Original ResearchThe contribution of health selection to occupational status inequality in Germany – differences by gender and between the public and private sectors
Introduction
The relationship between health and labor market positions has been studied intensively. One important process of stratification on the labor market that has received little attention is status hierarchy within occupations. Anderson et al.1 demonstrate that, for British white collar workers, a promotion is followed by a substantial reduction in the risk of heart disease. Chandola et al.2 show that an increase in employment grade among British white collar workers reduces the risk of negative health conditions. These studies investigated health inequalities due to hierarchical job status from a social causation perspective. The social causation hypotheses states that social circumstances and working conditions, which are different for jobs with different statuses, affect workers' health. An alternative explanation is the health selection hypothesis, which states that health-related inequalities arise due to a process selecting those in poor health into lower-status positions and those in good health into higher-status positions, a selection process which seems especially plausible for the labor market. When employers decide which persons to hire or to promote, health status or health-related productivity can be an important criterion.3, 4 Studies that take a health selection approach to the study of health-related inequalities have often investigated occupational class, employment status, or wages.5, 6, 7, 8, 9, 10 Hierarchical job status within occupations has only rarely been assessed within a framework of health selection. Elovainio et al. is one of the few exceptions.11 They find childhood health to be an important predictor of job status in adulthood, but not health during adult life. Using the same data from the Whitehall II study, Chandola et al.2 find no health selection effects on employment grade. However, the analysis of both studies is limited to civil servants. The authors acknowledge that there is almost no downward movement possible in this setting. It might therefore be worthwhile to compare a situation in which job security and career paths are fairly similar to the Whitehall II study with a situation in which competition and more flexible labor laws allow for upward and downward movement within an occupation. In this study, I use data from the German labor market to investigate the extent to which health inequalities between high and low status jobs are produced by health selection processes in the private and the public sector for men and women. The differentiation between the public and private sectors serves as a distinction between more open positions in which competition should lead to stronger selection (private sector) and closed positions in which high job security and promotion schemes based on tenure allow for little health-related selection (public sector). Promotion schemes in the public sector in Germany are determined to a lesser degree by performance than in the private sector, although recent years have seen an increase in policies such as performance measurement in the public sector in Germany;12 however, they have not been in place for the whole period of observation, and promotion procedures are still more bureaucratic than in most of the private sector. Therefore, I expect to find health selection effects to contribute to health inequalities between high and low status jobs in the private but not in the public sector. It is further expected that health selection effects are approximately the same strength for men and for women given the same sector. In addition, the question will be addressed how much health selection contributes to overall health inequalities between high and low job status for men and women in the private and public sector.
The focus on health selection does not include indirect health selection, which works through higher human capital in the form of educational credentials or skills acquired throughout life, and only examine direct health selection effects.13 As direct health selection effects I understand the influence of health through performance that cannot be explained by human capital, effort related (e.g. household burdens), or personality factors that might be a cause of both health and job status.
Section snippets
Methods
The study uses data from the German Socio-Economic Panel Study (SOEP) to conduct the analyses. The SOEP is a representative household survey with annual interviews, starting in 1984, and currently includes more than 20,000 personal interviews from more than 10,000 households drawn from the original sample and regular refreshment samples (in years 1998, 2000, 2002, 2006, and 2009 for the present study).14, 15 The sample for the regression analyses comprises the annual waves K (1994) to BB
Results
Fig. 1 shows differences in health status according to job status, gender, and sector of employment. On average, individuals in high status jobs report being in good or very good health 10 percentage points more often than those in low status jobs. All differences are significant at P < 0.01. There are no apparent differences in these inequalities between men and women or the private and public sectors. In order to judge the relevance of these overall inequalities, Fig. 2 reports the same
Discussion
This study presented results describing the effect of subjective health on job status on the German labor market. The descriptive results show that health inequalities between high and low status jobs are substantial in nature, approximately 60–100% of the size of health inequalities between individuals from the highest and lowest educational groups. As expected, no consistent role of health in the attainment of a high job status could be found in the public sector. Surprisingly, in the private
Ethical approval
The SOEP is approved as being in accordance with the standards of the Federal Republic of Germany for lawful data protection; all participants gave free and informed consent to participate in the survey. The survey ethics are monitored by an independent advisory board at the German Institute of Economic Research (DIW). No further ethical approval is needed.
