1. 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

2. 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

3. 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

4. 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.

5. 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

6. 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)

7. Summary What 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.

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

9. 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

10. 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

11. 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

12. 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

13. Three examples: Current research that speaks to the relationship between labour market experiences and health

14. 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

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

16. Case Study 1 Prospective risk of decline in health status by position in occupational hierarchy

17. Case Study 1: Contribution of job control to social variations in coronary heart disease incidence 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 1997;350:235-239 Low Job Control High Employment Grade Intermediate Low 8% 27%78% Odds ratio for new CHD event in men

18. Case Study 1: Cumulative psychosocial work exposures and risk of all-cause mortality 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. Job Control Low High Hazard Rate for all-cause mortality, five year lag

19. Case Study 2 Does health in childhood influence success in the labour market in young adulthood?

20. 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)

21. 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

22. The Ontario Child Health Study Occupational Position Relative to Parents Higher than Parents30.4% Same as Parents15.0% Lower than Parents54.6% Educational Attainment Relative to Parents Higher than Parents57.0% Same as Parents26.1% Lower than Parents16.9%

23. Childhood Health/Behavioral Risk Factors for Downward Socioeconomic Mobility in Early Adulthood OccupationMalesFemalesTotal OR95% CIOR95% CIOR95% CI Downward1.070.59-1.941.140.47-2.771.110.69-1.81 Stable1.00 Upward0.520.26-1.050.660.25-1.730.530.31-0.94 EducationMalesFemalesTotal OR95% CIOR95% CIOR95% CI Downward1.911.11-3.271.470.56-3.851.961.23-3.10 Stable1.00 Upward0.610.36-1.040.420.20-0.880.510.33-0.78 Health/Behavioral risk factor: Hyperactivity

24. Socioeconomic health status inequalities in early adulthood Odds Ratios for poor health (good, fair or poor health status)

25. Case Study 3 Are ‘income shocks’ (income instability or sudden changes in income) a risk factor for decline in health status?

26. Case Study 3: Income dynamics and adult mortality in the United States, 1972- 1989 McDonough P, Duncan GJ, Williams D, House J. Income dynamics and adult mortality in the United States, 1972-1989. American Journal of Public Health 1997;87:1476-1483. Adjusted odds ratios for all-cause mortality, ages 45-64, 1972-1989 Income dynamicPercentOR95% CI <$20K and one or more drops 4%3.732.41-5.70 <$20K and no drops 10%3.352.22-5.06 $20-$70K and one or more drops 6%3.211.90-5.47 $20-$70K and no drops 57%1.471.05-2.04 >$70K and one or more drops 2%1.400.67-2.55 >$70K and no drops 21%1.00