ResearchPDF Available

Consultation Response Second State Pension age review: independent report call for evidence

Authors:

Abstract

The 'The Health of Older People in Places (HOPE) response to the United Kingdome's 2nd State Pension Age review (April 2022). A link to the call for responses is available here: https://www.gov.uk/government/consultations/second-state-pension-age-review-independent-report-call-for-evidence Collectively, our peer-reviewed research is exploring which concepts and metrics of health are appropriate to measure the health of the older population in a given place, and how these health-in-a-place measures are related to employment outcomes of all adults in those places.
Dr Emily T Murray, PhD
Senior Research Associate in Epidemiology
Department of Epidemiology and Public Health
University College London
emily.murray@ucl.ac.uk
Department of Epidemiology and Public Health
University College London
1-19 Torrington Place
London WC1E 6BT
https://www.ucl.ac.uk/epidemiology
Consultation Response
Second State Pension age review: independent report call for
evidence
Written by Dr Emily T. Murray, in conjunction with Prof Nicola Shelton, Prof Jenny
Head and Dr Paul Norman.
About Us
1. Dr Emily T Murray is an international expert in examining how where people reside across their lives
relates to their health and socio-economic circumstances. Prof Shelton has published extensively on
geographic inequalities in health including in later life. Prof Head is an international expert on healthy
ageing, healthy life expectancy and healthy working lives. Dr Norman is an expert in health geography,
GIS and statistics.
2. Collectively, our peer-reviewed research is exploring which concepts and metrics of health are
appropriate to measure the health of the older population in a given place, and how these health-in-a-
place measures are related to employment outcomes of all adults in those places.
3. See more information of the research project ‘The Health of Older People in Places’ here.
3. Questions:
3.4. Metrics for setting State Pension age (SPA)
Are there other metrics which are relevant or more suitable to help determine State
Pension age in future, and if so, what metrics?
RESPONSE: Our research has shown that older people (aged 50-74 years) residing in
local authorities with the ‘unhealthiest’ older population, had higher odds of not being in
paid work, including all four types of economic inactivity.1
o We compared associations between nine health-in-a-place measures (including
objective and self-reported) and three employment outcomes in 2011: not being in
paid work, working hours (part-time, full-time), and economic inactivity (unemployed,
retired, sick/disabled, other).
o The nine measures included: self-rated health, long-term illness, age-specific
mortality rates, avoidable mortality, life expectancy (LE) at birth, LE at 65 years,
disability-free LE, health LE and infant mortality rate.
LONDON’S GLOBAL UNIVERSITY
o The strongest associations were seen for the health-in-a-place measures that were
self-reported: long-term illness and self-rated health.
o For example, adults 50-74y living in the third of local authorities with the highest
proportion of older people with a long-term illness (i.e., Unhealthiest) had 1.60 times
higher age-adjusted odds (95% CI 1.521.68) of not being in paid work than older
people who lived in the ‘Healthiest’ areas,
o Odds remained significant, at 1.33x higher for local authority-level Infant Mortality
Rates (95% CI 1.251.43), the weakest of the nine health-in-a-place measures
assessed.
o However, strengths of association did vary by economic inactivity category. For
example, sick/disabled people had 2.75 times higher odds (95% CI 2.552.97) than
economically active people to be living in the unhealthiest rather than healthiest
third of areas. Odds were 2.02 for the unemployed (95% CI 1.872.19), 1.49 for
other [not employed] (includes students, homemakers, and miscellaneous
categories) (95% CI 1.361.63) and 1.36 for retired (95% CI 1.291.44) economic
inactivity categories.
o These differences were robust to adjustment for age, gender and individual self-
rated health.
Based on this research, we would recommend that self-rated health measures be included
in determining the State Pension Age in future. Where self-reported place-level measures
are not available, healthy or disability-free life expectancy measures can be substituted with
the understanding that they will display a slightly weaker association with employment
outcomes. These measures will reflect both the proportions of the wider population fit for
work, but also reflect in some areas long term cycles of economic decline associated with
deindustrialisation and a low level of economic investment from both private and public
sources, which are beyond the control of individual jobs seekers.
Is it reasonable for people to expect to spend a fixed proportion of their adult life in
receipt of State Pension?
