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Health and
the older worker
Kevin P Balanda, PhD FFPH
Presentation to the “Living Longer – Working Longer?” Seminar.
Belfast, 10 November 2010
Institute of Public Health in Ireland
All-Ireland body:
North-South cooperation Inequalities in health Social determinants of health
Three work strands:
Capacity building Policy support Information & intelligence
www.publichealth.ie
Ageing population
Source: CARDI (2010)
Population prevalence of chronic conditions – RoI (2007)
Increasing life expectancy (age 65)
Source: CARDI (2010)
Some questions
1. “Big question”: Are people living longer, healthier lives or are we just extending the years spent with chronic illnesses and disabilities?
2. What are the factors driving the trend?
3. What is likely to happen in the future?
4. How should we respond/plan for this?
Health and the older worker
1. The big debate: prevention or treatment?
2. Those who are in paid work
3. Those who are not in paid work
4. Equity and fairness
5. The health and social care system
Life and health expectancies
1.Describe the temporal, demographic, geographical & socio-economic co-variation of • Life Expectancy (LE)• Disability Free Life Expectancy• Healthy Life Expectancy (HLE) on the island.
2.Highlight implications for older workers
Estimated expectancies (age 65) – 2005/2006
LE (65)
DFLE (65)
HLE (65)
2005 NI Male 16.7 7.4 12.8
2005 NI Female 19.7 9.2 14.7
2006 RoI Male 16.7 12.2 11.6
2006 RoI Female 19.9 14.8 13.7
Social inequalities in partial expectancies - males aged 65 NI 2005
NI 2005 Males Age 65-74 - 3 Nov 2010
9.38.9
8.7
8.1
7.2
6.2
5.5
4.13.6
2.0
3.0
4.0
5.0
6.0
7.0
8.0
9.0
10.0
Professional & managerial Skilled non-manual & manual Partly skilled & unskilled
Yea
rs
Male LE (65-74)
Male DFLE activity (65-74)
Male HLE (65-74)
SC (lowest:highest) ratios
----- 100% ------- 97% 74% 89% 94% 66% 76%
Trends in expectancies– males aged 65
N-S differences - Males - 2 Nov 2010
12.6
16.7
12.6 12.6
13.9
16.7
7.38.0
7.4
9.5
10.9
12.2
10.911.8
12.8
8.8
10.3
11.6
15.7
14.8
13.5 15.4
13.4
6.0
8.0
10.0
12.0
14.0
16.0
18.0
20.0
1981 1986 1991 1997 2001/02 2005/06Time
No. o
f yea
rs
NI Male LE (65)
RoI Male LE (65)
NI Male DFLEactivity (65)
RoI Male DFLEactivity (65)
NI Male HLE (65)
RoI Male HLE (65)
Trends in expectancies– females aged 65
16.5 16.217.5
8.2 8.19.2
11.6
13.713.3
18.817.4 18.4 19.7
18.8
15.817.0
19.9
14.813.9
10.7
12.5
14.7
12.0
0.0
5.0
10.0
15.0
20.0
25.0
1981 1986 1991 1997 2001/02 2005/06
Time
No
. of
year
s g
ain
ed
NI Female LE (65)
RoI Female LE(65)
NI Female DFLEactivity (65)
RoI Female DFLEactivity (65)
RoI Female HLE(65)
NI Female HLE(65)
Trends in social inequalities in (partial) health expectancies– males aged 65 NI
NI
0.94
0.74
0.66
0.76
0.890.93
0.73
0.79
0.73
0.5
0.6
0.7
0.8
0.9
1.0
1997 2001 2005
Time
Hea
lth e
xpec
tanc
y ra
tio
LifeexpectancyratioDFLE (activitylimitation) ratio
HLE1 ratio
(Lowest SC / Highest SC)
Trends in quality of older years: percentage of expected years that are disability free - age 65
73.374.6
44.0
47.0
71.167.9
66.3
74.1
51.149.7
44.4 43.0
30.0
35.0
40.0
45.0
50.0
55.0
60.0
65.0
70.0
75.0
80.0
1997 2001/02 2005/06
Years
Per
cen
tag
e
RoI Male (65)
RoI Female (65)
NI Male (65)
NI Female (65)
Social-class-specific trends in quality of older years: percentage of (partial) expected years that
are disability free – males aged 65 NI
69.7%
59.6%
45.5%
55.3%
41.7%
64.9%
49.6%49.2%
52.9%
30%
35%
40%
45%
50%
55%
60%
65%
70%
75%
1997 2001 2005
Time
Per
cen
tag
e
Professional & managerial
Skilled non-manual & manual
Partly skilled & unskilled
Trends in quality of older years: percentage of expected years that are in good health - age 65
62.9
61.2
76.7
74.7
69.1
66.8 68.9
66.7
73.975.3
65.2
70.9
50.0
55.0
60.0
65.0
70.0
75.0
80.0
1997 2001/02 2005/06
Years
Per
cen
tag
e
RoI Male (65)
RoI Female (65)
NI Male (65)
NI Female (65)
Social-class-specific trends in quality of older years: percentage of (partial) expected years
that are in good health –males aged 65 NI
79.4%
87.0%
80.6%
67.6%
71.0%
86.3%
71.3% 76.6%
70.9%
50%
55%
60%
65%
70%
75%
80%
85%
90%
1997 2001 2005
Time
Per
cen
tag
e
Professional& managerial
Skilled non-manual &manual
Partly skilled& unskilled
(Tentative) summary (age 65 years)• Males in lower SC-SEGs have lower life expectancies and health
expectancies.
• There is a social gradient in life expectancy and health expectancies in NI but they are unclear in RoI (possibly due to inconsistencies in coding).
• In NI; during 1997-2005 the inequalities in male LE(65) and male HLE(65) appear to have decreased and the inequality in male DFL(65) appears to have increased
• In RoI; during 1997-2006 the inequalities in male LE(65) and inequalities in male DFLE(65) appear to have increased; inequalities in male HLE(65) appears to have decreased.
(Tentative) summary (age 65 years)
Looking at disability;• There appears to have been an compression of morbidity in
females in NI and an extension of morbidity amongst males in NI (possibly due to relatively high levels of self-reported disability in NI).
• The extension of morbidity for males in NI seems to have occurred in all social classes in NI (greatest in the lowest SC). (Note: partial expectancy used)
Looking at self-rated health;• There appears to be a compression of morbidity amongst
males and females in NI. • The compression of morbidity seems to have been limited to
the middle social class in NI. (Note: partial expectancy used).
Concluding remarksImpact of work on health and health on work
Planning needs to take into account
– Impact on paid work
– Impact on unpaid work – Impact on retirement
Equity and fairness
Implications for health and social care system
Do we know enough to continue the debate?
– Fit-for-purpose information systems?
– Relevant research?
