SPIDA, June 7, 2004

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SPIDA, June 7, 2004 Making sense to
policy-making Some research examples from the
intersection of labour market policy and health
policy Cam Mustard, ScD Professor, Department of
Public Health Sciences University of Toronto
Faculty of Medicine President Senior
Scientist Institute for Work Health
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• Summary of the presentation
• Context a description of the Institute for Work
  Health
• Consider some of the features of research
  contribution to policy-making
• Summarize three examples of current research that
  speak to the relationship between labour market
  experiences and health

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• Context a description of the
• Institute for Work Health

• Independently incorporated, non-statutory,
  not-for profit corporation
• Established in 1990 (part of the WCB Medical
• Rehabilitation Strategy)
• Major contract funding from Workplace Safety and
  Insurance Board
• Additional funding (approximately 20) from
  competitive research grants, private and public
  sector contracts

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What do we do?Core Businesses

• Research
• Apply state-of-the-art research methods,
  primary evaluation of programs and outcomes.
  Provide a training ground for research
  investigators.
• Research Transfer
• Develop and apply evidence-based research
  transfer strategies to make knowledge accessible
  for application in practice, planning and
  policy-making to defined audiences including
  policy makers, workplace parties, and health care
  providers.

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• How are we governed?
• Multipartite Board of Directors
• Management, Labour, Health care, Workplace Safety
  Insurance Board, Academic leaders
• Scientific Advisory Committee
• International research leaders
• Formally affiliated with
• University of Toronto
• McMaster University
• University of Waterloo
• York University

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Who do we work with?

• Primary Stakeholders
• Workplace Safety Insurance Board
• Workplace Parties
• Employers
• Employees/labour
• Injured persons
• Policy-makers
• Ministries of Health, Labour and Finance
• Human Resources Development Canada
• Health Canada
• Rehab Health Services Community
• Other Stakeholders
• Insurance Industry (auto life disability)
• Academic Community (educators, researchers,
  students)
• Community Leaders
• Media (commercial and trade)

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SummaryWhat makes the Institute for Work
Health unique?

1. Scientific standard of excellence (staff and
   students hold numerous awards).
2. External sources of revenue.
3. Institutional arrangements with universities.
4. Active involvement in national research agencies
   and international networks.
5. Strong working relationship with business, labour
   and health care communities and the Workplace
   Safety Insurance Board.

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• Some features of policy-making
• and thoughts on the
• contribution of research

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• The purposes of research

• Enlightenment
• Research contributes new ways of understanding
• Instrumental
• Research contributes to the solution of an
  immediate policy requirement
• Strategic / Political
• Research is used to justify ort defend a policy
  decision

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• The nature of policy-making

• Political elites negotiate to balance often
  competing goals of powerful political or
  economics interests
• Policy-making is usually about making a choice
  among competing options of equivalent merit
• A preference for a policy option over another
  will often will arise from additional
  considerations at the margin

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• The nature of policy-making
• An example of a consideration
• at the margin

• Labour market policies balance macro-economic
  objectives with social policy objectives
  economic growth vs economic security of the
  person
• Labour market policies will typically focus on
  employment flexibility, skill training,
  geographic mobility and income protection
• While health may be a consequence of labour
  market policies, it is rarely a direct objective
• Health can therefore best inform labour market
  policy development at the margin

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• The nature of policy-making
• An example of a consideration
• at the margin

• The employment insurance illness benefit
• This policy extends benefit duration for
  claimants with health or functional impairment
• Acknowledges evidence that health deficits affect
  success in job search and re-employment
• Sickness benefits in the EI program in 2003 were
  700M

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• Three examples
• Current research that speaks to
• the relationship between labour
• market experiences and health

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• Each of the three research questions responds to
• two related objectives
• 1) the selection of a research design which has
  the potential to contribute new or more robust
  knowledge of the relationship between experiences
  in the labour market and the health of labour
  force participants, and
• 2) the definition of a research question which
  integrates, at least in part, an understanding of
  the current policy instruments applied in labour
  market and health policy

