employment, health, and well-being

16.10.2015 1

EMPLOYMENT, HEALTH, AND WELL-BEING.

SOME EVIDENCE FROM THE PALTAMO EMPLOYMENT MODEL EVALUATION

EU-HEMP workshop seminar, LSE, London / Lars Leemann

16.10.2015 EU-HEMP workshop seminar, LSE, London / Lars Leemann 2

Municipality of Paltamo

Before the start of the Paltamo Employment Model:

• Population: 3998 (31. 12. 2008, declining)

• Unemployment rate: 18.9% (Jan. 2009)

• Project duration: 2009 – 2013


Aims of the Paltamo Full-Employment Project

• to offer all jobseekers paid employment and concentrate social security to those who are not capable of working,

• to intensify cooperation with jobseekers to find employment,

• to improve social participation and to increase health and well-being,

• to provide occupational health care services to the jobseekers,

• to study, how many jobseekers continuously depend on an intermediate labour market,

• to compare the impacts of the full-employment model to current labour market policies.


Project Evaluation A)

Effects on health and well-being

(THL)

B)

Impacts on rehabilitation

(THL)

C)

Employment of persons over 50

(THL)

D)

Experienced well-being

(University of Lapland)

E)

Youth employment

(Kela)

F)

Process evaluation

(Kajanoja)

G)

Self-evaluation of the labour force

centre

H)

Shifts in income and incentives

(THL)

I)

Economical impacts

(VATT)

J)

Developing the evaluation model

Research coordination

(THL)


Research Focus

• Physical health

• Dental health

• Mental well-being

• Functional capacity

• Alcohol use disorders, substance abuse, smoking

• Nutritional behaviour

• Social exclusion

• Use of services

• Life quality


Research Design

• Unemployed of Paltamo to be compared with two control groups:

• Experimental group: Unemployed of Paltamo (per 31. 12. 2008, n = 292)

• Control groups: Employed of Paltamo (fitted sample, n = 313) Unemployed of Sonkajärvi (per 31. 12. 2008, n = 295)

• Total N 900


Research Design

• Data collection: 2009/2010: Baseline (beginning of the project) 2010/2011: Halftime 2012: close to end of the project

• Combination of interviews, questionnaires, medical check-ups, cognitive tests, and register data

• Panel data for 3 points of time

• “Intention-to-Treat” panel regression models


Key Findings

• The unemployed of Paltamo formed an heterogeneous group, i.e. there is a considerable polarisation for some indicators.

• Health and well-being were substantially poorer among Paltamo’s unemployed than Paltamo’s employed for most indicators.

• Sonkajärvi’s unemployed often took a middle position between the Paltamo groups.

• Many of these differences persisted over the evaluation period.


Key Findings

Over the evaluation period, Paltamo’s unemployed…

• … decreasingly reported back pains.

• … reduced regular use of painkillers.

• … changed to healthier eating habits.

• … reduced risky alcohol usage.

• … started to use health care services more often.

• … exhibited increasing trust towards local policy making and local media.

• … felt themselves less and less lonely and increased their participation in social activities.


Example: Mental Health

Share of persons scoring high on the General Health Questionnaire (GHQ-12; cut-off: 4 points or more; %):

Statistical significance:

Differences between groups:

All groups, all times: p < 0.0001***

Pto. unempl. vs. empl. 2009: p < 0.0001***

Pto. unempl. vs. Skj. 2009: p = 0.0589˚

Differences over time:

All groups: p = 0.0870˚

Pto unempl. 2009-2012: p = 0.5133

Differential development:

All groups: p = 0.5849

Pto. unempl. vs. empl. 2009-2012: p = 0.3626

Pto. unempl. vs. Skj. 2009-2012: p = 0.7672

Työttömät Työttömät Vertailuryhmä

0

10

20

30

40

2009 2010 2012

Paltamo Sonkajärvi Paltamo

Unemployed

Paltamo

Unemployed

Sonkajärvi

Employed

Paltamo


Example: Health Behaviour

Share of persons reporting risky alcohol use (AUDIT-C; cut-off: women 5 or more, men 6 or more points; %):



All groups, all times: p = 0.0620˚

Pto. unempl. vs. empl. 2009: p = 0.0145*

Pto. unempl. vs. Skj. 2009: p = 0.8265



Pto unempl. 2009-2012: p = 0.0332*



Pto. unempl. vs. empl. 2009-2012: p = 0.0325*



0

10

20

30

40

50

602009 2010 2012


Unemployed

Paltamo

Unemployed

Sonkajärvi

Employed

Paltamo


Example: Social Exclusion

Share of persons actively taking part in interest groups or clubs (%):



All groups, all times: p = 0.6365

Pto. unempl. vs. empl. 2009: p = 0.0570˚




Pto unempl. 2009-2012: p = 0.0015**


All groups: p = 0.0158*

Pto. unempl. vs. empl. 2009-2012: p = 0.0023**



0

10

20

30

40

50 2009 2010 2012


Unemployed

Paltamo

Unemployed

Sonkajärvi

Employed

Paltamo


Example: Social Exclusion

Share of persons feeling themselves often or all the time lonely (%):



All groups, all times: p = 0.0554˚

Pto. unempl. vs. empl. 2009: p = 0.0008***

Pto. unempl. vs. Skj. 2009: p = 0.0430*



Pto unempl. 2009-2012: p = 0.0414*






0

5

10

15

20

25

302009 2010 2012


Unemployed

Paltamo

Unemployed

Sonkajärvi

Employed

Paltamo


Example: Use of Services

Share of persons using occupational health care services within the last 12 months (%):


0

10

20

30

40

50

60

2009 2010 2012


Unemployed

Paltamo

Unemployed

Sonkajärvi

Employed

Paltamo



All groups, all times: p = 0.0017**

Pto. unempl. vs. empl. 2009: p = 0.0027**




Pto unempl. 2009-2012: p = 0.0004***


All groups: p = 0.0234*

Pto. unempl. vs. empl. 2009-2012: p = 0.0035**

Pto. unempl. vs. Skj. 2009-2012: p = 0.0061**


Example: Use of Services

Share of persons reporting a consultation with a public health care physician within the last 12 months (%):


0

20

40

60

80

1002009 2010 2012


Unemployed

Paltamo

Unemployed

Sonkajärvi

Employed

Paltamo



All groups, all times: p < 0.0001***

Pto. unempl. vs. empl. 2009: p = 0.0005***



All groups: p < 0.0001***

Pto unempl. 2009-2012: p = 0.0161*


All groups: p = 0.0008***


Pto. unempl. vs. Skj. 2009-2012: p = 0.0004***


Outlook

• Post-intervention follow-up 2015-2017: Currently a fourth data collection is getting underway, realisation in winter 2015/16, restriction to major indicators and Paltamo groups due to budget limitations.

• Deepening analyses: Stronger focus on re-employment (i.e. dynamic groups), more socioeconomic control variables, and possible mediators. Funding is currently not secured.


End of Presentation

• Both baseline and final report available online (in Finnish but with English abstracts): www.julkari.fi ( search “Paltamo”)

• Thank you very much!

employment, health, and well-being

Health & Medicine