
Given all that, it would be useful for policy makers and parents to better understand whether any particular work patterns or schedules are more or less associated with women breastfeeding and for us all to get to grips with how working nonstandard hours may complicate work and family life, and may constrain time with children that relates to their health and development. That’s where this research comes in.
Dual potential: opportunities or costs?
When I set out to look at this, it wasn’t easy to imagine a straightforward answer to this question of say whether working evening shifts might be more or less associated with a mum having started to breast feed or how long she breastfed compared with someone who worked weekends. There seemed to be a dual potential for each shift to make it harder or easier depending on how you looked at it.
Evening or night work might make it difficult to schedule consistent breastfeeding patterns. However, at the same time, these shifts might allow for dad or another caregiver to supply pumped milk if a mum is working odd hours.
Using information collected as part of the Millennium Cohort Study, which has followed the lives of children born at the turn of the century, we were able to look at more than 17,000 mothers and their children.
Mums were asked if they had ever tried to breastfeed and, if so, for how long. From this and informed by the UK infant feeding guidelines at the time of the survey, which recommended exclusive breastfeeding for 4–6 months, we were able to create 2 month bands for different breastfeeding duration e.g. ‘intermediate’ (terminated breastfeeding after 2 months but before 4 months).
When their babies were 9 months old, mothers who were working provided information about the sorts of shifts they worked and how often they worked them.
Breastfeeding and work
Nearly 70 per cent of mothers breastfed their child. Thirty percent of them stopped breastfeeding before 2 months and one-third breastfed for at least 4 months. About half of mothers were not working at the time of the survey, nearly 30 per cent were working a standard shift and one in five was working nonstandard shifts.
Looking more closely at nonstandard work, it was possible to see the prevalence of the different types of shifts.
An interesting thing to emerge when we looked just at work patterns and breastfeeding was that women who worked evenings were 70 per cent more likely than women who were unemployed to have breastfed at all. They were also more likely to breastfeed than women who worked other non standard shift patterns i.e. night or weekend shifts.
Women who worked evening shifts were also more likely than their unemployed counterparts to continue breastfeeding across all the different ‘duration bands’ including the longest. They were still also more likely than their peers doing other non standard patterns of work to be breastfeeding i.e. night, weekend and overnight shifts.
Evenings and breastfeeding
So what is it about evening work that appears to be ‘compatible’ with starting and continuing to breast feed (or vice versa?) Perhaps mothers working evening shifts have positive breastfeeding experiences and so keep on breastfeeding and working. Perhaps supportive and flexible working arrangements influence the decision to breastfeed for longer. Evening schedules perhaps have a less disruptive effect on sleep patterns than irregular or night shifts, leaving women feeling more able to manage a job and caring for/breastfeeding their children.
So perhaps evening work schedules have something of a unique role to play in child and maternal health when it comes to helping women back to work without losing the many benefits for them and their children of breastfeeding. There’s a lot more that needs disentangling here, but, nevertheless, food for thought!
A secure, comfortable and healthy retirement is something most of us aspire to. But, as we live longer, we are all being encouraged to work later, increasingly well into our late 60s, so what might that mean for those aspirations, particularly the desire to be fit and healthy? Whilst the number crunchers have done their homework about how the sums add up around the available money to support more retired people for longer, very little is known about how working longer will impact on our health and what the knock on personal, societal and economic costs of that might be. Peggy McDonough at the University of Toronto, together with colleagues at UCL and Kings College, has been using US data to get a clearer picture of what the latter part of working life and health look like for men and women. Here she explains the research and why flexible working policies, particularly those concerning part-time work, could be key to ensuring a healthy retirement is a reality as well as an aspiration.
Across the developed world falling birth rates and the so-called ‘baby-boom’ cohort’s retirement have raised the spectre of unsustainable State pension costs. This has led to a range of reforms, many of which have seen a rise in the age at which we can collect State Pension. In the UK in 2020, men and women will have to wait till they are 66; this will rise to 68 by 2028. In the States, the age will be 67 in 2027. In addition, other incentives to work longer and disincentives to take our pensions earlier have been trialled or introduced.
