Improving Disability
Employment Outcomes
Professor Anne Kavanagh
Melbourne School of Population and Global Health
University of Melbourne
Disability at Work Conference, 2017
@AKavanagh_melb

My background
• Public health research
• Social determinants of health and health
inequities
• Employment as a resource for health:
– Unemployment/Underemployment/Economic
inactivity
– Job quality
– Working arrangements (permanent, casual
etc.)
– Occupational class/skill level

ABS Survey of Disability and Carers 2015

Employment and disability
• Labour force participation (53% vs 83%)
Less likely to be in full-time employment
(27% vs 54%)
• More likely to be unemployed 10% vs 5%
• High levels of under-employment (24% of
men with disability vs 16% men without
disability (BMC Pub Health, 2016)
• Australia lower labour force participation
than most other OECD countries

UNCPRD: Article 27, clause 1b
• UNCRPD: Recognises the rights of people with
disability to work on an equal basis to others,
including (Article 27, clause 1b) to:
Protect the rights of persons with disabilities, on
an equal basis with others, to just and favourable
conditions of work, including equal opportunities
and equal remuneration for work of equal value,
safe and healthy working conditions, including
protection from harassment, and the redress of
grievances.

Disability and health
• Increased smoking, overweight/obesity
• Less physical activity
• Higher levels of diabetes and heart disease
• Poorer self-rated and mental health
• Less preventative health care
• High health service use
• Diabetes, CVD
• Lower personal wellbeing

Adult men’s health by disability status (Kavanagh
et al. BMC Public Health 2016)
• Reduced life satisfaction across all domains
of PWI:
– Standard of living
– Health
– Life achievements
– Relationships
– Safety
– Part of community
– Future security

Disability and health
• Emerging evidence poorer health of people
with disability partly due to disadvantaged
circumstances
• Employment is a key pathway to improving
the health and wellbeing of people with
disability
• Economic benefits of improving economic
participation likely underestimated because
do not take into account reduced health
costs

Disability, employment and health
• ARC LP 100200545. Gender, disadvantage
and the mental health of people with
disability. Kavanagh, Bentley, LaMontagne,
Baker, Beer, Mallet, Pate
• The Household Income and Labour
Dynamics of Australia (HILDA) survey.
– 2001 – to present
– About 18,000 participants, >=15 years

Employment status and mental health
0
10
20
30
40
50
60
Employment Unemployment Eco. Inactive
ScoreontheMentalComponent
Summary(MCS)oftheShortForm36
(SF-36)
Disability No disability

Results of the fixed effect regression model
Coefficient (95% CI)
0 (reference)
-1.85 (-2.96, -0.73)
-2.66 (-3.46, -1.86)
0 (reference)
-0.57 (-1.02, -0.12)
-0.34 (-0.64, -0.05)
DISABILITY
Employment
Unemployment
Economically inactive
NO DISABILITY
Employment
Unemployment
Economically inactive
0-3 0.5-2 -1.5 -1 -0.5 1-2.5-3.5
Note: Coefficients refer to a point change in the Mental Component Summary (MCS) of the
Short Form 36 (SF-36)
Regression results from fixed effects models, mental health associated
with labour force status among people with no disability and people with
disability

Employment arrangements

Occupational skill level

Job
demands
and
complexity
Job control
Job
security
Effort-
reward
imbalance
My job is complex and difficult
My job requires learning new skills
I use my skills in my current job
I have freedom to decide how I do work
I have a lot of say about what happens in
my job
I have freedom to decide when I do work
I have a secure future in my job
Company I work for will be in business
in 5yrs
I worry about the future of my job
I get paid fairly for the
things I do in my job
(fairness of pay)
Job quality and mental health,

Job quality and mental health

Job quality and mental health
• Elevated odds overall driven mainly by
low job security and perceived
unfairness of pay
• Perceived demands elevated particularly
for people working with psychological
impairments

How does employment influence the
effect of disability acquisition on
mental health?
Zoe Aitken, PhD in progress

EFFECT MODIFICATION RESULTS
Table 1. Linear regression coefficients representing average
difference in mental health scores between waves with disability
and waves with no disability, by categories of employment
Effect modifier: Coeff (95% CI) Interaction test
Employment/occupation
High skill -1.9 (-3.0, -0.9)
Medium skill -3.9 (-5.1, -2.7)
Low skill -6.4 (-7.8, -5.0)
Not in the labour force -3.7 (-4.5, -3.0)
Unemployed -4.4 (-7.9, -0.8) P<0.001

