Health Status of the Working-age Population in Israel: Trends, Factors, and Implications
Author: Anat Ziv, firstname.lastname@example.org
University: The Hebrew University of Jerusalem , Israel
Supervisor: Jona Schellekens
Year of completion: In progress
Language of dissertation: Hebrew
Areas of Research: Health , Logic and Methodology , Population
Life expectancy continues to rise. As a result of this evident increase in life expectancy are we sicker now than in the past? Is the level of our health lower than that of the previous generation? In recent years, attempts to assess the morbidity and health status have become increasingly significant. With population aging on the rise, the need to examine trends in health and the changes that have taken place over the years have increased. Most of the studies follow health trends of the aging population and the factors that influence them, even though tendencies in the health status of working-age groups have also impinged significantly on community budgets and services planning. Therefore, in this research I investigated health trends evident in the working-age population in Israel, and examined the factors— both at the micro and macro levels— that elicited such changes over time. This study is based on three surveys that were conducted by the Central Bureau of Statistics in Israel. The first is a Social Survey; it is conducted annually since 2002 and is based on data collected about individuals and their households; it provides information on the living conditions and welfare of the Israeli population. Data collection was conducted between the years 2002-2015 about individuals aged 30-64. The data file included 61,750 respondents. This survey enables the estimation of individual health resulting from self-rated health scores (SRH) and the examination of changes in the state of health over the years, as a function of both individual and macro level characteristics. The data of this survey allows for the examination of trends in health over a relatively short period of time of about a decade and a half; and therefore, I used a second source of data—a Labor Force Survey that enables tracking a longer and continuous period of time of three decades, between the years 1979-2011. Within the framework of this survey, however, it is not possible to estimate the status of SRH, as is in the Social Survey, but it is possible to estimate health status according to information collected about employees’ absences resulting from their (self-reported) state of health. Data for this survey was collected among employees in the civilian weekly-labor force aged 25-65. The data file included 248,093 respondents. The survey examined variables that contribute to the explanation of trends in sickness absences over the years, according to individual characteristics and macro level variables, including economic incentives (unemployment rates and "non-standard" employment arrangements) and morbidity rates. In order to validate the results obtained from the Labor Force Survey, I used a third data source, a Health Survey that covers overlapping time points and which examines the correlation of trends in sickness absences. Data for this survey was collected among employees in the civilian weekly-labor force aged 25-65. The data file included 30,239 respondents. However, the findings from the Health Survey cannot validate the Social Survey, because the questionnaire of the survey did not include information about SRH during all the years it was conducted. In this study, I used logistic regression models for the analysis of probabilities in order to assess the factors affecting health and sickness absences. In one chapter, the probability of reporting a "very good" / "good" health condition was compared to "not good" or "not at all good"; and in the other two chapters, the probability of "to be absent" was compared to "not absent" from work due to sickness. Results in these models show that in the years between 2002-2015 there is an improvement in the health status of the working-age population alongside an increase in life expectancy, evidenced by groups differentiated by gender, age, religion, ethnic origin, and level of education. Variables at the micro level have contributed in relatively small measure (in 23%) to explaining the increase in the health status of the working population, with the level of education having the most prominent effect in explaining this increase. On the other hand, it is apparent that unemployment rates contributed in the greatest measure (approximately in 77%) in explaining trends of health improvement. During the period between 2002-2015, there was a continuous and sustained decline in the level of unemployment which affected the health of the working population. A sense of economic security can affect the individual's lifestyle (such as smoking, excessive alcohol consumption) and well-being. When the relative contribution of employee characteristics and unemployment rates are merged in explaining the overall improvement in health, the model succeeds in fully explaining (in 100%) the increase trend for the period between 2002 and 2015. In addition, the results show that in the years between 1979-2011 there was a downward trend in sickness absences due to health conditions among both men and women, as well as among additional groups categorized by age, religion and ethnic origin, marital status, education level, occupation, full or part time employment. The contribution of employees’ characteristics in explaining the downward trend is estimated at 24%. Employees’ characteristics manage to explain only a relatively small part of the decline over time, whereas changes that have occurred at the macro level do explain most of the decline. It is clear that the greatest contributing factor is the reduction of morbidity rates (accounting for 34% of the decrease of absences), as measured by the mortality rate from pneumonia among the elderly. The increase in the percentage of the vaccinated population, along with improvements and updates in the components of the flu vaccine, which have made it more effective and efficient, has contributed to a significant decrease in the rates of morbidity and mortality from the flu and its various complications, with mortality from pneumonia figuring most prominently among them. The next contributing factor pertains to the raising numbers of alternative "non-standard" employment arrangements (this variable explaining 28% of the decrease). Under "non-standard" employment arrangements, absence becomes less economically viable, since the partial monetary compensation that it grants fails to fully cover the loss of working days. All the macro level variables explain 66% of the decrease in sickness absences. When the overall contribution of employee characteristics is merged with the influence of macro level factors, this compound variable explains 90% of the decrease in sickness absences. In other words, this model succeeds in explaining almost fully the reduction in sickness absences occurring during the years 1979-2011. This study makes an important contribution to the understanding of the factors affecting health status and sickness absence in Israel over the years. To date, no studies that attempt to explain trends over the years in Israel have been conducted. Such studies have been conducted in other parts of the world, but they have not measured the extent to which micro and macro levels affect the health status of the working-age population and sickness absences over the years. The findings and conclusions of this research thereby provide important sources that might contribute to studies in other parts of the world.