What we don’t know much about is what the health consequences are of stepping up the workplace participation of older adults. Will working longer make our health better or worse? And what if those consequences undermine other social and economic goals, such as those around wellbeing and inequality? In addition, are there differences in the way these things play out for women and men?
Research to date has tended to focus on retirement as an exact or single point in time, which doesn’t necessarily reflect the more complex things happening during the run up to and after retirement. Findings are also ambiguous and it’s not clear whether retiring early, partial retirement or working longer is generally associated with better health.
Our research looks across a much longer period, viewing retirement more as a project that unfolds over time and drilling down into what is going on as we move from the ‘family- and career-building years’ to the ‘frailty years of old age’. This way we hope to get a better and more nuanced picture of how our work and our health interact over this part of our life and get some pointers about what seems to work best when it comes to staying as healthy as possible into the Third Age.
Patterns of work
Our data come from the Health and Retirement Study, which has collected information from more than 25,000 Americans aged 50 + since 1992. Working with the original cohort, all of whom were born between 1931-41, we examined the working lives and health of some 6,500 men and women over 18 years.
It was interesting to see that only 14 per cent of the men in our study followed a ‘conventional’ path involving full-time work until retirement at around 65 years of age. More of them (21 per cent) acted in line with recent policy initiatives and worked longer or did the complete opposite and retired in their early 60s (18 per cent). Slightly less than one in ten men stayed working but shifted from full to part-time work; it was rare for men to have had a substantial period of the time in part-time work.
Less than half as many women (10 per cent) worked full-time throughout the period. They were three times more likely than the men in the study to have worked part-time from the outset. The largest proportion, double that for men, was not working across this period, but, if they were, they were more likely to retire around the age of 62 than 65.
Health at 70
When we took into consideration a range of other background factors, like education, income, marital status, and minority background, we could start to get a picture of the most ‘advantaged’ people in terms of health.
One group of men stood out: those who downshifted from full-time to part-time work around age 65 had the lowest chance of being in poor health at age 70. Women were slightly different: being in work (either part-time or full-time) was associated with the best health, as was retiring in the early to mid 60s. Women in long-term part-time work were especially advantaged.
At the other end of the spectrum, men retired early or worked very little in middle age were more likely to have poor health than others. The same was true for women.
Downshifting is key for men; long-term part-time work, for women
Whilst it was interesting to note that long-term part-time work for men was not linked with better health for men when it was for women, we think that is probably because for this generation, women (traditionally caregiver) would have perhaps engaged in part-time work through choice, whilst for men (traditionally breadwinner) the reason may have been linked to earlier poor health.
Our research certainly provides a more detailed picture of how people’s working lives pan out in their fifties and sixties and shows quite clearly that men who are able to shift to part-time work in their 60s are most likely to have better health in their 70s whilst for women a long-term part-time arrangement seems to reap the most health benefits.
In short, it seems there may be considerable health benefits to part-time work but in ways that play out slightly differently for men and women. It should provoke interesting discussions among employers, unions, policy makers in the areas of employment and health and, of course workers themselves as they think about the sort of retirement they want and the options they have (or don’t have) when it comes to flexible working.
Given that less than 10 per cent of men and less than 5 per cent of women in our study followed these ‘optimum’ pathways for better health in their 70s, it’s an area that could serve as a real focus in the coming months, preferably before the pension reforms outlined earlier come into force.
There’s a widely held preconception that people who are out of work are overweight, perpetuated by the media and, indeed, reinforced by some academic studies. But recent robust evidence throws a whole new light on things and indicates that unemployed people are in fact much more likely to be underweight, and less likely to be overweight, than their peers who have not recently been unemployed. Amanda Hughes from the Institute for Social and Economic Research explains how she came to question narratives about benefit claimants being lazy and overweight and go on to undertake research she believes provides a more accurate picture.