RESPONSE: No. Inequalities in life expectancy and healthy life expectancy across
socioeconomic groups and geography means the expectation of a fixed proportion of their
adult life in receipt of State Pension is a fallacy where State Pension Age is universal. Past
research from members of our team have shown that:
o Lower social class groups are negatively affected by uniform state pension ages,
because they are more likely to stop work at younger ages due to health reasons.2
o In 2014, in a representative birth cohort of 68-year-olds English and Welsh residents,
88% of men and 69% of women had retired from their main job before State Pension
Age. 28% of the men and 21% of the women who stopped working before or at SPA
did so because of negative reasons: own health, partner’s health, becoming a carer,
bereavement, redundancy, unhappiness with job or with working or work problems.
This is compared with 18% of men and 16% of women who retired before or at SPA
for positive reasons including being financially able, left early with good bonus, early
retirement or voluntary redundancy package, life style change, or retired with
partner.3
o Using prospective longitudinal data drawn from seven studies, including four from
the UK, older workers aged 50y with lower education level or low occupational grade
were more likely to leave work for health reasons, compared with workers age 50y
with high level education or occupational grade, after adjustment for self-rated health
and birth cohort.4
o There are regional differences in the likelihood of older workers being able to stay in
work past the age of 50 years. From 2001-2011, men in the ONS Longitudinal Study
(LS) had significantly higher odds of staying in paid work in the East Midlands (1.4×)
East of England (1.5×), South East (1.6×), and South West (1.6×) compared with the
North East. Women in all regions apart from London and Wales had significantly
higher chance of extended working compared with the North East: ranging from 1.15
times in the North West and West Midlands to 1.6 times in the South West.5
o Two likely explanations for geographic differences in extended working are local
employment opportunities and the health of individuals in those areas. Using data
from adults aged 40-69y in the ONS LS, we found that higher local authority-level
unemployment and worse individual self-rated health in 2001 were both
independently related to the likelihood of identifying as sick-disabled or retired,
compared to being in work, 10 years later; even after adjusting for socio-
demographic covariates.6
o There are large inequalities in healthy life expectancy and disability-free life
expectancy by area and socioeconomic group that imply that some groups will be
less able to extend their working lives due to poor health. Using data from the
English Longitudinal Study of Ageing, we found that both men and women in routine
and manual occupations could expect around four fewer years of healthy life beyond
the age of 50 compared to those in professional occupations.7 Similarly, there was
socioeconomic disadvantage in disability-free life expectancy according to peoples’
wealth: people in the poorest third could expect to live seven to nine fewer years
without disability than those in the richest third from the age of 50.8
Are there options for taking account of differences in circumstances when setting
State Pension age in future? What are the advantages and disadvantages of these
options, and how could they operate within the current pensions framework?
RESPONSE: One option highlighted by some participants in recent focus groups with
English and Welsh 5074-year-olds was an option for early State Pension receipt for
individuals working in physically demanding or dangerous occupations. Other participants
felt it would be unfair to base the SPA on differences in circumstances.
One solution could be to reduce the State Pension Age by following the current United
States model, and similar models in Scandinavia,9 of allowing any applicant to receive
benefits up to five years early (age 62) but the monthly benefit payment will be reduced
leading to a more equitable and potentially zero cost increase solution. For example, if a
person turns age 62 in 2022, their monthly benefit would be about 30% lower than it would
if they first claimed at the full retirement age of 67 years in 2027.10 Though this might lead to
short term increase in pensions and pension credit claimed it could reduce burden in other
parts of the benefits system, such as statutory sick pay, universal credit, and employment
support allowance. This could be operationalised within the current pensions framework by
using area level self-rated health (identified by the HOPE project as a key correlate of work
exit) to determine a suitable age to which reduce State Pension Age to nationally (or
regionally) and then extending to younger ages the current system for pension access or
deferment (currently deferment only available beyond State Pension Age). This also
removes stigma that may be attached to benefits other than pensions.
Alternatively, or additionally, focused reductions in State Pension Age could be attached to
specific dangerous occupations as they are in several European countries or the age at
which people joined the labour market (left full time education or training) could be used to
determine State Pension eligibility, though this would not reflect wider area level issues that
influence work exit.
REFERENCES
1 Murray ET, Head J, Shelton N, Beach B and Norman P. Linking the health of older
people in places with labour market outcomes for all: does it matter how we measure
health? SocArXiv, 23 Apr. 2022. Available here: https://osf.io/preprints/socarxiv/w9vcu/
2 Murray ET, Carr E, Zaninotto P, Head J, Xue B, Stansfeld S, Beach B and Shelton
N. Inequalities in time from stopping paid work to death: findings from the ONS
Longitudinal Study, 20012011. J Epidemiol Community Health 2019; 73: 11011107.
