Elsevier

Health & Place

Volume 16, Issue 5, September 2010, Pages 1014-1021
Health & Place

Worklessness and regional differences in the social gradient in general health: Evidence from the 2001 English census

https://doi.org/10.1016/j.healthplace.2010.06.006Get rights and content

Abstract

Background

There has been much focus on separating contextual and compositional influences on social inequalities in health. However, there has been less focus on the important role of place in shaping the distribution of risk factors. Spatial variations in worklessness are one such factor. In this paper, then we examine the extent to which between and within regional differences in the social gradient in self-rated general health are associated with differences in rates of worklessness.

Methods

Data were obtained for men and women of working age (25–59) who had ever worked from the Sample of Anonymised Records (Individual SAR)—a 3% representative sample of the 2001 English Census (349,699 women and 349,181 men). Generalised linear models were used to calculate region and age adjusted prevalence difference for not good health by education (as an indicator of socio-economic status) and employment status. The slope index of an inequality was also calculated for each region.

Results

For both men and women, educational inequalities in worklessness and not good health are largest in those regions with the highest overall levels of worklessness. Adjusting for worklessness considerably attenuated the educational health gradient within all English regions (by over 60%) and virtually eliminated between region differences.

Discussion

Macroeconomic policies, which influence the demand for labour, may have an important role in creating inequalities in general health of the working age population both within and between regions. Employment policy may therefore be one important approach to tackling spatial and socio-economic health inequalities.

Section snippets

Background

Worklessness is an important determinant of health with unemployment and other forms of economic inactivity (such as lone parenthood or long term sickness absence) being associated with an increased likelihood of morbidity and mortality (Bartley, 1994, Morris and Cook, 1994, Martikainen and Valkonen, 1996, Korpi, 2001, Rodriguez, 2001, Bartley and Plewis, 2002, Bartley and Ferrie, 2006). There is, for example, a well established literature on an individual and area level relationship between

Data and variables

The data set used in this study is the Individual Sample of Anonymised Records (Individual SAR); a 3% sample of the 2001 UK Census. The Samples of Anonymised Records scheme provides researchers with access to completely anonymised Census data to allow detailed micro level analysis. The Individual SAR was chosen for this study as it contained sufficiently detailed coding on employment status and socio-economic position. Full details on the Samples of Anonymised Records and the Individual SAR

Results

Overall 85.7% of men and 73.2% of women were employed in 2001 with regions of the north and London having the lowest levels (Table 1). There were also variations in employment by educational level within each region as illustrated in Fig. 1, Fig. 2 (with the age adjusted rates used given in Supplemental Table 1). For both men and women employment rates decline with lower education, but differences are largest in those regions with the lowest levels of employment. For example, the overall age

Discussion

In summary, the results suggest that for both men and women, differences in levels of worklessness play a significant role in educational inequalities in self-rated general health and in differences in the educational gradient between the regions of England. This extends the work of Arber (1987), who suggested an important role for employment status in understanding health inequalities in general health. It also extends previous work on inequalities in general health using the 2001 UK census

Conclusion

Health geography has focused on separating contextual and compositional influences on social inequalities in health. However, there has been less focus on the important role of place in shaping the distribution of risk factors (Tunstall et al., 2004). This paper is the first to examine regional variation in employment rates in England as an example of the role of place in shaping the distribution of social risks to health and of the social gradient in health. We have found that worklessness is

Acknowledgements

The 2001 SARs are provided through the Cathy Marsh Centre for Census and Survey Research (University of Manchester), with the support of the ESRC and JISC. All tables containing Census data, and the results of analysis, are reproduced with the permission of the Controller of Her Majesty's Stationery Office and the Queen's Printer for Scotland.

Contribution

CB had the original idea that both authors subsequently developed. FP conducted the analysis and CB drafted the paper. Both authors

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