Employment and ill-health among women in Israel

Recent studies carried out in the United States consistently showed employed women to enjoy better health than non-employed women. Various measures were used and a number of explanatory approaches have been advanced. The present study follows previous research and its purpose is two-fold: first, to identify several dimensions of ill-health and examine the role of employment in each; and second, to provide comparative data from Israel and thus assess the generalizability of previous findings. The analyses reported are based on a sample of 416 married women between the ages of 25 and 65 residing in urban communities south of Tel Aviv. While employment status generally had a positive effect on all measures of health, it accountes for variable portions of the differences between employed and non-employed women. Employment accounted for most of the gap in illness behavior, but only for a small portion of the difference in perceived sickness. Employment increased somewhat the likelihood of mild symptoms. These patterns are discussed in light of theoretical approaches that address the relationship between employment and health.     

Social class and psychological ill-health during unemployment

This study explores psychological health and the experience of being unemployed for between 6 and 11 months in two social class groups: unskilled and semi-skilled workers v. white-collar, managerial and professional workers. The respondents were British married men aged between 25 and 39. Information was obtained through interviews about financial and other problems, perceived threats associated with unemployment, anxiety, depression, general psychological distress and ratings of general health. It was expected that the working-class sample would exhibit poorer psychological health than the middle-class, but this was not confirmed. Medium-term unemployment appeared to have a homogenizing effect, with similarly poor health in both social class samples, although working-class respondents reported significantly greater financial problems and difficulties in filling the time.     

Mental ill-health and second claims for work-related injury

Background There is some evidence that mental ill-health (MIH) is associated with injury at work, but data are sparse. Aims To examine, within a cohort of workers with a first workers' compensation claim, whether those with a history of MIH had a higher than expected number of second claims. Methods All Workers' Compensation Board (WCB) records from January 1995 to December 2004 were linked to administrative health records, and a physician diagnosis of MIH in the 48 months prior to the first WCB claim extracted. The first and second (if any) claim for each worker were identified and time to second claim calculated. Survival time to second claim was estimated by Cox regression with history of MIH as a covariate. Results Results were available for 389 903 WCB first claimants. Of these 53% of men and 38% of women had a second claim, with a mean time between claims of 768 days (men) and 785 days (women). Those with a history of MIH were somewhat more likely to make a second claim and, in the survival analysis, to make this claim sooner. Type of injury at first claim did not appear to modify this effect. Conclusions Workers with a recent history of MIH at the time of making a first WCB claim for a work injury are at greater risk of a second injury, leading to a new claim. Strategies to get workers back to work after the first injury/claim should include management of MIH to reduce the risk of further injury.     

Physician diagnosed mental ill-health in male and female workers

Background Although there have been many studies of work demands and self-reported job strain, few have examined incident physician-diagnosed mental ill-health (MIH) by detailed occupational group. Aims To investigate whether linkage of occupation from worker compensation claims to diagnoses from administrative health records can give credible information on occupation and incidence of MIH by diagnostic group and gender. Methods Information on occupation from all worker compensation claims 1995-2004 in Alberta, Canada were linked to administrative health records of MIH diagnoses. Relative risks for affective, substance use and psychotic disorders by four digit occupational codes were calculated for men and women aged 18-65 years in a log-binomial regression adjusting for age and stratifying by sex. Results There were 327883 male and 88483 female compensation claims available for the analysis of incident cases. Affective disorders (5.2% men, 11.5% women) were much more common than substance use disorders or psychotic disorders (both ≤1%) in this population of working people. In men, the type of work appeared to either protect from or precipitate affective disorders, but no protective effect was seen for women. Substance use disorders clustered mainly in physically demanding occupations typically involving employment outside the urban areas. New onset psychotic disease was rare but seen in excess in painters, boilermakers and chefs. Conclusions Data linkage of occupation close to the time of new onset MIH can provide important insight into the relation between work and physician-diagnosed MIH and indicate areas in which intervention might be appropriate.     

