The relationship between health and employment status continually shows that individuals who work have lower levels of illness and higher self-reported health. This study examines how self-reported health and objective measures of health (multimorbidity and mental health problems) differ across employment status and occupations among adults of working age (25-65 years). In addition, the study examines how public health coverage – medical card and GP visit card (GPVC) – and private health coverage (PHI), and lack thereof, differ across occupations. Overall, individuals not in employment have much lower rates of self-reported health and higher rates of illness. In particular, mental health problems are three times higher among unemployed individuals across all age groups. Examining workers separately, differences in health status across occupations are small. However, rates of health coverage differ considerably across occupations. In general, occupations associated with poorer health status tend to have the highest percentages of workers without a medical card/GPVC or PHI. This affects workers’ ability to access lower cost or free healthcare, including for the purpose of certified sick leave. Read the full publication: https://www.esri.ie/publications/occupations-and-health

1. www.esri.ie
Occupations and Health
Budget Perspectives 2023
Date
10th June 2022
Presenters
Brendan Walsh
Karina Doorley

2. 2
Background
Relationship between health and work is nuanced
• Poor health can reduce employment or productivity
• Barriers and stigma may prevent people working
• Mental health problems in particular can impose large
earnings penalties
Less is known about health across workers
• Some jobs can have direct effects on health
• Injury, stress, shift work more common in some occupations
• Workers with different health status may select into different
jobs

3. 3
Questions and Data
Does subjective and objective health differ across workers,
non-workers, and workers with different occupations?
What about healthcare coverage?
Healthy Ireland Survey (2015-2020)
• 25,040 adults aged 25-65 years
• Self-reported health: “How is your health in general?”
• Multimorbidity: 2+ long-term health conditions
• Mental illness: “Any emotional, nervous or psychiatric
problems, such as depression or anxiety”
• Healthcare coverage: Medical Card, GPVC, PHI

4. 4
Workers have higher self-reported health
Source: See Figure 2.1 in “Self-reported health and multimorbidity”
65%
90%
50%
55%
60%
65%
70%
75%
80%
85%
90%
95%
100%
25 27 29 31 33 35 37 39 41 43 45 47 49 51 53 55 57 59 61 63 65
Age
Very Good or Good Self-Reported Health
Not Working Working
25pp difference

5. 5
Workers have lower morbidity rates
Source: See Figure 2.1 in “Self-reported health and multimorbidity”
25pp difference
28%
8%
0%
5%
10%
15%
20%
25%
30%
35%
40%
25 27 29 31 33 35 37 39 41 43 45 47 49 51 53 55 57 59 61 63 65
Age
Multimorbidity
Not Working Working
20pp difference

6. 6
Education gradient exists for non-workers
Source: See Figure 2.2 in “Self-reported health and multimorbidity”
60%
65%
70%
75%
80%
85%
90%
95%
100%
Age 25-34 Age 35-44 Age 45-54 Age 55-65
Very Good or Good Self-Reported Health
Good Health Working, Non-Degree Good Health Working, Degree

7. 7
Education gradient exists for non-workers
Source: See Figure 2.2 in “Self-reported health and multimorbidity”
60%
65%
70%
75%
80%
85%
90%
95%
100%
Age 25-34 Age 35-44 Age 45-54 Age 55-65
Very Good or Good Self-Reported Health
Good Health Not Working, Non-Degree Good Health Not Working, Degree
Good Health Working, Non-Degree Good Health Working, Degree
34pp

8. 8
Education gradient exists for non-workers
Source: See Figure 2.2 in “Self-reported health and multimorbidity”
0%
5%
10%
15%
20%
25%
30%
35%
40%
Age 25-34 Age 35-44 Age 45-54 Age 55-65
Multimorbidity
Multimorbidity Not Working, Non-Degree Multimorbidity Not Working, Degree
Multimorbidity Working, Non-Degree Multimorbidity Working, Degree
24pp

9. 9
Mental Illness higher in non-workers
Source: See Figure 3.1 in “Mental health”
19%
3%
0%
5%
10%
15%
20%
25%
25 27 29 31 33 35 37 39 41 43 45 47 49 51 53 55 57 59 61 63 65
Age
Anxiety/Depression
Not Working Working
16pp difference

10. 10
Education gradient exists for non-workers
Source: See Figure 3.2 in “Mental health”
0%
5%
10%
15%
20%
Age 25-34 Age 35-44 Age 45-54 Age 55-65
Anxiety/Depression
Anxiety/Depression Not Working, Non-Degree Anxiety/Depression Not Working, Degree
Anxiety/Depression Working, Non-Degree Anxiety/Depression Working, Degree
15pp difference

11. 11
Smalls differences in health across occupations
Source: See Figure 4.1 in “Health in workers”
0%
4%
8%
12%
16%
20%
Multimorbidity

12. 12
Larger differences for mental health across occupations
Source: See Figure 4.2 in “Health in workers”
0%
3%
6%
9%
12%
15%
Anxiety/Depression

13. 13
Healthcare coverage
Ireland lacks universal access to free public healthcare
Many workers have no public (Medical Card) or private
health insurance
• Coverage/costs can impact healthcare use for sick workers
• Workers may work when ill
• Spread illness (Covid-19), presenteeism, long-term health
Workers entitled to Illness Benefit
• New law likely to require 3 days sick leave for all workers

14. 14
Large difference in healthcare coverage
Source: See Figures 5.2 in “Healthcare coverage”
3% 3% 4% 4% 4% 5% 6% 8% 9% 11% 11% 11% 13% 15% 16% 19% 20% 20% 22% 22% 23% 25%
30% 31% 32% 34%
60%
6% 4% 1% 2% 2% 3% 3%
3% 2%
4% 7% 6% 4%
7% 4%
7% 6% 6%
12%
5% 7%
9%
5%
11% 12% 9%
10%
85%
69%
84% 80% 75% 73% 75% 66% 65%
66%
53%
48%
66% 59% 58% 45% 47%
36%
30%
52%
28%
31%
24%
30%
21%
34%
27%
10%
27%
14% 16% 22% 23% 19% 30%
26%
23%
34%
38%
22% 25% 28%
35% 31%
43%
43%
27%
47%
40%
43%
35%
42%
31%
15%
0%
20%
40%
60%
80%
100%
Medical
Card
GPVC
PHI
No
Coverage

15. 15
Health and healthcare coverage are negatively
correlated
Source: See Figure 5.3 in “Healthcare coverage”
Very Good or Good Self-Reported Health
10%
20%
30%
40%
50%
%
workers
with
no
medical
card,
GPVC
or
PHI
88% 90% 92% 96%
94%
% workers with very good or good reported health
10%
20%
30%
40%
50%
%
workers
with
no
medical
card,
GPVC
or
PHI
2% 4% 6% 8% 10%
% workers with multimorbidity
Multimorbidity

16. 16
Conclusions
Health status worse in non-workers
• This may reduce ability of some people to join workforce
• Reducing barriers within workplace may help integrate some
workers
• Mental Illness rates in non-workers high – labour market
participation and policies needed beyond current legislation
Health amongst workers
• Many occupations, with higher rates of multimorbidity and
mental illness, have lower levels of healthcare coverage
• Illness benefit/sick pay may reduce healthcare cost concerns
• Sláintecare/universal healthcare may remedy cost concerns