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Associations between labour market expenditures and self-rated health: A pooled multi-level analysis of 20 European countries

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Associations between labour market expenditures and self-rated health: A pooled multi-level analysis of 20 European countries, by Jongnam Hwang, Edwin Ng, Patricia O’Campo and Carles Muntaner. Presented at the 7th European Public Health Conference: "Mind the gap: Reducing inequalities in health and health care". Glasgow, 20th to 22nd November 2014.

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Associations between labour market expenditures and self-rated health: A pooled multi-level analysis of 20 European countries

  1. 1. Associations between labour market expenditures and self-rated health: A pooled multi-level analysis of 20 European countries Jongnam Hwang1, Edwin Ng1, Patricia O’Campo1,2, Carles Muntaner3 1Centre for Research on Inner City Health, St. Michael’s Hospital, Toronto, Canada 2Dalla Lana School of Public Health, University of Toronto, Toronto, Canada 3Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
  2. 2. Background  Existing studies find that the relationship between unemployment and poor health varies across different welfare states (Bambra & Eikemo, 2008).  Attempts to explain inter-regime differences infer that levels of social protection might have a moderating effect.  Labour market interventions are important forms of social protection that protect workers, promote employment, and stimulate efficient labour markets.  More work is needed to examine the health effects of labour market interventions. Source: Bambra, C., & Eikemo, T. (2008). Welfare state regimes, unemployment and health: a comparative study of the relationship between unemployment and self-reported health in 23 European countries. JECH.
  3. 3. Labour market expenditures  Active labour market policy expenditures : help unemployed people back to work • Job placement services, benefit administration and labour market programmes (i.e.,training, job creation)  Passive labour market policy expenditures : provide financial assistance • Unemployment compensation, early retirement for labour market reasons
  4. 4. Research questions 1. Do labour market expenditures affect self-rated health? If so, how - through active measures that support unemployed workers to return back to work or passive measures that provide financial assistance? 2. Do labour market expenditures affect the self-rated health of men and women differently?
  5. 5. Data source and methods  Data source • European Social Survey (ESS) rounds 2 (2004) and 4 (2008) • Organisation for Economic Co-operation Development (OECD) statistics • World Bank Statistics  Methods • A pooled sampled cross sectional design • Multi-level analysis  A total of 20 countries were selected  Working-aged respondents, 15-64 (n=42,542) were included
  6. 6. Countries by welfare regime typology Scandinavian Anglo-Saxon Bismarckian Eastern Southern Denmark United Kingdom Austria Czech Republic Italy Finland Ireland Belgium Hungary Portugal Norway France Poland Spain Sweden Germany Slovenia Luxembourg Netherlands Switzerland
  7. 7. Variables definition  Dependent variable • Individual self-rated health (Excellent/very good/good vs. Fair/bad)  Macro level independent variables • Active labour market policy expenditures (% of GDP) • Passive labour market policy expenditures (% of GDP)
  8. 8. Results  Active expenditures by gender Model1 Men Women OR (95% CI) p-value OR (95% CI) p-value 0.48(0.30-0.77) <0.01* 0.53(0.31-0.88) 0.02 Model2* Men Women OR (95% CI) p-value OR (95% CI) p-value 0.49(0.26-0.89) 0.02 0.60(0.35-1.05) 0.07 *Individual factors (age, education, employment status) and macro –social factors (welfare regimes, GDP growth and GDP per capita) included
  9. 9. Results  Passive expenditures by gender Model3 Men Women OR (95% CI) p-value OR (95% CI) p-value 0.73(0.54-0.98) 0.04 0.78(0.57-1.08) 0.13 Model 4* Men Women OR (95% CI) p-value OR (95% CI) p-value 0.76(0.53-1.10) 0.15 0.78(0.57-1.08) 0.14 *Individual factors (age, education, employment status) and macro –social factors (welfare regimes, GDP growth and GDP per capita) included
  10. 10. Results  Active expenditures are associated with less likelihood of bad self-rated health in men, but not in women in the fully adjusted model.  Passive expenditures are not associated with bad self-rated health in both men and women in the fully adjusted model.
  11. 11. Conclusions  As welfare regimes devote a larger share of their economy to active labour market policies, self-rated health tends to improve steeply.  Encouraging opportunities for unemployed workers to re-enter the workforce through active expenditures would likely improve population levels of self-rated health, especially in men.  Future work will consider cross-level interactions (i.e., educational levels and employment status).

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