Illness behaviour in mental ill-health in Kuwait

Two hundred and eight individuals were interviewed in order to study the behaviour they adopt in relation to the most common somatic and emotional symptoms of mental ill-health. Illness behaviour included ignoring, brooding, self-help and consultation of others. Older individuals tended more frequently to resort to meditation, native healers and doctors. Males consulted doctors more than females. Brooding was more frequent in well educated subjects. A group of married expatriates who left their wives in their original countries were the most likely to consult doctors. Education and marital status were the most predictive of brooding and self-help behaviour. Self-help was the most commonly adopted illness behaviour. The results are explained in terms of the social and cultural background of the individuals studied because this influences their methods of expressing distress and their action in relation to symptoms.     

Paraoxonase polymorphisms and self-reported chronic ill-health in farmers dipping sheep

BACKGROUND: Serum paraoxonase (PON1) provides protection against organophosphate induced toxicity. Recently we reported that the frequency of paraoxonase polymorphisms in sheep dippers with self-reported chronic ill-health differed from that in dippers with a similar dipping history but no ill-health. As these analyses may have included subjects with conditions unrelated to organophosphate exposure, the aim of this study was to examine whether the risk associated with PON1 polymorphisms varied using a more homogenous case and referent population. METHODS: Each subject completed a detailed symptom questionnaire and their general practitioner was asked whether there was any history of neurological disease that could be confused with the effects of organophosphate poisoning. Subjects were then excluded both on clinical grounds and where identified as atypical on discriminant analysis. RESULTS: Risk associated with the PON1 192 and 55 genotypes altered little with these changes in the population. CONCLUSIONS: These findings are consistent with the hypothesis that organophosphates contribute to the self-reported ill-health of sheep dippers.     

Domestic conditions, paid employment and women's experience of ill-health

Traditionally, research concerned with the relationship between paid employment and women's experience of ill-health has focused on one or other of two competing explanatory models: the role enhancement model which postulates a positive health effect of paid employment and the role overload model which postulates a negative effect. Though a synthesis of these two models is becoming apparent in the literature (Arber 1990, 1991) a number of important issues remain neglected. This paper focuses on three of these neglected issues: the extent to which the relationship between employment and health is mediated by the nature and/or extent of the workload associated with both formal and domestic work; whether the relationship differs for different types of ill-health; and the role of health related selection into different social roles. Using data from the Health and Lifestyles survey, an innovative approach is taken to the measurement of domestic conditions, and separate measures of long-term health status, and of short-term physical and psychological health state are used. Proportional odds models are used to assess the relationship between employment status, domestic conditions and type of employment (measured in terms of the socio-economic group of a woman's own occupation) independent of underlying long-term health status. Our findings suggest that the presence of long-term illness is the single most powerful influence on present health state, but that this does not explain away the positive relationship between employment and women's health. They also suggest that this relationship is different for different types of ill health and is not the same for women in different types of occupation. In particular, our findings suggest that the association between paid work and better health is rather less apparent for physical than psychological health, and in women working full time in professional or managerial occupations. Domestic conditions appear to have an effect on women's health equal to or greater than employment status, depending on the health measure used. However, there was no evidence of an interaction between employment status and domestic conditions. We conclude with a discussion of the ways in which our findings fit in with those of previous research. We argue in particular for more attention to be given to the nature of both the dependent (‘health’) and explanatory (‘work’) variables used in research on the relationship between employment and women's health.     

