THRIVE (Tackling Health Inequalities and Extending Working Lives)

Globally, many policymakers are facing challenges related to the demographic shift to older populations, increased life expectancy and the increased prevalence of ill health and disability. Less skilled workers have a shorter life expectancy, earlier onset of ill health, and are more likely to suffer from multiple health conditions (multi-morbidity) as they get older. Policymakers urgently need to develop strategies that account for these health inequalities when extending working lives.

The THRIVE project explored the effect of health inequalities on work opportunities for disabled and older workers, and the potential policy responses to this.  Our programme of research firstly investigated the changing pattern of inequalities and health challenges relevant to extending working lives in the study countries (UK, Canada, Sweden, Denmark), and secondly investigated potential policy approaches their impact, focusing on policies aiming to improve the employment of people with chronic illness and disabilities.

THRIVE was organised into 4 work packages:

1. International comparison of the changing pattern of longstanding illness, co-morbidity and caring across the life course, the employment consequences of this pattern and how this varies by SES, gender, country and cohort.
2. Comparative equity focused policy analysis to develop a typology and case studies of international policies.
3. Systematic reviews assessing the differential impact of policies to extend the working lives for older people with longstanding illness. We focus on the effects on the employment of older workers of changes to disability benefits.
4. Syntheses, scenario analysis, and policy implications. The findings from the other work packages were fed into this final work package and results disseminated to policy makers and other stakeholders.

International comparisons across Canada, Denmark, Sweden and the UK, demonstrate different approaches to tackling the challenge of an ageing population. The detailed comparison of the policy approaches can be found here:

Brief policy overviews for ‘Active Labour Market Policies’ and ‘Disability and Sickness Benefits’ can be found here:

Policy Brief on Active Labour Market Policies

Key Findings

First, the results from our studies demonstrate the effect of older age employment rates vary significantly by sex, educational status and health. Women, lower educated, and workers with both physical and mental health comorbidities are consistently shown to have lower employment rates at older ages. Multi-morbidity has increased over time even when accounting for the increasing age of the population –and the employment consequences of multimorbidity have deteriorated. Exit routes from the labour force vary by type of health condition.

The prevalence of reported mental health illness has increased in older age groups in recent years and the employment prospects of people with mental health problems have deteriorated. People with mental health problems seem to be more likely to become unemployed rather than leave the labour market all together, this is particularly true if they don’t also have comorbidities with other health conditions. This can mean they have to rely on more precarious social protection schemes rather than out of work disability benefits.

There are differences seen between the four comparator countries in employment rates for older workers, with the differing employment consequences of limiting illness explaining much of these differences. This implies that policies impact on extending working lives, but the demographic inequalities show that policies cannot be ‘one size fits all’; targeted and specific intervention will be required.

Many countries reforms have sought to increase employment incentives amongst older people by restricting access to disability benefits. However, these reforms do not appear to have increased the employment of people with disabilities. They have potentially shifted people off disability benefits and onto less secure benefits, increased risk of poverty and potential risk of mental health problems. Investment in labour market programmes does improve the employment of older people, but investment in education and training appears to have a greater impact on people with disabilities than those without potentially helping to reduce the disability employment gap.

The figure below shows how countries have approached this issue. The UK has focussed on restrictions to disability benefits, while Denmark has focussed on employer incentives:

The aim of THRIVE was to make evidence-based policy recommendations by combining the insights from our study countries and systematically examining research findings globally. Our findings highlight the importance of policies in extending working lives. Specific policies should be targeted to different demographic groups, and reforms to benefit systems should account for the limited employment effect and poverty risk of such reforms.

Funding

THRIVE is one of the projects of the Joint Programme Initiative More Years, Better Lives. The funders were The Innovation Fund Denmark (5194-00004B), the Swedish Research for Health, Working Life and Welfare (2015-01531), the UK Economic and Social Research Council (ES/N019261/1) and the Canadian Institutes of Health Research (EWL-14428).