While I was doing my PhD, I volunteered at a foodbank, and noticed that there were more people coming in who were painfully thin than too heavy. Some had not eaten that day or the day before. Others had walked for two hours to get there, because paying for a return bus journey was out of the question.
Of course, not all people who are out of work turn to food banks, and not all people who turn to foodbanks are unemployed. But that experience got me thinking: have researchers and public health officials been so concerned with obesity that they have missed a crucial part of the story? If weight loss or weight gain can occur during unemployment depending on personal circumstances, might there be an overlooked ‘U-shaped’ association of unemployment and body weight, with excess obesity and excess underweight among jobseekers?
We know that risk of dying is higher for jobseekers than for employed peers, and it is often assumed that increased overweight and obesity among jobseekers plays a role. But studies on the relationship of unemployment and body weight have been inconclusive; some document weight gain with unemployment, but others suggest weight loss. However, previous studies have compared only average effects – average change in body weight following job loss, or average differences between unemployed people and controls, and may have missed a more complicated ‘U-shaped’ association.
Working age BMI
Using Understanding Society, a longitudinal, nationally representative survey of more than 40,000 UK households, my colleague Meena Kumari and I were able to look at the BMI (body mass index) of 10,737 working-age adults between 2010 and 2012.
What was different about our study, was that we did not assume unemployment would impact BMI in the same direction for everyone. Rather, we allowed for a simultaneously raised risk among jobseekers of both underweight and obesity, by comparing the probabilities of being underweight, overweight, and obese between current jobseekers, recent jobseekers, and people who had not been unemployed since the start of the survey (the control group). To isolate the impact of unemployment itself, we took into account other factors such as demographics, chronic health conditions and mental health, smoking and physical activity.
A small proportion (0.7 per cent) of the people in our study who were employed were classed as underweight (i.e. had a BMI below 18.5). But for those in our sample who were unemployed, the proportion shot up to almost 4 per cent. This pattern remained when we took into account factors such as their education, gender, smoking, overall health, physical activity and alcohol consumption.
Certain groups were especially at risk: there were more extreme effects for longer-term unemployed people, for men, and people from lower-income households, suggesting household reserves or the support of family members may act as a sort of buffer against weight-loss effects. At the same time, currently unemployed people were much less likely to be overweight than peers who had not recently been unemployed (29 per cent v 40 per cent).
We did find that unemployed people were more likely to be obese, perhaps suggesting changes in dietary quality following unemployment towards energy-dense but nutrient-poor foods. However, this was only the case for non-smokers, which might reflect competing priorities between tobacco, food and other essentials for smokers on severely restricted budgets.
Together, these results point to a complex picture in which jobseekers, depending on the complexities of individual lives, are at increased risk of both underweight and obesity, each with their own associated health risks.
The elevated underweight and reduced overweight among current jobseekers are quantitative evidence that many unemployed people are not eating enough in simple caloric terms. Despite the political importance of this question, evidence of this effect has so far been fairly anecdotal.
Our results make an important contribution to research trying to explain the increased risk of chronic illness and mortality for unemployed people – suggesting that, at least in contemporary Britain, being underweight may contribute to that much more than previously realised.
At the very least, I hope our evidence will be used to challenge preconceptions and debunk myths about unemployment. It has implications for the way politicians, journalists and the wider public perceive unemployment, and for anyone concerned with the health effects of being out of work.
“Bad work just doesn’t fit in 2017!” Those are the words of Matthew Taylor, head of the Government’s recent review of modern work practices, who has called on politicians to make “all work good.” In an interview with the BBC, Mr Taylor, said that, as well as being bad for productivity and the economy, poor quality jobs were bad for people’s health and well-being. Recent research from Tarani Chandola from the University of Manchester has added further weight to those claims, finding that unemployed people who move into poor quality work have worse health than their peers who remain out of work. He explains more about the research findings and how they challenge the idea that having any job is good for your health.
