The relationship between self reported health, levels of economic activity and mortality: an analysis using the ONS-LS

Dermot O'Reilly, Michael Rosato and Sheelah Connolly, Queen's University, Belfast

[Project number 30083]

Self-reported morbidity measures are used widely within the UK to assess 'need' and guide resource allocation. However, their subjectivity is sometimes regarded as a potential weakness: levels of self-reported health are thought to reflect not only underlying variation in 'true' health status but also both variation in health expectation and the propensity to report health problems (especially in relation to underlying structural conditions pertaining over the whole society). This study is exploring the relationship between levels of long-term unemployment, permanent sickness and the reporting and recording of health (limiting long-term illness, general health) in the census.

Beatty et al found the four-fold increase in numbers of incapacity benefits claimants in Great Britain over the last twenty years difficult to reconcile with the sustained improvement in more objective measures of health during this period. He suggested it was due to a diversion of some less healthy individuals from unemployment benefits into sickness-related benefits during prolonged periods of high unemployment, producing a large cadre of working age people who (because defined as chronically sick or incapacitated) are classified as economically inactive and not counted in unemployment statistics. This group has been called the 'hidden unemployed'. They suggest this is particularly marked for men in manual occupations, getting towards the end of their working lives and living in areas characterised by the presence of a declining heavy industrial or manufacturing base. While Beatty et al stress that this shift to sickness-related benefits occurs without changes in the actual levels of ill-health, it is possible that one effect of this process may be to increase and distort the levels of ill-health recorded in surveys, especially those from government (such as the census) - that being defined as 'permanently sick' for occupational purposes will increase the likelihood of the respondent stating their health as poor in the census. This suggests that in areas characterized by high levels of unemployment there will be many people defining their health as poor who might not have done so had they remained in employment. In turn, this means that the relationship between self-reported morbidity and subsequent mortality should vary significantly across the country and especially for different subgroups of socio-economic activity. This study will be exploring variation in the relationship between self-assessed morbidity (general health and limiting long-term illness) and mortality across both different levels of economic activity and the regions of England and Wales.

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