INEQUALITIES IN

WORK AND HEALTH

Suzan Robroek
Department of Public Health
Erasmus University Medical Center

14 Jan 2022
KEY MESSAGES
1. How to link working life to life expectancy?
 large inequalities in life expectancy
 large inequalities in working life expectancy

2. How do work, lifestyle, and health influence paid employment?

 a good health is important to enter and stay in paid employment
 good working conditions and a healthy lifestyle matter!

3. What are the challenges in the near future?

 effectve interventions needed:
no magical solution
one size does not fit all
OUR RESEARCH

• It is a societal challenge to enable persons to work longer in good health.

This is in particular the case for vulnerable groups, such as workers with a
lower socioeconomic position or with health problems.

• With high quality research using state of the art methods we explore:
(1) The impact of work on health and vice versa
(2) Socioeconomic inequalities in participation in paid employment
(3) Determinants of sustainable employability
(4) The effectiveness of interventions and policy to enhance sustainable
employability and re-integration to work
 WE LIVE LONGER (MEN)
Life expectancy at birth, male (years)

Data from World Bank 5

 WE LIVE LONGER (WOMEN)
Life expectancy at birth, female (years)

Data from World Bank 6

BUT SOME ARE BETTER OFF THAN OTHERS (NL)

Years in good Years in poor health

health

50 years

Elementary school

Lower vocational education

Intermediate education

Higher education

Average number of years in Average life expectancy

good health

Data from Volksgezondheid Toekomstverkenning 7

 WE WORK LONGER (NL)
Average retirement age in years

Data from Statistics Netherlands 8

 INCREASING RETIREMENT AGE

NL:
• Statutory retirement age + 0.8 months for every 1 year
increase in life expectancy:
• 65 years in 2018, 66 years and 7 months in 2022

Indonesia:
• Statutory retirement age + 1 year every 3 calendar years:
• 56 years in 2018, 58 years in 2022, increasing to 65 years 2043?

9
THE OLDER EMPLOYEE?
Score work ability index (7-49 years)

Age in years

Data from Blik op Werk

 THE OLDER EMPLOYEE? LARGE
VARIATION!
Score work ability index (7-49 years)

Age in years

Data from Preventned

SOCIOECONOMIC INEQUALITIES IN
PARTICIPATION IN PAID EMPLOYMENT (M)
Participation in paid employment (%)

Schram J et al, BMJ Open 2019; 9: e024823.

SOCIOECONOMIC INEQUALITIES IN
PARTICIPATION IN PAID EMPLOYMENT (F)
Participation in paid employment (%)

Schram J et al, BMJ Open 2019; 9: e024823.

WORKING YEARS LOST (NL)

Robroek et al. Scand J Work Environ Health 2020;46:77-84.

TAKE HOME MESSAGES 1:

 large inequalities in life expectancy

 large variation in work ability across age
 large inequalities in working life expectancy
2. HOW DO WORK, LIFESTYLE & HEALTH INFLUENCE PAID EMPLOYMENT?

16
THE IMPACT OF WORK ON HEALTH
AND VICE VERSA: 2 MECHANISMS

selection
Health Paid employment

causation
HEALTH PROBLEMS PLAY AN IMPORTANT ROLE IN PREMATURE
DISPLACEMENT FROM PAID EMPLOYMENT
7,00

6,00

5,00
less than good health
Odds Ratio

chronic disease
4,00
depressive symptoms
mobility problems
3,00

2,00

1,00
unemployed retired homemaker disabled
Work status

Relative probability of displacement from the labour market during 2 year

follow-up 2004 to 2006 in the SHARE study
[Van den Berg et al. Occup Environ Med 2010;67:845-52]
WORK-RELATED FACTORS AND SICKNESS
ABSENCEEMPLOYABILITY

Leijten FRM. Scand J Work Environ Health 2013; 39:477-485

INFLUENCE OF WORK, LIFESTYLE AND HEALTH
HEALTH, LIFESTYLE, WORK AND EDUCATIONAL INEQUALITIES IN EXIT FROM
PAID EMPLOYMENT

Contribution to educational differences in labor participation

work unemployment (early)
disability retirement
Poor self-perceived health 36 - 40% 9 - 12% 0 - 3%
Unhealthy behaviour 31 - 54% 21 - 36% 14%
Working conditions 12 - 30% 2 - 6% 0%

Robroek et al. PLOsOne 2015;10;e0134867

TAKE HOME MESSAGES 2:

 a good health is important to enter and stay in paid

employment
 good working conditions and a healthy lifestyle matter!
 3. WHAT ARE THE CHALLENGES IN THE NEAR
FUTURE?

What to do ?
REDUCING SOCIOECONOMIC INEQUALITIES: WHAT KIND OF INTERVENTIONS?

Backholer et al. Am J Public Health 2014;104:e43-50.

BEHAVIOUR CHANGE INTERVENTIONS

Robroek S et al. Obes Rev 2020; 21:e13101.

PREVENTIVE MEDICAL EXAMINATION

Health risk and work ability assessment

Anonymized group report Individual report

Additional assessment in
case of unfavourable
outcomes

Action plan Action plan

WHAT TO INTERVENE ON?

Guided discussion within organizations:

• Prevalence (how common is the risk factor)
• Strength of relationship with employability
• To what extent is risk factor modifiable
NOT ONE MAGICAL SOLUTION

• Small effects
• Collaboration between human resources and occupational
health needed
• Focus on both individual and organisational level

28
3. WHAT ARE THE CHALLENGES IN THE NEAR
FUTURE?
The cost-effectiveness of interventions on work participation
 understand what will work for whom and when
(populations, context)

How to create an inclusive labour market for workers with

health problems
 evaluation of national policy, best practices in
organisations and specific interventions
THANK YOU FOR
YOUR ATTENTION!

Contact:
Suzan Robroek
Department of Public Health
Erasmus MC
S.Robroek@erasmusmc.nl
https://www.publichealthrotterdam.com/