There is considerable evidence to show that being out of work isn’t good for our health and that being in work can bring us a range of benefits, not just financial. It follows, then, that a move out of unemployment and into work is likely to be good for us, but does that hold true if the job we go into is a bad one?
Using rich social, economic and health data from the UK Household Longitudinal Study (UKHLS), our research examined the stress levels of a group of unemployed people aged 30-75, some of whom moved into poor quality jobs, some into good jobs and some who remained unemployed.
We also looked to see if any other factors, including their health at the outset of our study, had any bearing on the likelihood of them moving into a poor or good quality job.
As well as physical measurements such as height, weight and blood pressure, and self-reported information on their physical and mental health, some participants in the study gave blood samples. These could be tested for a range of markers, high levels of which might indicate diabetes, heart or kidney disease, acute or chronic stress. In total, we had 12 separate biomarkers, providing us with a comprehensive picture of participants’ health and an overall measurement of their stress, something referred to as their allostatic load.
How much people earned, how secure their job was and their working environment were all considered, in order to get a sense of the quality of their employment. Participants were asked how satisfied they were at work, how anxious or worried they felt about their job, how much control they had at work and whether they thought they might lose their job in the coming 12 months.
The people studied were divided into four groups:
Employed in a good quality job
Employed in a job with one poor quality measure
Employed with at least two poor quality measures
When we looked at the stress levels of the different groups, a clear pattern emerged. Unsurprisingly, people who moved out of unemployment and into a good job had the lowest levels of stress. People who went from being unemployed to working in a bad job (with more than two poor quality job measures) had the highest stress levels. These were 1.5 times higher than for those people who remained unemployed.
We took into consideration a host of other factors that might have had some role in propelling an unemployed person into a good or bad job, but even when we looked at their health at the outset of the study, this did not really play a role, other than to note that the people in better health moved into both good and bad jobs. In other words it wasn’t simply that people already in poor health were moving into the worse jobs.
Although numbers for this research were relatively small, the methods and analysis were extremely robust and we can, with some confidence, challenge the widespread belief that any employment, even poor quality work, is better for our health and wellbeing than being unemployed.
The findings serve to illuminate research published by the RSA and Populus recently, showing that three out of four people think we should do more as a country to improve the quality of work. Even more telling was the contrast between the over two thirds who think we can make all work fair and decent, and the less than one in ten who think this is already the case.
Making good work matter
Mr Taylor makes the case that “good work matters” and the RSA’s social media campaign #GoodWorkIs is a laudable effort to engage the wider public in a discussion about what good work looks like.
However, he, like many others, has said that the “worst work status for health is unemployment”. Our research shows that’s not necessarily the case, and our findings, together with more research in this area, should be considered carefully as strategies are hopefully developed to make his call to “make all work good” a reality not a pipedream, especially in the current political climate.
Ahhhh retirement: finally time to relax, enjoy life, unwind and feel less stressed. That is certainly how many people will be expecting or hoping that their retirement will pan out when it happens. But research by Tarani Chandola from the University of Manchester and colleagues at UCL and the University of Essex, shows that whilst dreams of a less stressful life in retirement may come true for those in higher status jobs, they are less likely to do so for those in low status occupations. Here he explains the research, which uses innovative methods to see whether retirement really is the stress buster many of us hope it will be.
We have known for some time that people from poorer backgrounds in low status jobs generally have poorer health across their lives and tend to suffer from greater levels of stress. Those health inequalities widen as people get older, but it had been assumed that retirement might see a closing of the gap, because poorer workers have higher levels of work stress, but this appears not to be the case, something that researchers have found hard to explain.
As most countries are now raising retirement age and, with it, the age at which workers can collect their State Pension, it is really important that we understand the impact these policies might have on the health and wellbeing of employees, particularly those in disadvantaged working conditions.
