Impact of interventions and policies on prolonging working life in good health: an international study

Lead Research Organisation: King's College London
Department Name: Social Science, Health and Medicine

Abstract

European governments have developed policies to keep workers stay in employment until older age, yet many workers leave work earlier than expected due to illness, disability or poor health. Despite the societal implications of this phenomenon, we know little about the health interventions and policies that could encourage workers to stay longer in work, as well as the economic costs of these interventions. This project aims to identify the policies and interventions that can help workers maintain employment by either diminishing the negative consequences of health problems or by improving the overall health of workers. In turn, the project also examines the impact of employment and retirement policies on maintaining good health. The project focuses on workplace interventions, health promotion programmes, and legislation and policies that support workers with health problems to remain in paid employment; and policies to prevent the development or aggravation of health problems. The project also studies the cost-effectiveness of interventions and policies for prolonging working lives in different social groups. The project will provide key evidence on the consequences of national policies on prolonging working careers and on the health of the workforce. It will also demonstrate the potential benefits of workplace and health interventions on the length of employment and worker's health.

Planned Impact

The primary target population that will benefit from the project are older workers, who have a chronic health problem that may affect their ability to enter and maintain paid employment throughout their work career. It is estimated that within the European union approximately 25% of workers suffer from a longstanding problem which restricts their daily activities, i.e. about 30 million in the European union. The main causes of longstanding health problems in the working age population are chronic diseases, such as musculoskeletal diseases, cardiovascular diseases, respiratory diseases, and mental, nervous or emotional problems [28]. The European Pact for Mental Health and Well-being has estimated that up to 10% of the European population will experience some type of depressive or anxiety related disorder every year, with women much more at risk than men. The estimated annual costs of depression in the workforce in the European Economic Area were approximately 100 billion Euro due to productivity losses from employment [29]. For other comparable diseases cost of illness studies have been published. These figures demonstrate that the target population is large and that the social and economic consequences of chronic disease are of paramount importance to the health and wealth of the working population.

Our research will contribute directly to current and evolving governmental policies on employment and retirement by providing sound evidence for impact on the length of employment and health. This will be achieved in several ways: First, our study will provide evidence of how health and employment interact to influence the likelihood of extended working careers, and will elucidate some of the pathways that connect employment and health among older workers. Understanding these mechanisms will be crucial for the development of interventions and policies that may be effective in extending working lives. Second, recent years have witnessed many policy reforms in European countries, particularly related to retirement ages and pension systems. However, little is known about the potential impact of these reforms for the health of workers and their ability to have extended working lives. Our study will provide key evidence of how these policies may have both intended, but also unintended consequences on worker's health and their ability to work longer. Finally, policy makers will benefit from the project by obtaining information on the cost-effectiveness and cost-benefits assessment of the multiple interventions and policy measures for a sustainable and inclusive workforce. This tool will enable policy makers to make evidence-based decisions that are expected to lead to better employment and health outcomes, and ultimately increase productivity and population health and well-being.
 
Description This project examines how extending-working-lives policies impact the welfare of Western societies, and is implemented in two Phases.
The first phase examines how extending-working-lives policies impact the health status of the affected population.
This phase was, in turn, implemented in four Stages.

Stage I focus on the United Kingdom, where the State Pension Age (SPA) has been gradually rising for women born after April 1950 (postponement up to 6 years). Our research question is whether women who find themselves to be ineligible for State pension due to the reform have worse health than a control group unaffected by the reform, who could collect their pension while at the same age.
We use the Special License Understanding Society dataset, augmented with a new individual-level variable for pension eligibility status. We focus on measures of mental-health (MCS;GHQ), physical-health (PCS), behavioural/lifestyle (drinking, smoking and sleeping habits), for women aged 60 to 64 between 2009 and 2016. We implement a difference-in-differences econometric model, exploiting the fact that otherwise-similar individuals were exposed to different pension eligibility status, based on their date-of-birth.
We report a rich set of relevant results.
- The SPA postponement led to a significant increase in self-reported paid-employment rates (+11%), as-well-as in sickness/disability rates (+2.2%), the latter effect being significantly higher for low-occupation workers.
- Affected women have a 15% (5%) reduction in individual (household) net monthly income.
- Affected women have worse mental-health with respect to women of similar/same age unaffected by the pension change. The effect is only present for women in low socioeconomic status. The negative health-impact increases with the extent of the SPA-shift, and is widespread across a diverse set of physical/mental/depression sub-components of our heath-indices.
- We have linked our data with recent Job-Exposure-Matrix, to show that the effect is concentrated among women in strenuous occupations with low control on their job, suggesting that prolonged exposure to strenuous job-conditions is detrimental for health.
- Using self-reported information, we find that women in strenuous occupations are more likely to be diagnosed with clinical depression.
- We find no evidence to support the hypothesis that the observed worsening in health is mainly driven by a reduction in income.
- We do not find evidence of changes in life-styles (smoking, drinking habits), or sleeping quality or length.

