Measuring progress towards healthy working lives
Authors: Jenny Head, Martin Hyde
Journal: The Lancet Public Health (2020)

In the UK we are witnessing two trends; on the one hand, increases in State Pension age and an expectation for people to work until later in life.1Department for Work and PensionsFuller working lives: a partnership approach.https://www.gov.uk/government/publications/fuller-working-lives-a-partnership-approachDate: Feb 2, 2017Date accessed: June 5, 2020Google Scholar On the other hand, increases in life expectancy appear to be slowing or even reversing, which might be partly due to widening health inequalities.2Marmot M Allen J Boyce T Goldblatt P Morrison J Health equity in England: the Marmot Review 10 years on. Institute of Health Equity, London2020Google Scholar Together, these trends raise the question of whether it is fair or feasible for everyone to work for longer. People with poorer health are more likely to permanently exit the labour market at younger ages than people in good health, and studies have observed socioeconomic inequalities in healthy life expectancy3Head J Chungkham HS Hyde M et al.Socioeconomic differences in healthy and disease-free life expectancy between ages 50 and 75: a multi-cohort study.Eur J Public Health. 2019; 29: 267-272Crossref PubMed Scopus (22) Google Scholar and rates of health-related retirement.4Carr E Fleischmann M Goldberg M et al.Occupational and educational inequalities in exit from employment at older ages: evidence from seven prospective cohorts.OccupEnviron Med. 2018; 75: 369-377Google Scholar One population indicator that has been used to monitor extending working lives is working life expectancy, the expected number of years that people spend in paid employment. This indicator has advantages over measures such as average retirement age as it can take into account possible returns to work. This measure is important as increasingly people go through a gradual transition to complete retirement.5Platts LG Corna LM Worts D Mcdonough P Price D Glaser K Returns to work after retirement: a prospective study of unretirement in the United Kingdom.Ageing Soc. 2019; 39: 439-464Crossref Scopus (25) Google Scholar Another indicator that has been proposed but for which far less research exists6Parker M Bucknall M Jagger C Wilkie R Extending working lives: a systematic review of healthy working life expectancy at age 50.Soc Indic Res. 2020; (published online Feb 28.)DOI:10.1007/s11205-020-02302-1Crossref Scopus (13) Google Scholar is healthy working life expectancy, the expected number of years spent in work with good health.7Lievre A Jusot F Barnay T et al.Healthy working life expectancies at age 50 in Europe: a new indicator.J Nutr Health Aging. 2007; 11: 508-514PubMed Google Scholar In The Lancet Public Health, Marty Parker and colleagues8Parker M Bucknall M Jagger C Wilkie R Population-based estimates of healthy working life expectancy in England at age 50 years: analysis of data from the English Longitudinal Study of Ageing.Lancet Public Health. 2020; 5: e395-e403Summary Full Text Full Text PDF PubMed Scopus (37) Google Scholar estimated healthy working life expectancy at age 50 years in England and examined inequalities in this indicator of healthy working life by sex, educational attainment, deprivation level, occupation type, and region. The authors used data from waves 1 to 6 (2002–3 to 2012–13) of the English Longitudinal Study of Ageing, a nationally representative sample of adults aged 50 years and older in England. They defined good health as having no limiting long-standing illness. Their estimate of healthy working life expectancy at age 50 years was 9·42 years; in other words, on average an individual living in England aged 50 years can expect to spend just over 9 years in paid employment and without limiting long standing illness. The average healthy working life expectancy was 10·94 years for men and 8·25 years for women. The authors found inequalities in healthy working life expectancy by area-level deprivation, such that individuals from the most deprived quintile could expect 3·73 fewer years of healthy working life beyond the age of 50 years than those from the most affluent quintile (healthy working life expectancy of 6·80 years for the most deprived quintile vs 10·53 years for the least deprived quintile). There were also inequalities by level of educational attainment, occupation type, and region. The authors used data on limiting long-standing illness, a health indicator that has been validated across different settings and countries. Interestingly, the authors obtained similar results in a sensitivity analysis based on self-assessed health (healthy working life expectancy was 9·63 years with self-assessed health compared with 9·42 years for limiting long-standing illness). Strengths of this study include the application of multi-state modelling methods based on longitudinal data from a nationally representative survey in England. A considerable proportion of the older working population is known to drop out of the labour market before reaching the State Pension age. Parker and colleagues make a novel and important contribution to this evidence by providing the first estimates of healthy working life expectancy for England. Their findings highlight that, at the time of the study, healthy working life expectancy for men was well below the 15 years between age 50 years and the State Pension age (65 years for men throughout the study period; 60 years for women until 2011). Although their data were for the period before the increase in the State Pension age, their findings make an important contribution to the debate around the practicalities and desirability of extending working lives. These findings are also highly relevant to the UK Government's stated goals to increase healthy life expectancy for all by 5 years and to reduce inequalities in health in later life. Further research is now needed to inform policy to promote both healthy lives and sustainable working lives. As the authors note, combining health and work into healthy working life expectancy poses challenges in terms of disentangling the relationship between work and health. As well as poor health being related to work outcomes, it is well known that work influences health. Thus, future research should consider both working life expectancy and the combined healthy working life expectancy. Although working conditions have been shown to predict healthy life years,9Magnusson Hanson LL Westerlund H Chungkham HS et al.Job strain and loss of healthy life years between ages 50 and 75 by sex and occupational position: analyses of 64 934 individuals from four prospective cohort studies.Occup Environ Med. 2018; 75: 486-493Crossref PubMed Scopus (22) Google Scholar there is limited evidence about how they affect working life expectancy and healthy working life expectancy. One of the challenges facing research, policy, and practice in this area is an absence of occupational specificity. In this study the authors categorised respondents according to whether they were self-employed or working in manual or non-manual jobs. To be able to develop policies to support workers across the occupational spectrum there is a need for more focused studies with different occupational groups. Future research should also investigate the impact of the life course, as other studies have shown life course factors such as earlier work and family histories have a substantial impact on both employment status and health in later life.10Wahrendorf M Previous employment histories and quality of life in older ages: sequence analyses using SHARELIFE.Ageing Soc. 2015; 35: 1928-1959Crossref Scopus (46) Google Scholar Finally, the authors also point to the north–south divide in their research, reflecting findings from many other studies of regional inequalities in the UK. Going forward, it will be important to monitor the impact of major events such as the ongoing COVID-19 pandemic and Brexit on regional economies and how these events could in turn affect health and employment for older adults. We declare no competing interests. Population-based estimates of healthy working life expectancy in England at age 50 years: analysis of data from the English Longitudinal Study of AgeingHealthy working life expectancy at age 50 years in England is below the remaining years to State Pension age. Older workers of lower socioeconomic status and in particular regions in England might benefit from proactive approaches to improve health, workplace environments, and job opportunities to improve their healthy working life expectancy. Continued monitoring of healthy working life expectancy would provide further examination of the success of such approaches and that of policies to extend working lives. Full-Text PDF Open Access