Funding
This work was supported by the European Research Council (ERC): [ERC: 313532] and by a Ph.D scholarship of the German science foundation
References (43)
- et al.
Health selection in the whitehall II study, UK
Soc Sci Med
(2003) - et al.
Dynamics of health and labor market risks
J Health Econ
(2009 Dec) - et al.
Employment status and self-rated health in north-western China
Public Health
(2010 Mar 1) - et al.
Health status and health behaviour as predictors of the occurrence of unemployment and prolonged unemployment
Public Health
(2013 Jan) What is self-rated health and why does it predict mortality? towards a unified conceptual model
Soc Sci Med
(2009 Aug)- et al.
A standard international socio-economic index of occupational status
Soc Sci Res
(1992 Mar) Self-care components of lifestyles: the importance of gender, attitudes and the social situation
Soc Sci Med
(1989)- et al.
The effects of promotions on heart disease: evidence from whitehall
Econ J
(2012) - et al.
The assessment of chronic health conditions on work performance, absence, and total economic impact for employers
J Occup Environ Med Am Coll Occup Environ Med
(2005 Jun) Unemployment and health: selection effects
J Community Appl Soc Psychol
(1996)
Negative health selection into physically light occupations
J Epidemiol Community Health
Health selection operating between classes and across employment statuses
J Epidemiol Community Health
Adjusting for selection bias in longitudinal analyses using simultaneous equations modeling: the relationship between employment transitions and mental health
Epidemiology
Socioeconomic differences in cardiometabolic factors: social causation or health-related selection? evidence from the whitehall ii cohort study, 1991–2004
Am J Epidemiol
Performance measurement in the public sector: the German experience
Int J Product Perform Manag
Indirect health-related selection or social causation interpreting the educational differences in adolescent health behaviours
Soc Theory Health
Data for years 1984-2012, version 29
The German socio-economic panel study (SOEP) – scope, evolutions and enhancements
Schmollers Jahrb
self-rated health: caught in the crossfire of the quest for “true” health?
Int J Epidemiol
The association between self-rated health and mortality in different socioeconomic groups in the GAZEL cohort study
Int J Epidemiol
Is the use of self-rated health measures to assess health inequalities misleading?
Int J Epidemiol
Cited by (12)
Allostatic load and women's brain health: A systematic review
2020, Frontiers in NeuroendocrinologyCitation Excerpt :That is, higher occupational status and increased psychological demands in the workplace were associated with lower allostatic load among women. Nevertheless, women are still more frequently found in occupations of lower occupational status, which may hinder women’s health (Kroger, 2016). In addition to this, however, seemingly positive psychosocial work characteristics, such as more meaningful work and higher perceived work-related rewards have been shown to be associated with increased allostatic load in women but not men (Dich et al., 2019).
Pathways between socioeconomic status and health: Does health selection or social causation dominate in Europe?
2018, Advances in Life Course ResearchCitation Excerpt :One argument against health selection addresses the timing of cause and effect over the life course: A central proposition of the selection hypothesis is that social mobility is partly due to health. While there are indications for a certain level of health-related social mobility in early adulthood when people enter the labour market (Smith, 1999), the relationship between health and social mobility is fairly weak (Kröger, 2015a). Moreover, the chronology of social mobility at younger ages and increasing health problems at higher ages seems to contradict the proposition of the health selection hypothesis, which postulates the reverse order: pre-existing health differences going on to influence SES.
The stratifying role of job level for sickness absence and the moderating role of gender and occupational gender composition
2017, Social Science and MedicineCitation Excerpt :Reported days of sickness absence have been shown to be strongly associated to records of actual sickness absence from health insurance register data (Ferrie et al., 2005). An individual's job level is based on categorizations of their position within their company's hierarchy, corresponding to the degree of autonomy, skill, and authority (Hoffmeyer-Zlotnik, 2003; H Kröger, 2016). It is not linked to occupational classifications, but measured in a separate question in the survey.
Work Adjustments by Types of Occupations Amongst People with Multiple Sclerosis: A Survey Study
2023, Journal of Occupational RehabilitationWorking Conditions and Health Among Italian Ageing Workers
2022, Social Indicators Research