Stage II investigates how health changes after people exit the labour market through retirement. Our aim is to estimate the immediate and medium-term impact of retirement on health among women in the UK, as the recent theoretical literature has shown that these effects might be contrasting, and linked with individuals' characteristics as the Socioeconomic Status. We are among the first to look simultaneously at short and long-term effects of retirement on mental health. We exploit the same UK survey as in Stage I, and implement a longitudinal analysis following women in paid-work, who transition into retirement between 2009 and 2017. We use an instrumental variable fixed effects specification, exploiting individuals' pension eligibility status as exogenous incentive to retire.
Our preliminary results are as follows:
- retirement is found to cause an immediate and large positive effect on mental health, but subsequently accelerates mental health declines over time compared to women of the same age who are still in work.
- we find no significant impact on physical health.
- the observed effects are mainly driven by women who held a psycho-socially exposed job prior to retirement.

In Stage III, together with our project partners at Erasmus MC, we investigate whether changes in employment protection levels within and between countries influence health-related labour force exit through different pathways (disability, unemployment, retirement and economic inactivity). We exploit EU-SILC longitudinal data (2003-2014), employing a mixed model with within- and between effects, adding interaction between national indicators and individual health, and controlling for macro- and individual-level characteristics.
- Results indicate that, where employment protection is higher, workers are less likely to exit paid employment due to disability, but more likely to retire. A within-country increase in employment protection is associated with a lower likelihood for unemployment- or retirement-related exit routes. Furthermore, changes in employment protection on disability-related exit routes have stronger effects on poor-health workers.

In Stage IV, we have examined the health impact of a major pension reform in Colombia, a country with limited coverage of pensions. The reform provided a non-contributory pension (that is, not dependent on working careers or earlier pension contributions) to poor older individuals without pensions. Using an instrumental variable approach that exploits the differential rollout of the programme across municipalities, we find evidence that the reform led to small but significant reduction in the probability of reporting poor health and being hospitalised. The programme, however, did not have an impact on the health of women. We conclude that such reform may need to be larger or combined with other approaches to be able to generate large improvements in health.


