Levelling Up goals should be assessed through self-reported health measures

Links between an area’s health and employment figures are stronger when looking at self-rated health measures, compared with life expectancy or mortality indicators, finds a new study by UCL researchers.

The research, published in BMC Public Health, sought to evaluate which health indicator is most closely linked to labour market outcomes, such as not being in paid work, working hours (i.e. full-time or part-time) and economic inactivity (i.e. being unemployed, retired, sick or disabled).

Researchers also wanted to assess whether the associations are restricted to those over the age of 50.

The team used a representative sample of English and Welsh census data of 430,377 adults aged 16-74 from 2011 to analyse which measures of health-in-a-place were also associated with employment outcomes.

To do so, the researchers assessed seven criteria from local authority census and vital records data, including self-rated health (at 50-74 years), long-term illness (at 50-74 years), age-specific mortality rate (at 50-74 years), avoidable mortality, life expectancy (at birth and 65 years), disability-free life expectancy (at 50 years), and healthy life expectancy (at 50 years).

They also considered life expectancy at birth and infant mortality rate to determine if associations were limited to the health of those over the age of 50.

The results found that there were links between an area’s health and employment with all nine health indicators. However, the strongest association was seen in the self-rated health measures of general health and long-term illness.

For example, if the self-rated health measure was used, individuals who lived in the third unhealthiest local authorities were 60% more likely to be out of work than those who live in the healthiest areas. This dropped to 33% more likely if infant mortality rate was used as the population health measure.

Links were also apparent but varied depending on why respondents were economically inactive. Using the self-rated health measure, respondents had 164% higher odds of being sick or disabled, 104% higher odds of being unemployed, 50% higher odds of other inactivity (homemaker, student or other) and 35% higher odds of being retired than in paid employment if they lived in the third unhealthiest, compared to third healthiest, local authorities.

Consequently, researchers are calling for the government to take these factors into account in their Levelling Up policies - rather than relying purely on data about mortality.

Lead author, Dr Emily Murray (UCL Institute of Epidemiology & Health), said: "We recommend that the UK government change the measure used in their Levelling Up health goal from ’Healthy Life-Expectancy’ to a self-reported health measure.

"If ’Healthy Life Expectancy’ continues to be used, it should be with the understanding that it will display a slightly weaker association with employment outcomes."

Researchers also recommend that population health monitoring organisations, including local and national governments, include self-reported health measures in their data collection.

Dr Murray added: "Further work is needed to identify the mechanisms linking these two vitally important aspects of people’s lives: population health and employment.

"If these findings reflect true causal associations, strategies to improve geographic inequalities in labour markets may be most effective if targeted toward local areas with high levels of poor health."