DOI: 10.1136/jech-2019-212487
3 Stafford M, Cooper R, Richards M, Murray ET, Zaninotto P, Head J, Stansfeld S,
Carr E, Kuh D. Physical and cognitive capability in midlife and later work participation.
Scandinavian Journal of Work, Environment and Health 2017 Jan 1;43(1):15-23 [Epub 30
Aug 2016]. doi:10.5271/sjweh.358
4 Carr E, Murray ET, Zaninotto P, Cadar D, Head J, Stansfeld S, Stafford M. The
association between informal caregiving and exit from employment among older workers:
prospective findings from the UK Household Longitudinal Study. Journal of Gerontology A
Biol Sci Med Sci. [Epub 7 Dec 2016]. doi: 10.1093/geronb/gbw156.
5 Shelton N, Head J, Carr E, Zaninotto P, Hagger-Johnson G, Murray ET. Gender
differences and individual, household, and workplace characteristics: Regional
geographies of extended working lives. Population, Space and Place 2018; 25(2): e2213.
DOI: 10.1002/psp.2213
6 Murray ET, Head J, Shelton N, Hagger-Johnson G, Stansfeld S, Zaninotto P,
Stafford M. Local area unemployment, individual health and workforce exit: ONS
Longitudinal Study. The European Journal of Public Health 2016; 26(3): 463-9. DOI:
10.1093/eurpub/ckw005
7 Head J, Chungkham HS, Hyde M, Zaninotto P, Alexanderson K, Stenholm S, Saol P,
Kivimaki M, Goldberg M, Zins M, Vahtera J, Westerlund H. Socioeconomic differences in
healthy and disease-free life expectancy between ages 50 and 75: a multi-cohort study.
Eur J Public Health 2018; 29(2): 267-272. DOI:10.1093/eurpub/cky215
8 Zaninotto P, Batty GD, Stenholm S, Kawachi I, Hyde M, Goldberg M, Westerlund H,
Vahtera J, Head J. Socioeconomic Inequalities in Disability-free Life Expectancy in Older
People from England and the United States: A Cross-national Population-Based Study. J
Gerontol A Biol Sci Med 2020; Apr 17;75(5):906-913. doi:10.1093/gerona/glz266.
9 OECD. Ageing and Employment Policies.
https://www.oecd.org/employment/ageingandemploymentpolicies.htm [Accessed 24 April
2022].
10 Social Security Administration. Retirement benefits. Publication No. 05-10035
January 2022. Available here: https://www.ssa.gov/pubs/EN-05-10035.pdf (page 3).
... All people who live in the areas of England and Wales with the highest proportion of older people in poor health are 1.6 times more likely to not be in employment, no matter their own age. 4 For older people, geographical health inequalities in these poorer areas are resulting in higher levels of early labour market exit and greater economic inactivity. 5 While older people's contribution to our economy is already significant, we know that health inequality is a significant barrier to unlocking their full potential. ...
Technical Report
The Government’s ‘Levelling Up’ agenda comes after decades of health inequalities. The effects of the COVID-19 pandemic and the long-term impacts of the UK’s ongoing cost of living crisis have both increased these inequities. While disability-free life expectancy (DFLE) improved overall in the UK from 1991 to 2011, there was still a significant gap between the local authority areas considered the ‘healthiest’ and the ‘unhealthiest’. In 2011, DFLE at age 50 varied from 13.8 to 25.0 years – that’s a gap of 11.3 years between the healthiest and unhealthiest areas. Unfortunately, over a decade later, the conversation hasn’t moved on much further. Health Equity in England: The Marmot Review 10 Years On, the 2020 follow-up to Sir Michael Marmot’s landmark study, found that the health gap between wealthy and deprived areas has continued to grow. The Health of Older People in Places (HOPE) project is a multidisciplinary research project funded by the Health Foundation under the Social and Economic Value of Health in a Place (SEVHP) programme. The research team includes scientists from the Department of Epidemiology and Public Health at University College London (UCL) and the School of Geography at the University of Leeds. The HOPE project has built on this research by showing the link between levels of employment and health in a place. It finds that: The higher the proportion of older people with poor health in a place, the less likely it is that any adults in that place will be in paid work. For example: Older workers from the unhealthiest areas are 60% more likely to be out of work than those who live in the healthiest areas: Women aged 50-74 living in the ‘healthiest’ areas of England and Wales were 5.6% more likely to be in paid work than those living in the ‘unhealthiest’ areas. Men aged 50-74 living in the ‘healthiest’ areas of England and Wales were 7.1% more likely to be in paid work than those living in the ‘unhealthiest’. How we measure health in a place matters: links between health in a place and employment are stronger for self-rated health measures, compared with life expectancy figures or mortality indicators. Historically disadvantaged areas continue to struggle: areas where people left paid work at a younger age due to poor health in 1991 were much more likely to experience this trend in 2011 as well. This disproportionately affects people in manual occupations: they’re much more likely to experience ill health, and they can expect four fewer years of healthy life beyond age 50, compared with workers in administrative or professional roles. There’s a correlation between health in a place and younger people being in paid employment: for example, the probability