The second phase of the projects investigate how legislation and policy measures prolonging labour force participation affect individuals' social activities and informal caregiving provision. Specifically, we focus on the UK, using the same data from Phase I (Stage I), and evaluate how women aged 55 to 65 who were induced to work longer by the recent pension reform have adjusted their supply of care to family and friends. Although both the economics and sociological theoretical literature predicts a negative trade-off between working longer and caregiving supply, empirical evidence is very limited. Our dataset includes rich information about amount care provided (in hours), location setting (extra-household or in-household care), and the relationship with the care-recipient (e.g., spouse, parent, etc.). We use an Instrumental Variable approach, exploiting the recent UK pension reform as an exogenous change in the incentives to retire.
Our results are as follows:
- we find a negative work-care trade off among women providing help outside the household: for someone working 30 hours/week, working longer due to higher SPA reduces care-intensity by 6.6 hours/week, as well as the probability of providing intensive care (20+hours/week).
- we find evidence for increasing inequality in care-provision, as most of the observed reduction is concentrated among women in strenuous occupations.
Exploitation Route Our findings offer major insights to both policy and research in pensions and social care.
First, the evidence of unintended negative effects of extending the state pension age on the physical and mental health of workers can be used by policy makers to justify a redesign of state pension age legislation. We highlight an increase in health inequalities by job-type directly caused by Government policy, suggesting that working longer in strenuous occupations impacts health. Further action might be needed to protect lower occupational groups, which may be unable to fulfil extended working careers in strenuous or stressful jobs, or may face significant barriers for re-employment. Our results show that this may not be fully justified on the ground of drops in financial wellbeing, which translate into negative wellbeing effects. In some cases, our results may be used by policy makers to potentially justify policy proposals that may question the cost-effectiveness of current state pension age policy, for example, by factoring in negative health effects into cost-effectiveness calculations. Finally, our results may be used to justify policies that increase pension literacy and lifelong-skill learning among workers approaching retirement age.
Second, we highlight that pension systems have important consequences for the demand and supply of formal and informal care. We show that extending working careers reduces the intensity of informal caregiving. This emphasises the need for coordination between pension and social care policies: if pension systems have an impact on the supply of informal care, social care systems need to adjust to address any gaps in care for older people, particularly among women. Analysing the interaction between the two welfare Phases is challenging as social care in Europe is highly fragmented, and often underfunded. We thus recently published an analysis estimating differences in the inclusiveness of European Long-Term Care systems, based on a comprehensive review of eligibility rules for public formal- and informal-care benefits.
Sectors Communities and Social Services/Policy,Healthcare,Government, Democracy and Justice