Unemployment and retirement and ill-health: a cross-sectional analysis across European countries

OBJECTIVE: To determine the associations between different measures of health and labor market position across ten European countries. METHODS: We studied 11,462 participants of the Survey on Health and Ageing in Europe (SHARE) who were 50-64 years old. Logistic regression was used to calculate the associations between health and other determinants and being retired, unemployed, or a homemaker. RESULTS: A large variation across European countries was observed for the proportion of persons 50-65 years with paid employment, varying among men from 42% in Austria to 75% in Sweden and among women from 22% in Italy to 69% in Sweden. Among employed workers 18% reported a poor health, whereas this proportion was 37% in retirees, 39% in unemployed persons, and 35% in homemakers. A perceived poor health was strongly associated with non-participating in labor force in most European countries. A lower education, being single, physical inactivity and a high body mass index were associated with withdrawal from the labor force. Long-term illnesses such as depression, stroke, diabetes, chronic lung disease, and musculoskeletal disease were significantly more common among those persons not having paid employment. CONCLUSION: In many European countries a poor health, chronic diseases, and lifestyle factors were associated with being out of the labor market. The results of this study suggest that in social policies to encourage employment among older persons the role of ill-health and its influencing factors needs to be incorporated.     

The state of industrial ill-health in the United Kingdom

Recent health and safety legislation in the United Kingdom comes at a time of economic crisis. The only way of understanding its impact is to look back at the roles of employers, the State, trade unions, workers, and the medical establishment over the past 150 years since the rise of industrial capital. In many ways, issues that were current at the turn of the century--such as the conflict between profits and health, whether to clean up the production process or insulate workers from its hazards, compensation, and employers' liability--are still very much present today, although these issues are often obscured by the notions that there is an identity of interest between management and workers over health and safety and that profits and safety go together. The role of the trade unions in dealing with existing and new hazards of production has historically been ambiguous, yet the need for them to develop an overall policy of prevention has always been obvious. Although they are now part of the governing apparatus, other arms of the State--in particular the civil service--initiate changes in health and safety organization, while trade unions make sure they are enacted. The development of trade-union area health and safety groups represents the most important potential change and may well provide the necessary focus for information and organization to cut through the "concerned" propaganda from management and its safety committees and start the long-awaited cleanup of industry.     

Psychological ill-health in Chinese communities in Hong Kong.

Psychiatric symptoms are widely distributed in the general population while psychiatric impairment or psychological ill-health is prevalent in many communities, especially those with stressful environments. Data concerning Chinese communities are scanty. The present study employed the use of a General Health Questionnaire to screen the general population for psychological ill-health in Hong Kong and the results showed that between 18.3% and 26.3% of Chinese could be considered as probable or potential candidates for mental illness. The authors discuss the significance of these findings.     

Return to work after ill-health retirement in Scottish NHS staff and teachers

BACKGROUND: Most major public and private sector pension schemes have provision for ill-health retirement (IHR) for those who become too ill to continue to work before their normal retirement age. AIM: To compare the causes, process and outcomes of IHR in teachers and National Health Service (NHS) staff in Scotland. METHODS: A total of 537 teachers and 863 NHS staff who retired due to ill-health between April 1998 and March 2000 were mailed an IHR questionnaire by the Scottish Public Pensions Agency. RESULTS: The response rate for teachers was 53% and for NHS staff 49%. The most common cause of IHR was musculoskeletal disorders for NHS staff and mental disorders for teachers. Teachers retired at a younger average age than NHS staff. Ninety-two per cent of NHS staff but only 11% of teachers attended occupational health services (OHS) prior to IHR. Eighteen per cent of NHS staff and 9% of teachers were offered part-time work by their current employer in response to their ill-health. Fifteen per cent of NHS staff and 5% of teachers were offered alternative work prior to retirement. Seventeen per cent of NHS staff and 36% of teachers subsequently found employment. Multiple logistic regression analyses showed the following variables as independent predictors of subsequent employment: occupational group, age group, sex, managerial responsibility and cause of IHR. CONCLUSIONS: Return to work after IHR suggests that some IHR could be avoided. Teachers had a higher rate of return to work and much less access to OHS.     

