Social factors

Individuals with lower socioeconomic position carry a far higher risk for long-term sickness absence and disability pensioning, and have a higher rate of chronic diseases and poorer health. In addition, their physical work demands are higher; work control is lower with correspondingly fewer possibilities for job adjustment or change; and less reward for continued working. Following up previous HUNT studies (35), we aim to examine mechanisms accounting for the social inequality in disability pension award. We will examine how much of these social inequalities in disability pensioning that can be explained by health and by environmental factors as described above.

         Further, women and elderly employees have higher outtake of disability pension awards. We will examine health and socio-demographic factors attempting to explain these age- and gender effects.

         Withdrawal from active working life can be seen as a coping response to a difficult life situation. Social learning and social support may play important roles (36, 37). In particular, whether other family members receive social welfare benefits may influence a person’s propensity to seek health insurance. In the HUSK study, participants were asked whether close family members had received health insurance benefits in the preceding years. We hypothesize disability pension award among close family members to be an independent risk factor for own disability pension award.

         In particular for workers with low income, single parents and others with dependants, the income replacement in the social insurance benefit system is very high and sometimes even above 100 percent. Persons falling into one or several of the categories mentioned above are overrepresented among those with poor health and hence also among receivers of social insurance benefits. It is not trivial to separate the importance of poor economic incentives from the effect of poor health on the propensity to uphold work. A common approach is to exploit exogenous variation in economic incentives, for instance related to legislation changes that affect the compensation level or the duration of the period one can receive benefits. Variation of this kind is hardly present in the Norwegian system for the time period of our data. Access to detailed information about physical as well as mental health never the less improves our understanding of the importance of economic incentives. We will study variation in working- and social insurance careers among workers with comparable health limitations. In this setting, differences in work related factors, household conditions and economic incentives may explain why some manage to uphold work despite health limitations while others do not.