In this research, rather than just making use of self-reported health information from workers, we wanted to get right under their skin to look at what signs of stress there were in their bodies in the run up to and after retirement. We wanted to compare the stress levels of those who had just retired to those still in work and we also wanted to compare the stress levels of workers in high and low grade jobs.
We were able to do this by looking at the changing levels of a stress related hormone called cortisol.
Our information came from The Whitehall Study, which has tracked the working lives of thousands of UK civil servants since the 1980s. As well as being a good fit for the research because of the type of information available, using a longitudinal survey like this enabled us to observe the same people over this important period of in their lives.
We focused on just over 1000 of the study’s participants who were aged around 60 and who, as part of the Study, provided a series of saliva samples across a day. Using these saliva samples, we could measure their changing levels of cortisol over the day. Waking up in the morning results in the release of cortisol, which declines to almost negligible levels by bedtime. The steeper the declines in a person’s cortisol measurement across the day, the less stressed they were. People with relatively higher levels of cortisol at bedtime are more stressed and have a flatter rate of decline of cortisol.
Their employment grade was categorised as ‘high’, middle or ‘low’ according to the civil service banding system.
Civil servants who were employed in the lowest status jobs had the highest levels of stress, whilst those in the highest status jobs were the least stressed. We could also see that, after retirement, when we might have expected biological stress levels to fall for all the workers, this was only the case for those in the top jobs. Lower grade workers who had just retired were just as stressed as their peers who were still working.
Stresses and strains of working life
Worryingly, far from being a time when the stresses and strains of working life melt away, retirement seems to bring little or no relief for those in lower grade occupations. It seems the health inequalities observed between those in high and low grade jobs are magnified not only as workers get older, but even in retirement, when we might think the opposite would occur. In other words, at a time when the gap might be expected to close, in fact it widens.
It’s important to note that we took a wide range of other factors into account when we looked at the lives of the people in the study, including their broader health, whether they had a serious life-limiting illness, whether they were married etc., but our results remained strong, giving us considerable confidence in our findings.
Of course, there can be many different factors at play as we prepare to retire. Workers who retire from low status jobs often face financial and other pressures, whilst their better paid peers enjoy good pensions and have the resources to engage in leisure and social activities.
Another key point to make is that if this is the picture for people working in the civil service, where working conditions are considered very good and certainly a great deal better than most other employment areas, things are likely to be worse in other types of job where working conditions are less favourable.
For those looking to tackle inequality and unfairness in the workplace and wider society, our findings add to a growing body of evidence of how they are magnified across the lifecourse. They serve to remind us also that if we want everyone to enjoy a relaxed, happy and fulfilled retirement, then those inequalities must be addressed early with policies that are based on solid evidence.
When we think of why someone might retire early, our minds are unlikely to make the leap to their childhood for the answer. But a group of researchers interested in what sorts of things affect our later working lives, believe that early retirement may indeed have some of its roots in our younger years. The research sheds new and important light on worldwide efforts to plug pensions gaps and get more people working longer. Hanno Hoven from the University of Dusseldorf outlines why he and colleagues from the International Centre for Lifecourse Studies at UCL think early retirement can be traced right back to having had a tougher childhood. He goes on to explain what the findings might mean for policy in this area.
All sorts of things are likely to influence the point at which older people stop working. External factors like tax incentives to stay in work or changes to when we can claim our State Pension play a role. Then there are our working conditions, what’s going on with our health and how our personal circumstances change as we get older.
A substantial body of research has shown in recent years that people whose socioeconomic circumstances are poor are more likely to retire early than their better off peers. But in our research, we wanted to see if retiring early can additionally be traced back to earlier stages of the life course, more specifically, to having had a tougher life as a child or during mid adulthood.
