Mind the gap! Tackling health-related early exit from work

In the latest of a series of blogs from the Prevention Programme, Professor Alan Walker, Professor of Social Policy and Social Gerontology at the University of Sheffield, and Dr Daniel Holman, Research Fellow in the Department of Sociological Studies, discuss what needs to be done to increase healthy life expectancy and reduce early exit from work.

Each year tens of thousands of older workers in England leave employment prematurely due to poor health and disability.

Chronic conditions are strongly implicated given their association with impaired function, pain, and depression. Around half the population will have at least one condition 10 to 15 years from pension age, so it is no wonder that they are a leading cause of older workers leaving employment, even if they want to continue working.

The UK government, like all others in the EU, is keen to extend working lives. There are huge economic and societal benefits to be had, and there is plenty of evidence on what works; the problem is a lack of uptake at both national and organisational levels.

Instead, the consistent response in the UK and other European countries has been to increase the state pension age, yet increases in life expectancy have not been matched by increases in healthy life expectancy. The gap between increasing state pension ages and healthy life expectancy is a serious concern for inequality given the fact that for the most deprived, this gap is substantial.

There is a strong need to focus specifically on the relationship between chronic diseases, the disability they often entail, and workplace exit in later life. There is much that needs unpicking here.

A new paper published in British Medical Journal (BMJ) Occupational and Environmental Medicine compared the extent to which different chronic conditions are risk factors for disability-related employment exit. It analysed the extent to which associated symptoms and limitations, such as muscle use limitations, pain and mobility are risk factors. This is important because not everyone experiencing these symptoms has a diagnosed condition.

Given differences in prevalence, what’s striking, and supported by previous research, is the significant proportion of employment exits that arthritis and depression account for. Furthermore, large numbers of people are leaving work because they have limitations in use of their muscles, and experience pain and mobility problems. There is an urgent need to directly address these symptoms and conditions as well as to tackle their effects.

Research also highlights the importance of gender in the relationship between illness and employment exit. Unfortunately, it seems to be a common theme that already disadvantaged women have their disadvantage compounded in the later life labour market. Given that women are more likely than men to experience arthritis and depression, larger numbers of them are leaving employment due to these conditions. Therefore, they are more likely than men to lose the benefits that work may bring, suffer further health deficits, and lost pension contributions, experiencing poverty in retirement.

What can be done? Interventions and policies are needed that address primary, secondary and tertiary prevention. Health needs to be a key aspect of the age management approaches that have been proven to help older people stay in work.

This would include workplace adaptation by focussing on specific job tasks in relation to experienced limitations, flexibility in terms of working days and times, and health promotion schemes, to get employees engaged in physical activity appropriate to their functionality, and linkage to health providers.

Symptoms and impairments that are the greatest risk factors for workplace exit should be prioritised. Best evidence suggests that multidomain interventions are most promising – joined up approaches which involve various age management approaches alongside service co-ordination – in other words ‘getting all players on side’.

There are significant gains to be had by focussing on chronic conditions, disability and employment exit, and the possibility to address gender inequality in the process. Although more work is needed to fully tackle the issues, there is already enough evidence to make major advances on workplace well-being and age management.

To do so would greatly advance the extending working lives policy goal as well as improving the well-being of hundreds and thousands of older workers.

Alan Walker

Alan Walker is Professor of Social Policy and Social Gerontology at the University of Sheffield. Previously Director of the 10 year UK research programme The New Dynamics of Ageing and several major European collaborations on ageing.

Dr Daniel Holman

Dr Daniel Holman is a Research Fellow in the Department of Sociological Studies at the University of Sheffield. He is currently researching inequalities in chronic diseases, and how they are patterned according to combinations of socioeconomic factors, age, gender and ethnicity (so-called ‘intersectionality’), and how this patterning is shaped by experiences across the life course.

Previously, he worked on a European project on extending working lives, particularly on the relationships between health, age management, pensions and retirement.