Ill health retirement in Scottish teachers: process, outcomes and re-employment

Objectives: To assess the process, causes and outcomes of ill health retirement (IHR) in teachers in Scotland. Perceptions and experience of occupational health services (OHS), access to rehabilitation and redeployment, current health, post retirement experience and predictors of re-employment were identified. Methods: 537 teachers who retired due to ill health between April 1998 and March 2000 were mailed our IHR questionnaire by the Scottish Public Pensions Agency. Results: The most common cause of IHR was mental disorders (37%), followed by diseases of the musculoskeletal system (18%). 11% of teachers attended an OHS prior to IHR. 9% of teachers were offered part-time work and 5% were offered alternative work. 63% of retired teachers stated their health had improved and 48% said they would like to work again. 36% of the surveyed teachers have found re-employment since their retirement. On unadjusted analyses, re-employment of teachers after IHR was significantly associated with sex, having dependants, job group, cause of IHR, health having improved and wanting to work again. Multiple logistic regression analyses showed three variables as independent predictors of re-employment: having dependants, job group and cause of IHR. Conclusion: This is the first comprehensive study investigating teachers’ experiences of IHR in Scotland. The findings highlight substantial lack of support for teachers in a number of areas which need to be addressed by managers and employers. Our study confirms the need for rehabilitation and teacher support services in order to try and retain experienced teachers in the profession.     

Transition to retirement and risk of cardiovascular disease: prospective analysis of the US health and retirement study

Transitioning from work to retirement could be either beneficial or harmful for health. We investigated the association between transition to retirement and risk of stroke and myocardial infarction (MI). We followed US Health and Retirement Study participants age 50+ working full-time for pay and free of major cardiovascular disease (n = 5422) in 1998 up to 10 years for transition to full retirement and self- or proxy-report of either stroke or MI (CVD; 665 events). We used discrete-time survival analysis to compare the CVD incidence for the fully retired versus the full-time working population. To distinguish short-term from long-term risks, we compared the association in the first year after retirement to estimates 2+ years after retirement. In the full model adjusting for age, sex, childhood and adult SES, behavior, and co-morbidities, being retired was associated with elevated odds of CVD onset (OR = 1.40, 95% CI: 1.04, 1.90) compared to those remaining in the full-time labor force. The odds ratio for CVD incidence within the first year of retirement was 1.55 (95% CI: 1.03, 2.33). From the second year post-retirement and thereafter, the retired had marginally elevated risk of CVD compared to those still working (OR = 1.35; 95% CI: 0.96, 1.91). Although confidence intervals were wide for some sub-groups, there were no significant interactions by sex or socioeconomic status. Results suggest that CVD risk is increased after retirement.     

Health insurance and retirement behavior: evidence from the health and retirement survey

This paper studies the role of health insurance in the retirement decisions of older workers. As policymakers consider mechanisms for how to increase access to affordable health insurance for the near elderly, considerations of the potential labor force implications of such policies will be important to consider--potentially inducing retirements just at a time when the labor force is shrinking. Using data from the 1992 and 1996 waves of the Health and Retirement Survey, this study demonstrates that access to post-retirement health insurance has a large effect on retirement. Among older male workers, those with retiree health benefit offers are 68% more likely to retire (and those with non-employment based insurance are 44% more likely to retire) than their counterparts who would lose employment-based health insurance upon retirement. In addition, the study demonstrated that in retirement models, when retiree health benefits are controlled for, the effects of pension coverage are reduced, suggesting that these effects may have been overestimated in the prior literature.     

Mental health expenditure in England: a spatial panel approach

We empirically investigate the determinants of local authority mental health expenditure in England. We adopt a reduced form demand and supply model, extended to incorporate possible interaction among authorities, as well as unobserved heterogeneity. The model is estimated using an annual panel dataset that allows us to explore both time-series and cross-municipality variation in mental health expenditure. Results are consistent with some degree of interdependence between neighbouring municipalities in spending decisions. This first attempt to apply spatial panels in investigating health expenditure offers insights and raises new questions.     

A longitudinal analysis of mental health mobility in Britain

This paper is concerned with quantifying the level of mental health mobility in the British Household Panel Survey (BHPS). We investigate whether the extent of intertemporal fluctuations in mental health is different across categories of socio-economic group such as income quintiles, educational attainment and social class. Our measure of mental health is the 12-item version of the General Health Questionnaire (GHQ) that serves as a self-administered screening test aimed at detecting psychiatric disorders. Using 11 waves of the BHPS and a variety of methods we show there is much mobility in mental health from one wave to the next. Further the extent of mobility varies across socio-economic categories with greatest persistence observed in more disadvantaged groups. In general, these groups suffer poorer mental health and experience more periods of ill-health. Our results have implications for the design of appropriate prevention policies targeting mental illness within different risk groups, and also for the measurement of long-term inequalities in mental health across socioeconomic groups.     