of a woman aged 16 to 49 not being in paid work was 33.7% in the ‘unhealthiest’ areas compared with 26.3% in the ‘healthiest’ areas. Those working in professional occupations were more likely to be in work 10 years later than those working in elementary occupations or doing repetitive manual labour: this gap in employment outcomes was most marked for people living in ‘unhealthy’ areas. The levelling up agenda is more important now than ever, and it’s vital it is not sidelined by the Government. It’s not just about helping people live longer, healthier lives but supporting local economies and economic growth. Although the prevalent narrative is often that individual health is an individual problem rather than a societal one, the whole community is affected by poor health. As part of its levelling up agenda, the UK Government set itself an ambitious target to add five additional healthy years to the average UK lifespan by 2035. It has also set a target of narrowing the gap in Healthy Life Expectancy (HLE)8 between the ‘healthiest’ and ‘unhealthiest’ local authority areas by 2030. It’s unclear how the Government intends to achieve these two goals, especially given the recent decision to abandon the promised white paper on health disparities. In addition, the fallout from the COVID-19 pandemic and the current cost of living crisis are likely to widen existing inequalities. If the UK had achieved the current levelling up agenda goal of reducing the HLE gap by five years between 2001 and 2011, older people’s participation in the labour market would have increased by 3.7% between 2001 and 2011. This is equivalent to 250,000 additional older people in paid employment. The HOPE project used Disability-Free Life Expectancy (DFLE) as a proxy for HLE, as HLE data for local authorities is not available in 2001.
... All people who live in the areas of England and Wales with the highest proportion of older people in poor health are 1.6 times more likely to not be in employment, no matter their own age. 4 For older people, geographical health inequalities in these poorer areas are resulting in higher levels of early labour market exit and greater economic inactivity. 5 While older people's contribution to our economy is already significant, we know that health inequality is a significant barrier to unlocking their full potential. ...
Technical Report
Full-text available
The Government’s ‘Levelling Up’ agenda comes after decades of health inequalities. The effects of the COVID-19 pandemic and the long-term impacts of the UK’s ongoing cost of living crisis have both increased these inequities. While disability-free life expectancy (DFLE) improved overall in the UK from 1991 to 2011, there was still a significant gap between the local authority areas considered the ‘healthiest’ and the ‘unhealthiest’. In 2011, DFLE at age 50 varied from 13.8 to 25.0 years – that’s a gap of 11.3 years between the healthiest and unhealthiest areas. Unfortunately, over a decade later, the conversation hasn’t moved on much further. Health Equity in England: The Marmot Review 10 Years On, the 2020 follow-up to Sir Michael Marmot’s landmark study, found that the health gap between wealthy and deprived areas has continued to grow. The Health of Older People in Places (HOPE) project is a multidisciplinary research project funded by the Health Foundation under the Social and Economic Value of Health in a Place (SEVHP) programme. The research team includes scientists from the Department of Epidemiology and Public Health at University College London (UCL) and the School of Geography at the University of Leeds. The HOPE project has built on this research by showing the link between levels of employment and health in a place.
Article
Full-text available
Background: There are striking socioeconomic differences in life expectancy, but less is known about inequalities in healthy life expectancy and disease-free life expectancy. We estimated socioeconomic differences in health expectancies in four studies in England, Finland, France and Sweden. Methods: We estimated socioeconomic differences in health expectancies using data drawn from repeated waves of the four cohorts for two indicators: (i) self-rated health and (ii) chronic diseases (cardiovascular, cancer, respiratory and diabetes). Socioeconomic position was measured by occupational position. Multistate life table models were used to estimate healthy and chronic disease-free life expectancy from ages 50 to 75. Results: In all cohorts, we found inequalities in healthy life expectancy according to socioeconomic position. In England, both women and men in the higher positions could expect 82-83% of their life between ages 50 and 75 to be in good health compared to 68% for those in lower positions. The figures were 75% compared to 47-50% for Finland; 85-87% compared to 77-79% for France and 80-83% compared to 72-75% for Sweden. Those in higher occupational positions could expect more years in good health (2.1-6.8 years) and without chronic diseases (0.5-2.3 years) from ages 50 to 75. Conclusion: There are inequalities in healthy life expectancy between ages 50 and 75 according to occupational position. These results suggest that reducing socioeconomic inequalities would make an important contribution to extending healthy life expectancy and disease-free life expectancy.