URL https://www.sheffield.ac.uk/polopoly_fs/1.735856!/file/C1_3_Carrino.pdf
 
Description We have carried out several activities to ensure our work reaches several stakeholders outside of academia (the list below provides details), particularly those involved in policy making. First, we established a close connection with governmental institutions with crucial roles in the design of economic and pension policy and reforms, namely, the Department for Work and Pension (DWP) and Her Majesty's Treasury (HMT), as well as with major charity organisations working with older people (Age UK and Centre for Ageing Better). After being invited to present our work in several DWP and HMT workshops on the "extended working lives" policies (in May 2018 and July 2018), we organised a policy-expert workshop and roundtable in February 2019, with senior figures from all of the aforementioned stakeholders attending. All the stakeholders have expressed a substantial interest in our findings, and expressed a clear view that our results help in shaping future reforms of extending working lives. They agreed to further disseminate our findings within their respective bodies, and accepted to be involved in the draft of fact-sheets that could help reaching a wider audience, from policy-circles, to older workers and older people. Our research has raised interest in the media as well: findings from WORKLONG have been the subject of an article in the ESRC Society Now Magazine (Spring 2019), and we have recently been contacted by the Guardian newspaper as well. Second, our project has aimed to influence international policy advisors and societal stakeholders: in January 2019, we were invited to present our findings at the European Centre for Social Policy and Welfare in Vienna, where we engaged in fruitful discussion and dissemination with the Austrian Institute for Advanced Studies, the Austrian Institute of Economic Research, as well as other stakeholders in the field of pensions and social-care in Austria. In 2018 and 2017 we presented our research in international workshops organised within the Joint Programmes Initiative "More years better lives" in London and Brussels, where we engaged with international stakeholders such as the Organisation for Economic Co-operation and Development (OECD) and the World Health Organisation (WHO), as well as representatives from the European Commission; the Council of European Municipalities and Regions; the European Trade Union Confederation; The Netherlands Organisation for Health Research and Development; the Swedish Research Council for Health, Working Life and Welfare; the Austrian Federal Ministry of Science, Research and Economy. Third, we have formed and worked together with our Impact Advisory Group led by the Erasmus Medical Center in the Netherlands. We met with members of the Impact Advisory Group in Brussels to discuss our results and examine the potential ways the results could reach local governments. The Group includes Prof. Lars L Andersen (Aalborg University, Denmark), Prof M. Lindeboom (VU University of Amsterdam, the Netherlands), Greet Vermeylen (Working Conditions and Industrial Relations -WCIR, Eurofound) and Manuel Flores (OECD). We elicited and will continue to elicit the stakeholders' views of how results of the project can be best summarized, presented and disseminated via their own channels of communication. We have also created a website, which features key information on our research. Fourth, we have partnered with the WHO Observatory on Health Systems to produce a WHO Europe Policy Brief addressing the implications of working at older ages for health and health systems. The Policy Brief places the results of WORKLONG into the context of broader literature and examines the complex health effects of policies that have extended working lives to increase the sustainability of pension systems. We aimed to reach clinical practitioners, geriatricians, social workers and policy makers by presenting at major national and international conferences. In 2018, we have presented our papers at the Conference of the European Association for Population Studies in Brussels, the conference for International Association for Applied Econometrics in Montreal, the British Society of Gerontology Conference in Manchester, the Italian Health Economics association in Naples, the European Public Health Conference in Lubiana. Our work will also be featured in important forthcoming events such as the conference of the Population Association of America (April), International Health Economics Association (July), the European Labour Economics Conference (September), as well as the American-European Health Economics Study Group (July). In 2017 we presented our results at the "Fuller Working Lives" event organised by ESRC and the Centre for Ageing Better, as well as at the Conference "Global ageing: Challenges and Opportunities" organised by the Royal Society of Medicine in London. We held seminars at the Congress of the International Health Economics Association in Boston (United States), as well as at the Work, Pensions and Labour Economics Study Group Conference in Sheffield (WPEG), at the Society for Epidemiological Research (SER) Conference in Seattle, USA; the Bordeaux School of Social Epidemiology; and at the workshop on aging, health and disability in Lausanne. Finally, we have been invited to present our research in seminars in the UK and abroad, including the KCL/LSE ALPHA Seminar Series jointly organised by the London School of Economics and the King's College, which is open to the public and policy makers, the Summer School of Ageing in Venice, the DIW Economics Institute in Berlin, and the Institute of Education at UCL in London. The full list of dissemination activities and publications is presented below: 1. ALPHA Seminar Series, London School of Economics, 14/12/2016, Invited seminar, Carrino 2. Fuller Working Lives ESRC Event, London, 30/03/2017, Invited presentation, Carrino 3. JPI More Years Better Lives Networking meeting, London, 30/03/2017, Invited member, Carrino 4. Global ageing Conference, Royal Society of Medicine, London, 24/04/2017, Invited speaker, Avendano 5. Department for Work and Pensions, London, 27/04/2017, Invited seminar, Carrino 6. Workshop on aging, health and disability, Lausanne, June 2017, speaker Avendano 7. Summer School of Ageing, Venice International University, 7/6/2017, Invited speaker, Carrino 8. Society for Epidemiological Research (SER) Conference 2017, Seattle, speaker, Avendano 9. Bordeaux School of Social Epidemiology, July 2017, speaker, Avendano 10. World Conference - International Health Economics Association, 10/7/2017, speaker, Carrino 11. WPEG Conference, Sheffield, 27/7/2017, invited speaker, Carrino 12. ALPHA Seminar Series, King's College London, 29/11/2017, Invited seminar, Carrino 13. Department for Work and Pensions, London, 31/01/2018, Invited seminar, Carrino 14. JPI More Years Better Lives Conference, Brussels, 13/2/2018, invited speaker, Carrino 15. JPI More Years Better Lives, Networking Meeting, Brussels, 13/2/2018, invited member, Carrino 16. JPI More Years Better Lives, Progress Dialogue Meeting, 14/2/2018, invited member, Carrino 17. European Association for Population Studies Conference, Brussels, 6/6/2018, speaker, Carrino 18. Microeconomics Seminar Series at DIW Berlin, invited speaker Carrino. 19. International Association for Applied Econometrics, Montreal June 2018, speaker Carrino 20. Annual Conference - British Society of Gerontology, Manchester, 4/7/2018, speaker, Carrino 21. Department for Work and Pensions, London 25/07/2018, Invited seminar, Carrino 22. International Long-Term Care Policy Network Conference, Vienna, 10/09/2018, speaker, Carrino 23. Italian Health Economics Association, Napoli, 28/09/2018, speaker, Carrino 24. Institute of Education seminar series, London, 21/11/2018, speaker, Avendano 25. European Public Health Conference, Ljubljana, 1/12/2018, speaker, Carrino 26. Global Ageing and Health Seminars, London, 5/12/2018, invited seminar, Carrino 27. European Centre for Social Policy and Research, Wien, 23/01/2019, invited seminar, Carrino 28. WORKLONG project: Policy-expert workshop, London, 14/2/2019, organised event, Carrino&Avendano 29. Porto Institute of Public Health, Porto University (Portugal), invited seminar, Porto, 01/03/2019, Avendano International publications: - Hessel P, Avendano M, Rodríguez-Castelán C, Pfutze T. Social Pension Income Associated With Small Improvements In Self-Reported Health Of Poor Older Men In Colombia. Health Affairs. 2018;March. - Brugiavini, A., Carrino, L., Orso, C. E., & Pasini, G. (2017). Vulnerability and Long-term Care in Europe: An Economic Perspective. Palgrave MacMillan - Carrino, L., Orso, C.E., & Pasini, G. (2018). Demand of longterm care and benefit eligibility across European countries. Health Economics. - Carrino, L., Glaser, K., Avendano, M. (2018). Later pension, poorer health? Evidence from the new State Pension age in the UK. Harvard Pop. Centre Series, Vol. 17, n.4 - Carrino, L., Nafilyan, V., Avendano, M. (2019). Should I care or should I work? The Impact Of Working In Older Age On Caregiving. SSRN Economics Working Paper Series. - Carrino, L., Avendano M. (2018), Prolonged working lives and health: evidence from the UK, European Journal of Public Health, Volume 28 - Schuring M, Robroek SJW, Oude Hengel K, Carrino L, Burdorf A (2018); Educational inequalities in the contribution of poor health to labour force exit and employment protection legislation in European countries. European Journal of Public Health, Volume 28 Unpublished working papers - Sochas, L., Carrino, L., Avendano, M. (2019). The end of the grind or the beginning of the end? Inequalities in the impact of retirement on women's health in the UK - Avendano, M., Carrino, L., Nafilyan, V. (2019). Mental health and income: evidence from UK pension eligibility. - Avendano M. Working at older ages: what are the implications for health, health systems and the economy? WHO Observatory of Health Systems Policy Brief, 2019
First Year Of Impact 2017
Sector Communities and Social Services/Policy,Healthcare,Government, Democracy and Justice
Impact Types Societal,Policy & public services

