Interview conducted by April Cashin-Garbutt, BA Hons (Cantab)
What percentage of people retire due to ill health?
In our study population, which was drawn from NSW Australia only, the proportion of working aged men who were fully retired due to ill-health in cities is five percent, eight percent for inner regional areas and nine for outer regional areas.
For fully retired working aged women the percentages were four percent for the city, five percent for inner regional and six percent for outer regional areas.
On a national level in Australia, the 2010-11 Multipurpose Household Survey (MPHS) showed that among both retired men and women aged 45, the second most commonly reported main reason for quitting work was 'own sickness, injury or disability' (26% of men and 21% of women). (Source : ABS 6238.0 - Retirement and Retirement Intentions, Australia, July 2010 to June 2011)
Your recent research looked into retirement due to ill health in people living in regional areas compared to those living in cities. How did this research originate?
There are inequities between rural and urban areas in Australia such as access to health care, increased injuries, risk factors and mortality. Unemployment rates are also higher in rural areas and recent research has shown that the rural unemployed have higher psychological stress levels and disability.
We therefore wanted to know if there is also a difference between rural and urban areas in terms of retirement reasons due to ill-health as this is important for future policy work and rural health reform.
The University Centre for Rural Health’s program of work integrates research around rural health reform and we aim to improve the health in our communities.
What did your research involve?
The study analysed self-reported data of 21,719 women and 16,393 men from the Sax Institute's 45 and Up Study of people aged 45 to 65 living in New South Wales, Australia. The study was set up as a long-term collaborative resource to examine healthy ageing, including retirement.
Participants aged between 45 and 65 were asked about their work status, retirement status and reasons for retirement. Participants were also asked about common health problems and other health related and socio-demographic issues.
How did your research take into account other factors that may influence retirement choice?
We used a technique called multinomial logistic regression to investigate the associations of health problems and geographical location with partial and full retirement due to ill-health or other reasons.
We adjusted the results for marital status, education and age. All variables were put in the models simultaneously.
There are of course other factors that impact on why people retire early for health reasons such as the work environment but in this research we focussed specifically on the health factors.
What were the main findings of your research?
28% of women and 26% of men aged between 45 and 65 were fully or partially retired.
Women who reported ever having been told by a doctor that they had cancer (other than skin cancer or breast cancer), stroke, thrombosis, anxiety, depression, osteoarthritis or osteoporosis were more likely to be fully retired than to be working, when compared to women without these health problems.
Women who reported ever having been told by a doctor that they had breast cancer or depression or who had been treated for osteoarthritis were more likely to be partially retired than to be working, when compared to women without these health problems.
Compared to men who were not retired, men who reported having the following health problems were more likely to be fully retired for health reasons than those without the health problems: cancers (excluding melanoma, skin and prostate cancer), heart disease, stroke, diabetes, anxiety, depression, thyroid problems, osteoarthritis and osteoporosis.
Being partially retired was associated with the following health problems: cancer (excluding melanoma, skin and prostate cancer), heart disease, anxiety and depression.
Compared to the city, women and men living in inner regional areas were more likely to be fully retired due to ill-health but they were not more likely to be partially retired due to ill-health.
Both men and women from outer regional and remote areas were more likely to be fully retired due to ill-health. Men from outer regional and remote areas were also more likely to be partially retired due to ill-health, whereas we did not find this association amongst women.
What impact do you think this research will have?
It will mainly stimulate debate about health in rural and regional areas and the need to develop initiatives on how we can reduce early retirement due to ill-health in regional areas.
It will contribute to rural health care reform by alerting people that not only is their inequity in terms of health-related outcomes but also in terms of early retirement due to ill-health.
How do you think early retirement due to ill health could be reduced?
Retirement is influenced by a multitude of factors other than health such as labour market conditions, financial retirement incentives, and working conditions and these factors interact with health. The solution is multifactorial because of its complexity but much can be done.
Partnerships between private industry and government is crucial on both federal, state and local council level. Additionally, people need to become entrepreneurs of their own career so they can manage their health and work throughout their career. I will just give some examples of what can be done.
In the Netherlands, the government has promoted the concept of “work ability” and “sustainable employability” since early 2000. Sustainable employability refers to a person’s ability to gain or maintain quality work throughout their working lives, whilst maintaining good health and wellbeing and having the opportunity and the right work context to be able to transfer skills, knowledge and competencies to another job, company or other future roles.
As the Dutch realised, government must act as a catalyst to overcome potential resistance from employers to implement sustainable employability practices and demonstrate it pays financial dividends.
In 2012, their latest project was called “Sustainable employability’. Their goal is to put the theme high on the agenda for both employers and employees and to stimulate and facilitate this in the workplace. The Department helps employers and employees by making it easier for them to share current knowledge and practical experiences in the area of sustainable employment.
