Socio-economic consequences of longstanding illness

Abstract

This thesis focuses an old research area of social medicine, the social and economic consequences of chronic illness and factors modifying this effect. Historically, illness was the main predictor of poverty. Since then, the welfare system and labour market policies have developed with an aim to protect people from socio-economic consequences of illness. The structural changes in the labour market in the 1990s and cuts in services and benefit levels in the welfare systems seemed to hit the most vulnerable people more than others. This raised the issue of social and economic consequences of chronic illness again. The socio-economic consequences studied in the thesis were restricted to such adverse employment and economic conditions, which might also contribute to the course of illness and on which labour market regulations and social policies may act.

The thesis is based on five papers. The first study focused the role of labour market regulations and social policies for social consequences of illness by comparing Sweden and Britain. In the next three papers limiting longstanding illness was examined as a causal factor contributing to unemployment, economic inactivity and financial difficulties and whether socio-economic group and social context have a modifying effect on this relation. The impact of a person's employment status was studied as a mediating factor to financial difficulties in different social contexts. The impact of labour market changes in the 1990s on working conditions and the risk of non-employment among persons with limiting longstanding illness was studied. These papers were all based on cross-sectional and longitudinal survey data. Persons with and without limiting longstanding illness were compared. The last paper was based on data from an in-patient register combined with a random sample of inhabitants in the Stockholm County Council and examined differences in social consequences between some diseases that might be hidden behind the global measure of limiting longstanding illness.

In the international comparison, Swedish labour market and social policies seemed to ameliorate social consequences of illness to a greater extent than in Britain. However, in the other Swedish studies in spite of the welfare system chronically ill person showed higher risk of economic inactivity, unemployment and financial difficulties. There was an interaction effect between limiting longstanding illness and socio-economic: group on economic inactivity and also between having longstanding illness and high physical job demands on non-employment, which might contribute to inequalities in health. The risk for financial difficulties and unemployment following longstanding illness was more equally distributed across the socio-economic groups. The labour market changes in the 1990s seemed to have similar impact on employment among persons with and without limiting illness but ill persons seemed to stay in more physically demanding jobs, which increased their risk of later non-employment. Differences in social consequences between diseases decreased after adjustment for age, sex and socio-economic group across the somatic diseases but not between those and the mental disease studied.