-
SPIDA, June 7, 2004
Making sense to policy-making:Some research examples from the
intersection of labour market policy and health policy
Cam Mustard, ScDProfessor, Department of Public Health
SciencesUniversity of Toronto Faculty of MedicinePresident &
Senior ScientistInstitute for Work & Health
-
Summary of the presentation
Context: a description of the Institute for Work &
HealthConsider some of the features of research contribution to
policy-makingSummarize three examples of current research that
speak to the relationship between labour market experiences and
health
-
Context: a description of the Institute for Work &
Health
Independently incorporated, non-statutory, not-for profit
corporationEstablished in 1990 (part of the WCB Medical
Rehabilitation Strategy)Major contract funding from Workplace
Safety and Insurance BoardAdditional funding (approximately 20%)
from competitive research grants, private and public sector
contracts
-
What do we do?Core Businesses
Research:Apply state-of-the-art research methods, primary
evaluation of programs and outcomes. Provide a training ground for
research investigators.
Research Transfer:Develop and apply evidence-based research
transfer strategies to make knowledge accessible for application in
practice, planning and policy-making to defined audiences including
policy makers, workplace parties, and health care providers.
-
How are we governed?
Multipartite Board of Directors:Management, Labour, Health care,
Workplace Safety & Insurance Board, Academic leaders
Scientific Advisory Committee:International research leaders
Formally affiliated with:University of TorontoMcMaster
UniversityUniversity of WaterlooYork University
-
Who do we work with?Primary Stakeholders:Workplace Safety &
Insurance BoardWorkplace PartiesEmployersEmployees/labourInjured
personsPolicy-makersMinistries of Health, Labour and FinanceHuman
Resources Development CanadaHealth CanadaRehab & Health
Services Community
Other Stakeholders:Insurance Industry (auto; life;
disability)Academic Community (educators, researchers,
students)Community LeadersMedia (commercial and trade)
-
SummaryWhat makes the Institute for Work & Health
unique?Scientific standard of excellence (staff and students hold
numerous awards).
External sources of revenue.
Institutional arrangements with universities.
Active involvement in national research agencies and
international networks.
Strong working relationship with business, labour and health
care communities and the Workplace Safety & Insurance
Board.
-
Some features of policy-making and thoughts on the contribution
of research
-
The purposes of researchEnlightenmentResearch contributes new
ways of understandingInstrumentalResearch contributes to the
solution of an immediate policy requirementStrategic /
PoliticalResearch is used to justify ort defend a policy
decision
-
The nature of policy-makingPolitical elites negotiate to balance
often competing goals of powerful political or economics
interestsPolicy-making is usually about making a choice among
competing options of equivalent meritA preference for a policy
option over another will often will arise from additional
considerations at the margin
-
The nature of policy-making:An example of a consideration at the
marginLabour market policies balance macro-economic objectives with
social policy objectives: economic growth vs economic security of
the personLabour market policies will typically focus on employment
flexibility, skill training, geographic mobility and income
protectionWhile health may be a consequence of labour market
policies, it is rarely a direct objectiveHealth can therefore best
inform labour market policy development at the margin
-
The nature of policy-making:An example of a consideration at the
marginThe employment insurance illness benefitThis policy extends
benefit duration for claimants with health or functional
impairmentAcknowledges evidence that health deficits affect success
in job search and re-employmentSickness benefits in the EI program
in 2003 were $700M
-
Three examples:Current research that speaks tothe relationship
between labourmarket experiences and health
-
Each of the three research questions responds to two related
objectives: 1) the selection of a research design which has the
potential to contribute new or more robust knowledge of the
relationship between experiences in the labour market and the
health of labour force participants, and
2) the definition of a research question which integrates, at
least in part, an understanding of the current policy instruments
applied in labour market and health policy
-
Case Study 1The health effects of labour market experiences
relative toposition in the occupationalhierarchy
-
Case Study 1Prospective risk of decline in health status by
position in occupational hierarchy
-
Case Study 1:Contribution of job control to social variations in
coronary heart disease incidenceMarmot MG, Bosma H, Hemingway H,
Brunner E, Stansfeld S. Contribution of job control and other risk
factors to social variations in coronary heart disease incidence.