 
Description Dissemination and dialogue with Department for Work and Pensions
Geographic Reach National 
Policy Influence Type Participation in a advisory committee
 
Description Dissemination and dialogue with Her Majesty's Treasury
Geographic Reach National 
Policy Influence Type Participation in a advisory committee
 
Description Ca' Foscari University of Venice, Department of Economics 
Organisation Ca' Foscari University of Venice
Country Italy 
Sector Academic/University 
PI Contribution Dr. Ludovico Carrino is providing expertise on the SHARE dataset as well as on eligibility rules and recent reforms for European Pension systems.
Collaborator Contribution The research group at Ca' Foscari is providing expertise on handling the SHARE dataset, as well as substantial expertise on econometrics analysis and pension systems.
Impact The research groups at King's College and Ca' Foscari are producing a dataset of individual-level and comparable measures of Pension Wealth for a subgroup of the SHARE countries.
Start Year 2016
 
Description EMC-NL & UU-SE 
Organisation Erasmus University Rotterdam
Department Department of Epidemiology
Country Netherlands 
Sector Academic/University 
PI Contribution Dr. Ludovico Carrino is providing our partners with substantial expertise on Pension systems in Europe for several ongoing research papers at Erasmus University, with reference to both eligibility rules to receive pension and the reforms occurred in the last two decades. Furthermore, Dr. Mauricio Avendano and Dr. Ludovico Carrino are providing intellectual inputs and empirical expertise for several research papers at both Erasmus and Umea University, with particular reference to methods for identifying causal effects between changes in pension regulations and health outcomes.
Collaborator Contribution Both Erasmus and Umea University teams are providing intellectual inputs on the research design of our current main research focus, as well as substantial expertise on health variables and health indices adopted to identify specific health consequences of postponing the Statutory Pension Age in the UK. Furthermore, Umea University is providing access to micro-data to investigate the relationship between health and retirement in Sweden.
Impact The project is in its first year so there are no concrete outputs yet; outputs are expected during the second year.
Start Year 2016
 