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• Case Study 1
• The health effects of labour
• market experiences relative to
• position in the occupational
• hierarchy

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Case Study 1Prospective risk of decline in
health status by position in occupational
hierarchy
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Case Study 1 Contribution of job control to
social variations in coronary heart disease
incidence
Odds ratio for new CHD event in men
Low Job Control
27
78
8
High
Intermediate
Low
Employment Grade
Marmot MG, Bosma H, Hemingway H, Brunner E,
Stansfeld S. Contribution of job control and
other risk factors to social variations in
coronary heart disease incidence. Lancet
1997350235-239
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Case Study 1Cumulative psychosocial work
exposures and risk of all-cause mortality
Hazard Rate for all-cause mortality, five year lag
Low
High
Job Control
Amick B, McDonough P, Chang H, Rogers WH, Pieper
CF, Duncan G. Relationship Between All-Cause
Mortality and Cumulative Working Life Course
Psychosocial and Physical Exposures in the United
States Labor Market from 1968 to 1992.
Psychosomatic Medicine 64, 370-381. 2002.
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• Case Study 2
• Does health in childhood influence
• success in the labour market in young
• adulthood?

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• Case Study 2
• Childhood Health Status and
• Intergenerational Socioeconomic Mobility
• The unequal distribution of health status among
  adults
• relative to socioeconomic position is understood
  to
• arise from two processes
• the effects of socioeconomic disadvantage on
  health status (social causation), and
• the effects of health status (both current health
  and potentially health early in the lifecourse)
  on socioeconomic status (health selection)

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The Ontario Child Health Study The effect of
health status deficits in childhood and
adolescence on socioeconomic attainment in
early adulthood is not well described in
Canada Prior to completion of 2000 OCHS
Follow-up, no Canadian studies of representative
samples of children followed to early adulthood
with childhood measures of health and function
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The Ontario Child Health Study
Occupational Position Relative to Parents
Higher than Parents 30.4
Same as Parents 15.0
Lower than Parents 54.6

Educational Attainment Relative to Parents
Higher than Parents 57.0
Same as Parents 26.1
Lower than Parents 16.9


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Childhood Health/Behavioral Risk Factors for
Downward Socioeconomic Mobility in Early Adulthood
Occupation Males Females Total
OR 95 CI OR 95 CI OR 95 CI
Downward 1.07 0.59-1.94 1.14 0.47-2.77 1.11 0.69-1.81
Stable 1.00 1.00 1.00
Upward 0.52 0.26-1.05 0.66 0.25-1.73 0.53 0.31-0.94

Education Males Females Total
OR 95 CI OR 95 CI OR 95 CI
Downward 1.91 1.11-3.27 1.47 0.56-3.85 1.96 1.23-3.10
Stable 1.00 1.00 1.00
Upward 0.61 0.36-1.04 0.42 0.20-0.88 0.51 0.33-0.78

Health/Behavioral risk factor Hyperactivity
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Socioeconomic health status inequalities in early
adulthood Odds Ratios for poor health (good, fair
or poor health status)
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• Case Study 3
• Are income shocks (income instability or
• sudden changes in income) a risk factor
• for decline in health status?

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Case Study 3Income dynamics and adult mortality
in the United States, 1972- 1989
Adjusted odds ratios for all-cause mortality,
ages 45-64, 1972-1989
Income dynamic Percent OR 95 CI
lt20K and one or more drops 4 3.73 2.41-5.70
lt20K and no drops 10 3.35 2.22-5.06
20-70K and one or more drops 6 3.21 1.90-5.47
20-70K and no drops 57 1.47 1.05-2.04
gt70K and one or more drops 2 1.40 0.67-2.55
gt70K and no drops 21 1.00
McDonough P, Duncan GJ, Williams D, House J.
Income dynamics and adult mortality in the United
States, 1972-1989. American Journal of Public
Health 1997871476-1483.