• To answer the question WHY people with disabilities
experience poor mental health outcomes?
• What are the pathways or mechanisms by which
disability acquisition leads to a deterioration in
mental health? Do employment and income
mediate the effect?
• Causal mediation analysis
MEDIATION

MEDIATION RESULTS
Table 6. Linear regression coefficients representing controlled direct
effect of disability acquisition on mental health score if employment
status or income were set to the average level among people without
disability
Coeff (95% CI) % reduction
Total causal effect -5.3 (-6.8, -3.7)
CDE employment -3.4 (-5.5, -1.4) 35%
CDE income -4.3 (-6.0, -2.7) 18%

Summary
• Descriptive information on employment characteristics:
– ↑ unemployment, underemployment, ’economic inactivity’
– ↑ low skill jobs and jobs with poor job quality (worse for people
with intellectual and psychosocial disability)
• Relationships between disability, employment and mental
health
– Low skill and poor quality jobs results in poorer mental health
– Being unemployed or economically inactive worse for mental
health of people with disability than people without
– Having low skill level jobs or unemployed at time acquire a
disability is worse for mental health than if in high or medium skill
jobs
– Employment ‘explains’ 35% of deterioration in mental health
following acquisition of disability in adulthood

Papers from ARC LP 100200545
1. LaMontagne AD, Krnjacki L , Milner A, Butterworth P, Kavanagh A. Psychosocial job quality : A comparison of
persons working with versus without disability. Soc Sci Medicine – Pop Health. 2016; 2; 175-181.
2. Kavanagh A, Zoe Aitken, Eric Emerson, Sash Sahabandu, Allison Milner, Rebecca Bentley, Anthony D.
LaMontagne, Jane Pirkis and David Studdert. Inequalities in socio-economic and health and wellbeing of men with
and without disabilities BMC Public Health 2016, 16(Suppl 3):1042. doi 10.1186/s12889-016-3700-y
3. Milner A, Krnjacki L, Butterworth P, Kavanagh A, LaMontagne AD. Does disability status modify the association
between psychosocial job quality and mental health. 2015 Soc Sci Med Nov; 144:104-11.
4. Kavanagh AM, Aitken Z, Krnjacki L, LaMontagne AD, Bentley R, Milner A. Mental health following acquisition of
disability in adulthood—the impact of wealth. PLoS One. 2015 Oct 7;10(10):e0139708.
5. Milner, Allison, Aitken, Zoe, Krnjacki, Lauren, Bentley, Rebecca, Blakely, Tony, LaMontagne, Anthony D. and
Kavanagh, Anne 2015, Perceived fairness of pay among people with and without disabilities: a propensity score
matched analysis of working Australians, Scand J Work Enviroment Hlth, vol. 41, no. 5, pp. 451-459
6. Mitthen J, Aitken Z, Ziersch A, Kavanagh AM. Inequalities in social capital and health between people with and
without disabilities. Social Science and Medicine 2015, Feb 2015; 126: 26-35. doi:10.1016/j.socscimed.2014.12.009.
Kavanagh AM, Krnjacki L, Aitken Z, LaMontagne A, Beer A, Baker E, Bentley R. Intersections between disability,
type of impairment, gender and socio-economic disadvantage in a nationally representative sample of 33,101
working-aged Australians. Disabil Health J. 2015 Apr;8(2):191-9. doi: 10.1016/j.dhjo.2014.08.008.
7. Milner A, LaMontagne T, Aitken Z, Bentley R, Kavanagh AM. Employment status and mental lamong persons with
and without a disability: evidence from an Australian cohort study, J Epidemiol Comm Hth, 2014; 68: 1064-1071.
8. Kavanagh AM, Krnjacki L, Beer A, LaMontagne AD, Bentley R. Time trends in socio-economic inequalities for
women and men with disabilities in Australia, International J Equity Health, 2013, 12(1): 73.
9. Aitken Z, Simpson J, Bentley R, Kavanagh A. Disability acquisition and mental health: an analysis of excess mental
health inequalities according to demographic and socioeconomic characteristics BMJ Open (accepted)
10. Aitken Z, Baker E, Mason K, Badland H, Bentley R, Beer A, Kavanagh A. Precariously placed: Housing
affordability, quality and satisfaction of Australians with disabilities. Disability and Society (under review)
11. Kavanagh AM, Aitken Z, Baker E, LaMontagne AD, Milner A, Bentley R. Housing tenure and affordability and
mental health following disability acquisition in adulthood. Social Science and Medicine. 2016 Feb, Vol 151: 225-32