Ambivalent helpers and unhealthy choices: public health practitioners' narratives of Indigenous ill-health

Public health practitioners in Australian indigenous health work in a complex political environment. Public health training is limited in providing them with conceptual tools needed to unpack the postcolonial nexus of 'fourth-world' health. A workshop was designed by the authors to facilitate critical reflection on how the concepts of race and culture are used in constructions of indigenous ill-health. It was attended by researchers, students, clinicians and bureaucrats working in public health in northern Australia. A thematic analysis of the workshop minutes provided insight into public health practitioners' narratives of Indigenous ill-health. The major themes that emerged included tension between structure and agency and between sameness and difference, and ambivalence surrounding the 'helper' identity of public health practitioners. We suggest that these narratives can be understood as attempts to maintain the moral integrity of both Indigenous people and practitioners. This task is necessitated by the specter of cultural relativism intrinsic to contemporary liberal discourses of multiculturalism that attempt to reconcile the universal rights of the citizen with the special rights of minority groups. We argue that the concepts of self-determination and neocolonialism mark the spaces where universal and particular discourses overlap and clash. Practitioners who seek to escape neocolonialism must inhabit only the discursive space of public health congruent with self-determination, leaving them in a bind common to many postcolonial situations. They must relieve the ill-health of indigenous people without acting upon them; change them without declaring that change is required.     

Economic consequences of ill-health for households in northern rural India

Background

As compared to other countries in South East Asia, India’s health care system is characterized by very high out of pocket payments, and consequently low financial protection and access to care. This paper describes the relative importance of ill-health compared to other adverse events, the conduits through which ill-health affects household welfare and the coping strategies used to finance these expenses.

Methods

Cross-sectional data are used from a survey conducted with 5241 households in Uttar Pradesh and Bihar in 2010 that included a household shocks module and detailed information about health care use and spending.

Results

Health-related adverse events were the second most common adverse events (34%), after natural disasters (51%). Crop and livestock disease and weddings each affected about 8% of households. Only a fourth of households reported to have recovered from illness and/or death in the family (by the time of the survey). Most of the households’ economic burden related to ill-health was depending on direct medical costs, but indirect costs (such as lost earnings and transportation or food costs) were also not negligible. Close to half of the health expenditures were made for chronic conditions. Households tried to cope with health-related expenditures mostly by dissaving, borrowing and selling assets. Few households reported having to reduce (food) consumption in response to ill-health.

Conclusions

In the absence of pre-financing schemes, ill-health events pose a substantial threat to household welfare in rural India. While most households seem to be able to smooth consumption in the short term, coping strategies like selling assets and borrowing from moneylenders are likely to have severe long term consequences. As most of the households’ economic risk related to ill-health appears to depend on out of pocket spending, introducing health insurance may contribute significantly to alleviate economic hardship for families in rural India. The importance of care for chronic diseases, however, represents a big challenge for the sustainability of community based health insurance schemes, since it is necessary to ensure a sufficient degree of risk pooling.

     

Passive smoking and ill-health: practice and process in the production of medical knowledge

This paper examines the development of medical knowledge about passive smoking from a constructionist perspective. It draws upon the work of Ludwik Fleck, particularly his central idea that facts are produced in relation to the possibilities of stylised thought. Early epidemiological insights into changing disease patterns, with regard to active smoking, are initially discussed and shown to be related to a style of thought which encourages the production of a world of disconnected bodies. The paper then explores how connections between those bodies were constructed, and the medicalisation of passive smoking advanced, by a stylised perception of tobacco smoke. Problems of ‘subject’ visibility, however, remained; problems overcome by the production rather than the revelation of facts, notably the distinction between mainstream and sidestream smoke. This development opened up the space for the emergence of the previously invisible passive smoker. This processual reordering of reality is then mapped onto other processual patterns and the stylisation of social relationships, particularly apparent in the later ‘spouse as index’ studies, is discussed. The point is further explored in an analysis of the ideas associated with biochemical markers, particularly the notion that once invisible social connections can now be rendered visible through a reading of these markers in the body.