In addition we wanted to dig a bit deeper into older people’s working lives, by giving a clearer and more detailed picture that describes entire patterns of employment trajectories (and not retirement timing only). To do this, we took into account the employment history between 50 and 70, including details on type of job people did, whether they worked full- or part-time or whether they were self-employed.
We used information collected by the Survey of Health, Ageing and Retirement in Europe (SHARE), which has carried out interviews with more than 28,000 older people from 14 different countries. For our research, we focused on 5,857 men and women from the survey who wereaged 70 or over and who had provided details of their previous working and personal lives.
Work and retirement
We created clusters of their work and employment histories, and you can see in the table below the proportion of men and women in each cluster. On this basis we could link these clusters or types of employment histories to earlier adversity for both men and women.
Looking at types of employment histories between the ages of 50 and 70, we could see that men were more likely than women working in full-time employment or self-employed.. Women worked more likely in a part-time job or looked after home or family during those years.
Adversity in childhood
After modelling the effect of early life information and taking a range of background factors into account (e.g., among others, health conditions prior and during working life in mid adulthood), we were able to see that men who had experienced adversity in childhood were 5 percentage points more likely to have retired early (around age 55) from full-time employment, but they were less likely self-employed in late life. The same was true of men who experienced adversity in adulthood, although it is important to note that the effects were independent of each other.
Women who had suffered adversity in childhood were also less likely to be self-employed and retire later on. However, it was not related to early (around age 55) retirement from a full-time job. Women who faced adversity in adult life were more likely to work part-time or to look after the home/family than their peers who suffered no adversity during that period. This was not the case for childhood adversity.
Some other interesting things emerged from the research, which we believe provides a more comprehensive picture than has been provided before.
One very notable point was that early retirement was more closely associated with being in full-time employment rather than being self-employed. This could be because employed people have more restricted opportunities to work for longer (even if they want to) compared with their self-employed counterparts who have more freedom in deciding when to retire.
Food for thought
For those, including the Government’s Business Champion for Older Workers, who want to see thousands more older workers in British companies by 2022, this will be food for thought. More flexible retirement arrangements are likely to be necessary for employed workers who want to work longer, for example, through retirement schemes that allow a reduction of working time before leaving the labour market. This argument is further supported by the fact that such a cluster (where employed people reduced their working hours before retiring) was not found in our research.
Interesting differences emerged between men and women when it came to their employment histories and the way in which childhood adversity was linked to them. Whilst men were more likely to follow a path of full-time employment into retirement, women were more likely to have been continuously looking after home or family (without retirement) or have worked part-time.
When we factored in childhood adversity in the women’s lives, there was a close link with discontinuous employment in later life. This link was stronger for women than for men. Other research has suggested that traditional gender roles make it harder for women to gain a foothold in the labour market, a disadvantage that any adversity in childhood is likely to compound.
Looking across the lifecourse in this way sheds considerable new and important light on the timing of retirement, and offers some pointers for policymakers looking to increase the numbers of older workers. One specific implication is that certain measures are likely to work better for different age groups and should address different stages of the lifecourse.
There has been a great deal of focus on pension age and working conditions for older people. However, our research suggests that our childhood circumstances are also important and that policies to tackle childhood poverty and create good stable jobs for young people may also have a key role to play over time.
The Government’s Business Champion for Older Workers, Andy Briggs, has called for one million more older people to be in work by 2022. But to enjoy the benefits of working longer, we need to remain in good health. Professor Keith Palmer from the University of Southampton and colleagues investigated whether signs of frailty in mid-life can predict difficulties in continuing to work later on. Here he outlines their findings and makes the case for developing screening to identify those workers most in need of support.
By 2020 the over-50s will comprise almost one third of the UK’s working age population, and more recent Government policies, including changes to the age at which we can claim our State Pension, have been focused on extending our working lives.
For people with poor health, previous studies have shown that extending their working lives may not be in their best interests. Our research is the first to measure frailty and symptoms of pre-frailty in people aged 50-65 and determine whether and how it is associated with employment difficulties. The idea was to see if there is a way to identify early those people most likely to find it difficult to continue working.