Perceived health as a predictor of early retirement

OBJECTIVES: This study examined the association between perceived health and early retirement. METHODS: A cohort of 1748 men aged 42 to 60 years from eastern Finland was followed from 1984 to 2000. At baseline, the participants had answered a questionnaire regarding their general (as measured by physician diagnoses) and perceived health status. Comprehensive pension records were obtained from the Social Insurance Institution of Finland and the Central Pension Security Institute. The risk of disability pensioning in various disease categories and nonillness-based early pensioning was analyzed using Cox regression modeling. RESULTS: Over 11 years, 855 (48.9%) men received a disability pension, and 331 (18.9%) received a nonillness-based early pension. Only 273 (15.6%) received an old age pension, without previous early pensioning. At the end of the follow-up, 289 (16.5%) were still working. After adjustment for potential confounders, men with poor perceived health at baseline had a relative risk of 2.37 [95% confidence interval (95% CI) 1.79-3.13] for disability pensioning and the highest risk of disability was due to mental illness (RR 3.84, 95% CI 1.86-7.92), followed by musculoskeletal disorders and cardiovascular diseases. The relative risk of receiving a nonillness-based pension was 2.94 (95% CI 1.92-4.50) for this group. CONCLUSIONS: Self-assessed poor health is a strong predictor of early retirement due to mental disorders, musculoskeletal disorders, and cardiovascular diseases. Moreover, the risk of retirement on a nonillness-based pension is increased among those with poor perceived health.     

Wage policy in the health care sector: a panel data analysis of nurses' labour supply

Shortage of nurses is a problem in several countries. It is an unsettled question whether increasing wages constitute a viable policy for extracting more labour supply from nurses. In this paper we use a unique matched panel data set of Norwegian nurses covering the period 1993-1998 to estimate wage elasticities. The data set includes detailed information on 19,638 individuals over 6 years totalling 69,122 observations. The estimated wage elasticity after controlling for individual heterogeneity, sample selection and instrumenting for possible endogeneity is 0.21. Individual and institutional features are statistically significant and important for working hours. Contractual arrangements as represented by shift work are also important for hours of work, and omitting information about this common phenomenon will underestimate the wage effect.     

Issues and opportunities in public health informatics: a panel discussion.

A panel was convened at the American Medical Informatics Association Spring Congress to discuss issues and opportunities that arise when informatics methods, theories, and applications are applied to public health functions. Panelists provided examples of applications that connect efforts between public health and clinical care, emphasizing the need for integration of clinical data with public health data and the analysis of those data to support surveillance and informed decision making. Benefits to be gained by both medical informatics and public health at the interface were evident; both encounter the same major issues including privacy, systems integration, standards, and many more.     

Health outcomes following retirement: a comparative study of health and non-health pensioners in Ghana

Journal of Public Health - Occupation is a major determinant of health outcomes. Healthcare workers are assumed to know how to prevent diseases and live a healthy life. The aim of this study is to...     

Psychosocial working characteristics before retirement and depressive symptoms across the retirement transition: a longitudinal latent class analysis

Objectives:Retirement is a major life transition. However, previous evidence on its mental health effects has been inconclusive. Whether retirement is desirable or not may depend on pre-retirement work characteristics. We investigated trajectories of depressive symptoms across retirement and how a number of psychosocial working characteristics influenced these trajectories.Methods:We included 1735 respondents from the Swedish Longitudinal Occupational Survey of Health (SLOSH), retiring during 2008–2016 (mean retirement age 66 years). They had completed biennial questionnaires reporting job demands, decision authority, workplace social support, efforts, rewards, procedural justice and depressive symptoms. We applied group-based trajectory modelling to model trajectories of depressive symptoms across retirement. Multinomial logistic regression analyses estimated the associations between ­psychosocial working characteristics and depressive symptom trajectories.Results:We identified five depression trajectories. In four of them, depressive symptoms decreased slightly around retirement. In one, the symptom level was initially high, then decreased markedly across retirement. Perceptions of job demands, job strain, workplace social support, rewards, effort–reward imbalance and procedural justice were associated with the trajectories, while perceptions of decision authority and work efforts were only partly related to the trajectories.Conclusions:We observed a rather positive development of depressive symptoms across retirement in a sample of Swedish retirees. For a small group with poor psychosocial working characteristics, symptoms clearly decreased, which may indicate that a relief from poor working characteristics is associated with an improvement for some retirees. However, for other retirees poor working characteristics were associated with persistent symptoms, suggesting a long-term effect of these work stressors.     