Implications and future work
• Health returns if improve employment outcomes of
people with disability:
– Attaining and maintaining employment incl. when
disability is acquired at working-age
– Aspire for high job quality and abolition of under-
employment
• Employment services are the major government
investment in facilitating employment outcomes for
people with disability
• Most research has focused on services and employers
not job seekers and none focus on health costs/benefits

IDES Research
Project
Improving Disability Employment
Study
Professor Anne Kavanagh

Aim to provide evidence on how people with
disability obtain and sustain long-term
employment
Main aims:
1. Jobseekers’ aspirations and expectations of employment
services and workplaces
2. Individual and service-related characteristics supporting
jobseekers in gaining and maintaining employment
3. The characteristics of workplaces, jobs and employment
services that contribute to sustained and meaningful
employment
Aims
Melbourne School of Population and Global Health
Centre for Health Equity

• Aim to recruit 2,500 jobseekers with a
disability aged 18 years or older
• Jobseekers with a disability attending Job
Active (mainstream) or a Disability
Employment Services (DES) provider
• Identified by employment service providers’
front-line staff
• Recruiting from Queensland, NSW, Victoria
and Western Australia (city suburbs, outer
suburbs, regional and rural)
Recruitment
Melbourne School of Population and Global Health
Centre for Health Equity

• Eight employment service providers
throughout Australia, who are Linkage
Partner organisations, have agreed to recruit
participants
• Frontline staff will:
– Explain study
– Gain consent from clients to pass on details
– Social Research Centre (SRC) will contact
participants and conduct data collection
Recruitment
Melbourne School of Population and Global Health
Centre for Health Equity

• Three waves of planned data collection
• Participants to complete three surveys over
18-months
• Online or phone interview
Design
Melbourne School of Population and Global Health
Centre for Health Equity
Wave 1
Wave 6 months later
Wave 12 months
later

• Developed by the Chief and Partner Investigators on
the project
• Some questions from routine Australian population
based surveys (e.g. ABS surveys, HILDA)
• Domains include:
Questionnaire
Melbourne School of Population and Global Health
Centre for Health Equity
– Demographic information
– Details of disability
– Employment history
– Prior experiences of employment
and training
– Access to social and economic
resources
– Characteristics & experiences of
jobs
– Aspirations regarding employment
– Expectations of employment
services
– Personal wellbeing and quality of
life

• Identify ways to improve employment
outcomes for people with disabilities incl.
services, workplace characteristics, job seeker
aspirations etc.
• Contribute to new government policies and
models of service delivery
Expected outcomes
Melbourne School of Population and Global Health
Centre for Health Equity

If you’re interested in being involved and think
you may be able to help with recruitment,
please contact the Project Coordinator:
Stefanie Dimov
(03) 9035 4554
stefanie.dimov@unimelb.edu.au
www.ides-study.org.au
Want to be involved?
Melbourne School of Population and Global Health
Centre for Health Equity

Project Investigators
University of Melbourne: Prof. Anne Kavanagh, Dr Allison Milner, Dr Cathy
Vaughan, A/Prof Rebecca Bentley
Deakin University: Prof Tony LaMontagne
Australian National University: Dr Anne Nevile3, 1, 1
Partner Investigators
Kerrie Langford (National Disability Services), Peter Defteros (Jobs Australia), Rick
Kane (Disability Employment Australia), Jessica Zammit (AFDO), Chrisa
Majorbanks (PWDA)
Partner Organisations
Ostara Australia, National Disability Services, Matchworks/Karingal, Jobs
Australia, Efocus, Personnel Group, Nova Employment, Australian Federation of
Disability Organisations, Wise Employment, Disability Employment Australia
Funding
Australian Research Council Linkage grant + partners
Melbourne School of Population and Global Health
Centre for Health Equity

If you’re interested in being involved and think
you may be able to help with recruitment,
please contact the Project Coordinator:
Stefanie Dimov
(03) 9035 4554
stefanie.dimov@unimelb.edu.au
www.ides-study.org.au
Want to be involved?
Melbourne School of Population and Global Health
Centre for Health Equity