The social context of health selection: a longitudinal study of health andemployment

Health selection out of the labour force has received considerable attentio n by analysts attempting to disentangle the "true" biological dimensions of ill-health from its social meaning. Rejecting this dualistic separation. w e argue that the effect of health on labour force participation is an inher ently social process reflecting differential access to material and symboli c rewards that are structured by social position. Using longitudinal data f rom the US-based Panel Study of Income Dynamics, we examine the extent to w hich structural arrangements, including those designated by gender, race, e ducation and age, differentially affect the risk of a labour market exit wh en health is compromised. Individuals employed at entry into the study (fro m 1984 - 1990) were followed for the duration of the study or until they le ft the labour force. Analyses were stratified by gender and age (25-39 and 40-61 years at baseline). We round suggestive evidence that the hazard of l abour market exit in the context of perceived ill-health depended on gender , race and education, but in ways that were not constant across each of the se social positions. For example, men may be more vulnerable to the labour market effects of poor health, but only in the younger group, black men wer e less likely to leave the labour force than white men, and education matte red, but only among younger women and older men. While these patterns may r eflect differential access to disability pensions or other work-related ben efits, we suggest that a more detailed analysis of trajectories of health a nd employment, as well as the meaning of health states would be useful in f urther elucidating the social dimensions of health selection. (C) 2001 Else vier Science Ltd. All rights reserved.