They answered a range of questions about whether they suffered from exhaustion, had a slow walking speed, a weak grip (determined by whether they had problems opening new jars), low levels of physical activity and whether they had unintentional weight loss in the past year.
People with more than three of the above symptoms were classed as ‘frail’, while those with one or two symptoms were classed as ‘pre-frail’.
They were also asked employment-related questions: were they currently working and, if not, had their previous job ended for health reasons?
Those in work were asked:
their total sickness absence over the past 12 months
had they needed to cut down at work because of their health?
were they coping with the physical and mental demands of their work?
Did they expect to be able to do the same work in two years’ time?
Was their job secure?
Did their work affect their sleep?
Information about their well-being, including back and other pain, was also collected, and participants’ jobs were classified as higher managerial, intermediate or routine/manual.
More than one third of the women, and 27 per cent of the men studied were no longer working. Of these, around one third of both sexes said they had left their job because of a health problem.
Disorders or pain affecting movement, such as bone, joint or nerve problems, and mental illness, were the most common reasons for stopping work.
Many of those still working reported difficulties with their jobs, with between 6 and 7 per cent having taken 20 or more days’ sick leave in the last year. Around one third reported problems coping with work’s physical demands, and 20 per cent said their job was insecure.
Four per cent of the group studied were classed as ‘frail’ and, within this group, more than three-quarters reported low physical activity, weak grip and slow walking speed, with women more likely to report symptoms. Nearly one third of the participants were classed as ‘pre-frail’.
When work situations were taken into account, we found three quarters of those classified as ‘frail’ were no longer working, with 60 per cent of these leaving their job for a health reason. Only a quarter of the ‘non-frail’ participants had stopped working.
The odds of not being in paid work were more than ten times higher for frail compared with non-frail participants, while the likelihood of leaving work for health reasons was higher still (up 30-fold). In frail people who were in work, the odds of prolonged sick leave, cutting down a lot at work and struggling with work’s physical demands were about 11 to 17 times greater than for non-frail workers.
‘Pre-frail’ subjects also had more work problems, although not to the same extent as frail subjects. For example, their odds of health-related job loss were up 3.7-fold, and their odds of having prolonged sick leave or having to cut down a lot at work in the past year were up 2.5 to 3-fold.
The impact of frailty on not being in work, taking more sick leave, and not coping with work demands was about 2–3 times greater among those from poorer backgrounds. However, we found ‘frailty’ was strongly associated with poor work outcomes even for those in higher managerial positions.
Looking at the frailty symptoms individually, we found most of the work problems to be most strongly linked with slow walking speed. Strong links were also found with poor grip strength and exhaustion.
Our findings showed strong associations between certain symptoms, for example those with slow-walking speed also tended to be exhausted or have a weak grip. Similarly, there were links between weak grip and exhaustion, and slow walking speed and low physical activity.
While our findings need further follow up, assessing the same group of patients over time to confirm the links between different physical symptoms and future work problems, our large sample size has confirmed frailty symptoms are common in people aged 50-65.
As the first study linking frailty and pre-frailty symptoms to work outcomes, we have shown strong associations with worklessness, health-related job loss, sickness absence and not coping at work.
Through further study, these symptoms could be refined to form the basis for simple screening tests for older workers, and spearhead the development of targeted support to improve physical function in those most at risk.
To realise the call of the Government’s older workers’ champion for one million more older people to be in work in five years’ time, identifying those most likely to struggle to remain in the workplace will be crucial.
The Government, NHS and employers will need to heed the call from the Centre for Ageing Better to develop workplace adaptations and age-friendly practices, and extend occupational health support and targeted preventive approaches that help people stay in work and stay well.