A hundred small and large employers from different industries who are all frontrunners in the area of sustainable employability came together and were asked what they do, what works well and what is the return on investment? The 100 employers identified five key success factors that they invest in:
organization of work
development (education and mobility)
periodically measuring the sustainable employability of current staff.
Australia and other countries could take similar initiatives.
On a more practical level and organisation level, there are also many free resources available from national organisations that look at specific health problems, such as www.beyondblue.org.au for depression in Australia, that assist employers and occupational health and safety officers to tackle health problems in the work place. These resources need to be promoted more widely. A one-stop shop resource centre would be useful to assist employers in this area.
From a research point of view, more evidence based high-quality research is required to determine the effectiveness of different interventions on sustainable employability in the workplace. I would be keen to see more randomised controlled trials in this area and that more health-related intervention studies include sustainable employability measures as an outcome rather than only measuring quality of life and other health-related outcome measures.
In summary, I believe periodic measurement and consequent action planning and implementation on both national, organisational and individual level will lead to sustainable employability and therefore a healthier nation that will be fit for the future.
Are there any plans in place to achieve this?
There are several academic groups looking at improving the work environment and how we can best re-design work and improve sustainable employability in different industries and more randomised controlled trials are starting to include sustainable employability measures.
In 2012, the Australian Government has set up an Advisory Panel on Positive Ageing and, for example, one of its objectives is “to conduct consultation with key stakeholders, in particular the business community, on ways that the Government and community can increase the economic and social participation of senior Australians”.
I hope that this will assist in action plans so we can reduce retirement due to ill-health. The government has also indicated that there are also plans to develop a Positive Ageing website and integrated information services.
I would also like to advocate that we develop a National Sustainable Employability Survey and measure these trends on a population level over time so we can measure whether we improve sustainable employability as a country overtime. We need to measure it to manage it.
Countries like Austria and Finland have done much work in this area. I also believe that the Sustainable Employability Survey should be conducted among formal and informal volunteers and carers as they form an important part of our invisible workforce.
Is delaying retirement always in the best interest of those suffering illness and their employers?
Not always. There is debate about whether prolonging working lives is of benefit to all older people and how we prolong working lives?
On one hand, the benefit of working longer for older people has been recognised for individuals in terms of improved health, social connectedness and income and for governments in terms of increased tax revenue and GDP and less reliance on pensions.
On the other hand, prolonged working lives may also negatively impact the wellbeing of older workers if the work is not quality work, involuntary, unskilled or manual labour. There is the danger of a new type of poor working class that will have to continue to work under poor circumstances and risk social exclusion in our society.
Low quality work can increase poor health if the work environment and circumstances are not conducive to good health so it may not always be in the best of interest of those suffering illness both from a physical and psychological point of view. If workers are suffering illness, this can lead to poor productivity, absenteeism and presenteeism in the workplace.
It is important to measure and improve sustainable employability amongst workers so we can ensure a healthy, skilled, happy and sustainable rural workforce. A happy, healthy, engaged workforce means a productive workforce and less absenteeism and turnover.
Where can readers find more information?
The paper and information on the 45 And Up study can be found on:
Other related full-text papers that can be downloaded for free are:
Some systematic reviews on work ability and sustainable employability models to measure sustainable employability:
I welcome collaborations with researchers, businesses and organisations to measure and improve sustainable employability on national level and within the workplace. Please contact me directly via Sabrina.firstname.lastname@example.org.
About Dr Sabrina Pit
Dr Pit is the Workforce Research Stream Leader at the University Centre for Rural Health, University of Sydney, Lismore, Australia. She is also a Gen X migrant, entrepreneur, investor, mother of three children, Director of Experience Plus Consulting and Founder of Work Wiser International and Migrants Plus More.
She has a PhD in Health Behaviour (University of Newcastle), a Master of Science Degree in Household & Consumer Sciences (The Netherlands) and finished her Diploma in Occupational Health and Safety (RMIT University) in 2012.
Sabrina Pit has over 20 years experience in public health research to improve the quality of life of older people. She has experience in complex data analysis, longitudinal data analysis, randomized controlled trials, and mixed methods.
During her Ph.D. work, she conducted an NHMRC-funded cluster-randomized controlled trial which improved the use of medicines and reduced falls among older people through changing GPs behavior.
In 2008, she was awarded a 4-year postdoctoral NHMRC part-time research training fellowship to continue her research in ageing well and productively by exploring pathways to healthy workforce participation
Currently, she is investigating how to prolong general practitioners and nurses working life in a healthy and happy manner. Among her research areas are work ability, productivity, sustainable employability, absenteeism, medicines use, healthy ageing, quality of life, rural health, preventative health, and health promotion.
She believes in improving intergenerational communication through training. Her world vision is to create thousands of healthy and happy workplaces to increase sustainable employability and prolong working lives and to learn from the wisdom of our elders and migrants to make our world a better place and encouraging others to do the same.