Curnock Esther, Leyland Alastair H, Popham Frank
MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, UK.
MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, UK.
Soc Sci Med. 2016 Aug;162:1-10. doi: 10.1016/j.socscimed.2016.05.042. Epub 2016 May 29.
Employment status has a dynamic relationship with health and disability. There has been a striking increase in the working age population receiving out-of-work disability benefits in many countries, including the UK. In response, recent UK welfare reforms have tightened eligibility criteria and introduced new conditions for benefit receipt linked to participation in return-to-work activities. Positive and negative impacts have been suggested but there is a lack of high quality evidence of the health impact when those receiving disability benefits move towards labour market participation. Using four waves of the UK's Understanding Society panel survey (2009-2013) three different types of employment and welfare transition were analysed in order to identify their impact on health. A difference-in-difference approach was used to compare change between treatment and control groups in mental and physical health using the SF-12. To strengthen causal inference, sensitivity checks for common trends used pre-baseline data and propensity score matching. Transitions from disability benefits to employment (n = 124) were associated on average with an improvement in the SF12 mental health score of 5.94 points (95% CI = 3.52-8.36), and an improvement in the physical health score of 2.83 points (95% CI = 0.85-4.81) compared with those remaining on disability benefits (n = 1545). Transitions to unemployed status (n = 153) were associated with a significant improvement in mental health (3.14, 95% CI = 1.17-5.11) but not physical health. No health differences were detected for those who moved on to the new out-of-work disability benefit. It remains rare for disability benefit recipients to return to the labour market, but our results indicate that for those that do, such transitions may improve health, particularly mental health. Understanding the mechanisms behind this relationship will be important for informing policies to ensure both work and welfare are 'good for health' for this group.
就业状况与健康及残疾存在动态关系。在包括英国在内的许多国家，领取非在职残疾福利的劳动年龄人口显著增加。作为回应，英国近期的福利改革收紧了资格标准，并引入了与参与重返工作活动相关的福利领取新条件。虽然已有人提出了积极和消极影响，但在领取残疾福利者转向劳动力市场参与时，缺乏关于其对健康影响的高质量证据。利用英国理解社会小组调查的四个阶段（2009 - 2013年），分析了三种不同类型的就业和福利转变，以确定它们对健康的影响。采用差异中的差异方法，使用SF - 12量表比较治疗组和对照组在心理健康和身体健康方面的变化。为加强因果推断，使用基线前数据和倾向得分匹配对共同趋势进行敏感性检查。与仍领取残疾福利的人（n = 1545）相比，从残疾福利转向就业的人（n = 124），其SF12心理健康得分平均提高5.94分（95%置信区间 = 3.52 - 8.36），身体健康得分提高2.83分（95%置信区间 = 0.85 - 4.81）。转向失业状态的人（n = 153）心理健康有显著改善（3.14，95%置信区间 = 1.17 - 5.11），但身体健康没有改善。转向新的非在职残疾福利的人未发现健康差异。残疾福利领取者重返劳动力市场的情况仍然很少见，但我们的结果表明，对于那些确实重返劳动力市场的人来说，这种转变可能改善健康，尤其是心理健康。了解这种关系背后的机制对于制定政策以确保工作和福利对这一群体都“有益健康”至关重要。
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