Description EMC-NL & UU-SE 
Organisation Umea University
Country Sweden 
Sector Academic/University 
PI Contribution Dr. Ludovico Carrino is providing our partners with substantial expertise on Pension systems in Europe for several ongoing research papers at Erasmus University, with reference to both eligibility rules to receive pension and the reforms occurred in the last two decades. Furthermore, Dr. Mauricio Avendano and Dr. Ludovico Carrino are providing intellectual inputs and empirical expertise for several research papers at both Erasmus and Umea University, with particular reference to methods for identifying causal effects between changes in pension regulations and health outcomes.
Collaborator Contribution Both Erasmus and Umea University teams are providing intellectual inputs on the research design of our current main research focus, as well as substantial expertise on health variables and health indices adopted to identify specific health consequences of postponing the Statutory Pension Age in the UK. Furthermore, Umea University is providing access to micro-data to investigate the relationship between health and retirement in Sweden.
Impact The project is in its first year so there are no concrete outputs yet; outputs are expected during the second year.
Start Year 2016
 
Description Interview for ESRC Society Now Magazine 
Form Of Engagement Activity A press release, press conference or response to a media enquiry/interview
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Media (as a channel to the public)
Results and Impact We were invited to be part of an interview for the Spring Edition of ESRC Magazine "Society Now" (in print). The interview gave us the chance to discuss the WORKLONG project findings about the health consequences of the recent UK reform which postponed the State pension age for women, and its important policy implications. This output will help us disseminate our findings to relevant policy stakeholders in the field of ageing and welfare policies, raising awareness about the unintended effects of pension reforms for older workers' health.
Year(s) Of Engagement Activity 2019
URL https://esrc.ukri.org/news-events-and-publications/publications/magazines/society-now-magazine/
 
Description Policy expert workshop 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Policymakers/politicians
Results and Impact We organised an event with 18 policy experts, in a form of presentations and roundtable discussion, to present and debate the findings and implications of the WORKLONG project. We engaged with senior analysts and chief economists from the Department from Work and Pensions (Pensions and Later Life Analysis) and Her Majesty's Treasury (the Head of State Pension Branch as well as policy advisors). We engaged as well with senior policy managers at Age UK and Centre for Ageing Better (the largest charities working with older people in the UK), and senior academics from the London School of Economics and the University of Manchester.
All the policy stakeholders showed a substantial interest in our findings and their policy relevance. Several attendees highlighted how our results challenge some of the current assumptions underlining recent policies extending working lives. The workshop produced an oral agreement in which each group expressed its willingness to disseminate our findings to their respective fields. The representatives for the Department for Work and Pensions and AgeUK agreed to cooperate in the process of drafting a policy-note summarising the findings from the WORKLONG project.
Year(s) Of Engagement Activity 2019
 
Description Stakeholders Dialogue Meeting, JPI More Years Better Lives, Brussels 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Policymakers/politicians
Results and Impact We presented our research in an international workshop organised within the Joint Programmes Initiative "More years better lives". In a specific "progress dialogue" meeting, we discussed our findings in front of a stakeholders board which included international organisations such as the Organisation for Economic Co-operation and Development (OECD) and the World Health Organisation (WHO), as well as representatives from the European Commission, the Council of European Municipalities and Regions, the European Trade Union Confederation, The Netherlands Organisation for Health Research and Development, the - Swedish Research Council for Health, Working Life and Welfare, the Austrian Federal Ministry of Science, Research and Economy, Age UK and the UK Centre for Ageing Better.
Year(s) Of Engagement Activity 2017,2018
URL http://www.jp-demographic.eu/news/jpi-mybl-2018-brussels-conference/conference-program-brussels-2018...
 
Description Talk at the European Centre in Vienna 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Third sector organisations
Results and Impact In January 2019, we were invited to present our findings at the European Centre for Social Policy and Welfare in Vienna, where we engaged in fruitful discussion with the Austrian Institute for Advanced Studies, the Austrian Institute of Economic Research, as well as other stakeholders in the field of pensions and social-care in Austria.
Year(s) Of Engagement Activity 2019
URL https://www.euro.centre.org/events/detail/3347