Published papers

• McAllister A, Bentley L, Brønnum-Hansen H, Jensen NK, Nylen L, Andersen I, Liao Q, Bodin T, Mustard C, Burström B. Inequalities in employment rates among older men and women in Canada, Denmark, Sweden and the UK. BMC Public Health. 2019 Mar 18;19(1):319. doi: 10.1186/s12889-019-6594-7.
• Chen WH, 2019. Health and transitions into nonemployment and early retirement among older workers in Canada. Economics & Human Biology, 35, pp.193-206. doi: 10.1016/j.ehb.2019.06.001
• Jensen, N.K., Brønnum-Hansen, H., Andersen, I., Thielen, K., McAllister, A., Burström, B., Barr, B., Whitehead, M. and Diderichsen, F., 2019. Too sick to work, too healthy to qualify: a cross-country analysis of the effect of changes to disability benefits. Journal of Epidemiology Community Health, pp.717-722. doi: 10.1136/jech-2019-212191
• Philip McHale, Andy Pennington, Cameron Mustard, Quenby Mahood, Ingelise Andersen, Natasja Koitzsch Jensen, Bo Burström, Karsten Thielen, Lisa Harber-Aschan, Ashley McAllister, Margaret Whitehead, Ben Barr. What is the effect of changing eligibility criteria for disability benefits on employment? A systematic review and meta-analysis of evidence from OECD countries. PLoS One. 2020; 15(12): e0242976. Published online 2020 Dec 1. doi: 10.1371/journal.pone.0242976.
• McAllister A, Bodin T, Brønnum-Hansen H, Harber-Aschan L, Barr B, Bentley L, Liao Q, Koitzsch Jensen N, Andersen I, Chen WH, Thielen K, Mustard C, Diderichsen F, Whitehead M, Burström B. Inequalities in extending working lives beyond age 60 in Canada, Denmark, Sweden and England-By gender, level of education and health. PLoS One. 2020 Aug 17;15(8):e0234900. doi: 10.1371/journal.pone.0234900.
• Harber-Aschan L, Chen WH, McAllister A, Koitzsch Jensen N, Thielen K, Andersen I, Diderichsen F, Barr B, Burström B. The impact of longstanding illness and common mental disorder on competing employment exits routes in older working age: A longitudinal data-linkage study in Sweden. PLoS One. 2020 Feb 25;15(2):e0229221. doi: 10.1371/journal.pone.0229221.
• Chen, W., Bentley, L., Whitehead, M., McAllister, A., Barr, B. Poverty and Sources of Income Support Among Older People With Disabilities and Out of Work: Comparison of Canada and the United Kingdom. 2021. Journal of Social Policy, 1-21. doi:10.1017/S0047279421000209

Book chapter

• Barr B & McHale P. (2018). The rise and fall of income replacement disability benefit receipt in the United Kingdom: What are the consequences of reforms? in The Science and Politics of Work Disability Prevention (pp. 242-257).
• Barr B, McHale P, Whitehead M. (2020). Reducing inequalities in employment of people with disabilities in Handbook of Disability, Work and Health (pp 309-327). Springer.
• Diderichsen F. (2020). Investing in integrative active labour market policies in Handbook of Disability, Work and Health. Springer.

Conference presentations

• A McAllister, L Bentley, H Brønnum-Hansen, Q Liao, LL Nylen, C Mustard, B Burström. 2017. Social differentials in older persons’ employment in Canada, Denmark, Sweden and the UK in 2010-15. European Journal of Public Health, 27(suppl_3).
• L Bentley, Q Liao, B Barr, B, C Mustard. 2018. OP26 Temporal trends in multi-morbidity and how it impacts employment among older adults in Canada and England: understanding generational and social inequalities.
• Workshop: Organised by: University of Liverpool, UK and Chairpersons: Ben Barr, UK, Bo Burström, Sweden, 2018. 9. Q. Workshop: Tackling Health Inequalities in Extending Working Lives–Findings from the THRIVE Project. European Journal of Public Health, 28(suppl_4), pp.213-815.
• WH Chen, A McAllister, B Burström. 2018. The impact of comorbidity on employment exits at older working ages: a longitudinal analysis of a Swedish population sample. European Journal of Public Health, Volume 28, Issue suppl_4.
• L Bentley, B Barr. Poverty and income support among older people with disabilities and out of work in the UK and Canada. European Journal of Public Health, Volume 28, Issue suppl_4.
• B Barr. 2018. The policy effects on employment of older people with disabilities: a comparative analysis of Canada, Denmark, Sweden, and the UK. European Journal of Public Health, Volume 28, Issue suppl_4.
• NK Jensen, H Brønnum-Hansen, I Andersen, K Thielen, A McAllister. 2018. Too sick to work too healthy to qualify: a cross country comparison of the effect of changes to disability benefits. European Journal of Public Health, Volume 28, Issue suppl_4.