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.     

Social policies and the pathways to inequalities in health: a comparative analysis of lone mothers in Britain and Sweden

The aim of this study is to contribute to the emerging field of health inequalities impact assessment. It develops further a conceptual framework that encompasses the policy context as well as the pathways leading from social position to inequalities in health. It then uses this framework for a comparative analysis of social policies and their points of potential impact on the pathways leading from lone motherhood to ill health in Britain and Sweden. The British General Household Survey and the Swedish Survey of Living Conditions are analysed for the 17 years from 1979 to 1995/96. First, the results show that the health of lone mothers is poor in Sweden as well as in Britain and, most notably, that the magnitude of the differential between lone and couple mothers is of a similar order in Sweden as in Britain. This is despite the more favourable social policies in Sweden, which our results indicate have protected lone mothers from poverty and insecurity in the labour market to a much greater degree than the equivalent British policies over the 1980s and 1990s. Second, the pathways leading to the observed health disadvantage of lone mothers appear to be very different in the two countries in relation to the identified policy entry points. Overall, in Britain, around 50% of the health disadvantage of lone mothers is accounted for by the mediating factors of poverty and joblessness, whereas in Sweden these factors only account for between 3% and 13% of the health gap. The final section discusses the implications of the findings for future policy intervention and research in the two countries.     

Class and health: comparing Britain and Sweden

The questions addressed in this article are two, namely are class differences in health apparent in Sweden in the same manner as was shown for Britain in the Black Report? and is it possible to learn anything new about inequality patterns in different stages of life from analyses of self-reported morbidity data? By analysing data on long-standing illness by the means of logistic regression, it is shown that the risk of falling ill is distributed in very similar ways in the two countries, although the dispersion of these risk factors seems to be greater in Britain. In an analysis of acute sickness this result is not obtained, which is assumed to be an effect of differences in answering patterns. For Sweden, it is shown that social classes do not differ much in terms of health among the young. Instead, inequalities in health seem to be established at first in middle age.     

Employment transitions and mental health: an analysis from the British household panel survey

STUDY OBJECTIVE: To describe the impact of changes between employment and various forms of non-employment, and vice versa, on the psychological wellbeing of men and of women. DESIGN: Separate multivariate models for men and for women were constructed to study the association between employment transitions and episodes of psychological distress (general health questionnaire). PARTICIPANTS: 13,359 employment transitions from 5092 people aged 16-74 years in the British household panel survey from 1991 to 1998. MAIN RESULTS: Transitions from paid employment to either unemployment or long term sick leave were associated with increased psychological distress for both men and women. Starting maternity leave or staying home to look after the family were also associated with psychological distress for women. Transitions from these roles to formal employment resulted in an improvement in mental health. There was some evidence that the effects were felt most strongly within six months of the transition. CONCLUSIONS: This paper provides further evidence that movements between paid employment and various forms of non-employment, in addition to unemployment, have an impact on mental health. The emphasis on transitions between a full range of employment states for both men and women from a large population based longitudinal study and a comparison of the relative magnitude of effects are unique features of this analysis. Interventions are suggested to minimise the psychological distress associated with transitions.     

Employer-sponsored health insurance for early retirees: impacts on retirement,health, and health care

The proportion of large employers offering retiree health insurance in the US has declined by half in the past 20 years. This paper examines the potential implications of this change by estimating the effects of a retiree health insurance (RHI) offer on a comprehensive set of labor, health and health care use outcomes in the near-elderly population. An RHI offer increases the probability of early retirement by 37% for both men and women. While the results suggest that an RHI offer has little, if any, effect on health, there is strong evidence that RHI provides significant protection from high out-of-pocket medical costs. In the top 40% of the out-of-pocket spending distribution, those with an offer of retiree coverage spend 22% less on average. Estimates of the value of RHI of over $4,000 per year suggest that increasing opportunities for the near-elderly to purchase coverage at actuarially-fair prices through the individual market or public programs could significantly increase insurance coverage and reduce financial risk for this age group.