Academic journal article Scandinavian Journal of Work, Environment & Health

Sickness Absence in a Re-Employment Program as a Predictor of Labor Market Attachment among Long-Term Unemployed Individuals: A 6-Year Cohort Study in Finland

Academic journal article Scandinavian Journal of Work, Environment & Health

Sickness Absence in a Re-Employment Program as a Predictor of Labor Market Attachment among Long-Term Unemployed Individuals: A 6-Year Cohort Study in Finland

Article excerpt

There is a large body of research on the effects of unemployment on health. There is also a growing number of studies suggesting improved health status among reemployed individuals compared to those who remain unemployed (1-5). Much of the concern on how to improve the re-employment prospects of unemployed people is associated with concern about how to prevent health deterioration resulting from long-term unemployment (6, 7). In attempting to address this concern, labor authorities in several European countries have instituted active labor market policy measures such as job training, subsidized re-employment programs, and re-education courses, but the effectiveness of these measures has remained controversial (8-10). Hence policy-makers need to review and develop the current measures and seek for means that would contribute to the realization of the goal of improving re-employment.

A better understanding of the factors that constitute barriers to re-employment is crucial when planning preventive interventions aimed at promoting re-employ ment. Earlier studies have identified self-perceived general poor health (11-14) and musculoskeletal pain (15) as factors that may reduce the likelihood of reemployment. Research also suggests that unemployed people with physician-diagnosed mental problems (6, 16, 17) are at greater risk of not re-entering the labor market than their counterparts with no such health problems. However, an aspect that has been less explored is the association between previous sickness absence and re-employment. Assessing sickness absence during unemployment is complex due to the lack of a concrete everyday job. Our access to the sickness absence records of unemployed people during their participation in active labor market policy measures (ALMP) affords us the possibility of addressing the knowledge gap on the role of previous sickness absence on re-employment outcomes.

Sickness absence, particularly medically certified absence, is a well-known risk marker for mortality (17, 18) as well as many chronic health problems (19). Medically certified sickness absence has also been associated with increased risk of future sickness absences (20), job termination (21, 22) and unemployment (22-24) among active employees. Therefore, sickness absence during participation in ALMP could serve as a strong proxy for poor health and as such presents an objective measure to investigate the sustainability of the re-employment intervention for persons with serious health problems.

In our earlier study (17), we identified employment trajectories of re-employed people after their participation in a state subsidized re-employment program. Our aim in the present study is to examine whether sickness absence during such programs is a predictor of subsequent labor market attachment. We hypothesize that sickness absence is associated with poor labor market attachment, and that the risk of poor attachment increases with increasing number of sickness absence days.

Methods

Design and study population

We derived our study data from the Finnish Public Sector (FPS) study, which is an ongoing prospective study of employees in ten towns and five hospital districts in Finland. The overall aim of the FPS study is to assess the work life of employees and the impact of work and work-related changes on employee health and well-being (25). The Ethics Committee of the Hospital District of Helsinki and Uusimaa approved the study.

We used the part of the FPS study that included data on originally long-term unemployed individuals (N=23 213) who had their first period of subsidized re-employment in the service of the ten towns in 1994-2005. Subsidized re-employment schemes are an essential component of Finland's ALMP measures. They are designed for long-term unemployed people (as a rule those unemployed for >12 months) who have problems finding a job in the regular labor market. Participation in the program is voluntary and the selection of the participants is coordinated by the municipalities in cooperation with the local employment authorities. …

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