Lancet 1997;350:235-239Low Job ControlHighEmployment
GradeIntermediateLow8%27%78%Odds ratio for new CHD event in men
-
Case Study 1:Cumulative psychosocial work exposures and risk of
all-cause mortalityAmick B, McDonough P, Chang H, Rogers WH, Pieper
CF, Duncan G. Relationship Between All-Cause Mortality and
Cumulative Working Life Course Psychosocial and Physical Exposures
in the United States Labor Market from 1968 to 1992. Psychosomatic
Medicine 64, 370-381. 2002. Job ControlLowHighHazard Rate for
all-cause mortality, five year lag
-
Case Study 2Does health in childhood influence success in the
labour market in young adulthood?
-
Case Study 2:Childhood Health Status and Intergenerational
Socioeconomic Mobility
The unequal distribution of health status among adults relative
to socioeconomic position is understood to arise from two
processes:the effects of socioeconomic disadvantage on health
status (social causation), andthe effects of health status (both
current health and potentially health early in the lifecourse) on
socioeconomic status (health selection)
-
The Ontario Child Health Study
The effect of health status deficits in childhood and
adolescence on socioeconomic attainment in early adulthood is not
well described in Canada
Prior to completion of 2000 OCHS Follow-up, no Canadian studies
of representative samples of children followed to early adulthood
with childhood measures of health and function
-
The Ontario Child Health Study
Occupational Position Relative to ParentsHigher than
Parents30.4%Same as Parents15.0%Lower than Parents54.6%
Educational Attainment Relative to ParentsHigher than
Parents57.0%Same as Parents26.1%Lower than Parents16.9%
-
Childhood Health/Behavioral Risk Factors for Downward
Socioeconomic Mobility in Early AdulthoodHealth/Behavioral risk
factor: Hyperactivity
OccupationMalesFemalesTotalOR95% CIOR95% CIOR95%
CIDownward1.070.59-1.941.140.47-2.771.110.69-1.81Stable1.001.001.00Upward0.520.26-1.050.660.25-1.730.530.31-0.94
EducationMalesFemalesTotalOR95% CIOR95% CIOR95%
CIDownward1.911.11-3.271.470.56-3.851.961.23-3.10Stable1.001.001.00Upward0.610.36-1.040.420.20-0.880.510.33-0.78
-
Socioeconomic health status inequalities in early adulthoodOdds
Ratios for poor health (good, fair or poor health status)
Unadjusted
Adjusted
Occupation
OR
95% CI
OR
95% CI
Unskilled Worker
2.23
1.42-3.50
2.01
1.27-3.17
Semi-skilled worker
2.24
1.48-3.39
2.04
1.34-3.10
Skilled worker
1.34
0.85-2.11
1.25
0.79-1.97
Supervisor
1.49
0.88-2.50
1.36
0.80-2.30
Semi-professional
1.04
0.68-1.60
1.05
0.69-1.62
Professional, Mgmt
1.00
1.00
Education
No high school diploma
4.95
3.39-7.25
4.05
2.67-6.13
High school diploma
2.55
1.79-3.62
2.31
1.58-3.38
Some college
2.60
1.81-3.73
2.33
1.60-3.40
College completion
2.10
1.59-2.77
1.94
1.44-2.60
Some university
2.09
1.47-2.97
1.98
1.38-2.82
University completion
1.00
1.00
-
Case Study 3Are income shocks (income instability orsudden
changes in income) a risk factorfor decline in health status?
-
Case Study 3:Income dynamics and adult mortality in the United
States, 1972- 1989McDonough P, Duncan GJ, Williams D, House J.
Income dynamics and adult mortality in the United States,
1972-1989. American Journal of Public Health 1997;87:1476-1483.
Adjusted odds ratios for all-cause mortality, ages 45-64,
1972-1989
Income dynamicPercentOR95% CI$70K and no drops21%1.00
18