Motivating older employees to stay working longer is seen as a key way of tackling the current pensions crisis facing many countries. Something of a fly in the ointment for those looking to address the problem is the option to take voluntary early retirement, especially where among those who are in good health and best placed to continue working. Dr Nina Breinegaard and colleagues at the University of Copenhagen have been researching the situation in Denmark and, as Nina explains here, they find that a key area of focus for employers and policymakers could be organisational change.
A whole host of things influence our decision around when to retire. These include obvious things like our finances, the state of our physical and mental health and what’s going on with our family and close friends.
Another key influence is what is happening in the workplace. A job may have become too physically demanding for example. A number of studies have shown that when a company is restructuring or downsizing, employees may feel less secure about their position. This in turn can be a catalyst for early retirement, sometimes on the grounds of ill health.
In our research, however, we wanted to try to get to the bottom of how organisational change might influence those without any health problems to retire early. We also wanted to take a close look at the combined influences of the psychological and social sides of work on that decision.
In Denmark, men and women who have paid into an early retirement benefits insurance fund can claim those benefits between the ages of 60-64 even if they are in good health. At the end of 2012, 34 per cent of women and 27 per cent of men aged 60-64 received these early retirement benefits.
We linked Denmark’s DREAM database, which collects information on all public benefit payments, with a survey collected over a two month period in 2011 from more than 28,000 public sector workers. This enabled us to look at which employees decided to take early retirement benefits and whether changes at work were linked to that decision.
All this information was then linked to administrative data to take a range of social and economic background factors into account.
We ended up with a group of 3254 employees aged 60-64 who were entitled to early retirement benefits. Details of any changes at their workplace: a change of manager, a merging or demerging of departments or workgroups, moving to a different office or having a new base, were collected independently from current or previous managers.
They also rated the quality of their work environment e.g. how good their managers were at leading, how positive relationships were with other colleagues and how fairly and well concerns and conflicts were dealt with (organisational justice). The answers to all these questions were then used to create overall scores for each employee’s work environment.
When we followed up with our survey participants, we found that one in five women and one in seven men had taken early retirement benefits with early retirement being common in all occupational groups except for doctors and dentists.
65.1 per cent of the 2206 employees for whom we had information about all types of organisational change had experienced one or more changes. Change was most frequent among social and healthcare workers (74.9 per cent) and least frequent among laboratory technicians (46 per cent).
Employees whose workplace had undergone a change of management or a merger were much more likely to have taken early retirement than those who had not. After taking background factors including age, marital status, gender etc. into account where a change in management had occurred, the likelihood of early retirement increased even more. Adjusting for the same factors for those whose workplace had experienced a merger made no difference to the likelihood of early retirement.
Relocation was linked somewhat less closely to early retirement and the demerging of departments or workgroups had no effect at all.
On their own, poor quality work relationships and networks and low levels of organisational justice were also associated with early retirement. How well people felt they were managed had an effect only once background factors (apart from age) were taken into account. When any organisational change was factored in as well as the quality of the work environment variables, the likelihood of an employee retiring early increased further.
Organisational change matters
Taking everything into account, we can say, for the first time, and with considerable confidence, that when it comes to early retirement, organisational change makes a difference, particularly where it involves a change of management. Organisational changes on top of a work environment that is perceived to be poor compounds the likelihood of an employee retiring early.
Given that our research focuses on people who are not retiring because of poor health or disability – the very employees that organisations and policy makers want to encourage to work for longer – our findings are likely to be of considerable interest.
Key would seem to be careful consideration of the impacts of any restructuring within a business or organisation. Improving the workplace environment could also have a role in reducing the numbers of employees calling time on work before the age of 65.
The frequent occurrence of organisational change in the Danish healthcare sector is interesting in the light of medical doctors, nurses and other health and social care workers recently being identified as shortage occupations in Denmark. Managing those changes and improving the working environments of people working in these occupations could be a priority, not least because ageing populations not just in Denmark, but the world over, clearly need these groups of workers more than ever before.