Linking the health of older people in places with labour market outcomes for all: does it matter how we measure health? SocArXiv
  • E T Murray
  • J Head
  • N Shelton
  • B Beach
  • P Norman
Murray ET, Head J, Shelton N, Beach B and Norman P. Linking the health of older people in places with labour market outcomes for all: does it matter how we measure health? SocArXiv, 23 Apr. 2022. Available here: https://osf.io/preprints/socarxiv/w9vcu/ 2
Inequalities in time from stopping paid work to death: findings from the ONS Longitudinal Study
  • E T Murray
  • E Carr
  • P Zaninotto
  • J Head
  • B Xue
  • S Stansfeld
  • B Beach
  • N Shelton
Murray ET, Carr E, Zaninotto P, Head J, Xue B, Stansfeld S, Beach B and Shelton N. Inequalities in time from stopping paid work to death: findings from the ONS Longitudinal Study, 2001-2011. J Epidemiol Community Health 2019; 73: 1101-1107. DOI: 10.1136/jech-2019-212487
Physical and cognitive capability in midlife and later work participation
  • M Stafford
  • R Cooper
  • M Richards
  • E T Murray
  • P Zaninotto
  • J Head
  • S Stansfeld
  • E Carr
  • D Kuh
Stafford M, Cooper R, Richards M, Murray ET, Zaninotto P, Head J, Stansfeld S, Carr E, Kuh D. Physical and cognitive capability in midlife and later work participation. Scandinavian Journal of Work, Environment and Health 2017 Jan 1;43(1):15-23 [Epub 30 Aug 2016]. doi:10.5271/sjweh.358
The association between informal caregiving and exit from employment among older workers: prospective findings from the UK Household Longitudinal Study
  • E Carr
  • E T Murray
  • P Zaninotto
  • D Cadar
  • J Head
  • S Stansfeld
  • M Stafford
Carr E, Murray ET, Zaninotto P, Cadar D, Head J, Stansfeld S, Stafford M. The association between informal caregiving and exit from employment among older workers: prospective findings from the UK Household Longitudinal Study. Journal of Gerontology A Biol Sci Med Sci. [Epub 7 Dec 2016]. doi: 10.1093/geronb/gbw156.
Gender differences and individual, household, and workplace characteristics: Regional geographies of extended working lives
  • N Shelton
  • J Head
  • E Carr
  • P Zaninotto
  • G Hagger-Johnson
  • E T Murray
Shelton N, Head J, Carr E, Zaninotto P, Hagger-Johnson G, Murray ET. Gender differences and individual, household, and workplace characteristics: Regional geographies of extended working lives. Population, Space and Place 2018; 25(2): e2213. DOI: 10.1002/psp.2213
Local area unemployment, individual health and workforce exit: ONS Longitudinal Study
  • E T Murray
  • J Head
  • N Shelton
  • G Hagger-Johnson
  • S Stansfeld
  • P Zaninotto
  • M Stafford
Murray ET, Head J, Shelton N, Hagger-Johnson G, Stansfeld S, Zaninotto P, Stafford M. Local area unemployment, individual health and workforce exit: ONS Longitudinal Study. The European Journal of Public Health 2016; 26(3): 463-9. DOI: 10.1093/eurpub/ckw005
Socioeconomic Inequalities in Disability-free Life Expectancy in Older People from England and the United States: A Cross-national Population-Based Study
  • P Zaninotto
  • G D Batty
  • S Stenholm
  • I Kawachi
  • M Hyde
  • M Goldberg
  • H Westerlund
  • J Vahtera
  • J Head
Zaninotto P, Batty GD, Stenholm S, Kawachi I, Hyde M, Goldberg M, Westerlund H, Vahtera J, Head J. Socioeconomic Inequalities in Disability-free Life Expectancy in Older People from England and the United States: A Cross-national Population-Based Study. J Gerontol A Biol Sci Med 2020; Apr 17;75(5):906-913. doi:10.1093/gerona/glz266. 9 OECD. Ageing and Employment Policies.