Report 3 - Exploring the Link Between Work-Life Conflict and Demands on Canada's Health Care System

Chapter 4 - How Do Canadian Employees See Their Health?

This chapter addresses the following questions:

• How do Canadian employees view their physical health?
• What is the impact of gender, job type, dependent care status and sector of employment on perceived health?
• What is the link between work-life conflict and perceived health?

This chapter is divided into three parts. Data on the perceived health of Canadian employees are presented and discussed in Section 4.1. Included in this section is a discussion of how gender, job type, dependent care status and sector of employment are associated with perceived health. The link between perceived health and work-life conflict is made in Section 4.2. A summary of the key findings with regard to perceived health are given in the final section of the chapter, Section 4.3. The data discussed in this section of the report can be found in the appendices at the end of the report.

4.1 Perceived Health

The vast majority of health status indicators are oriented to disease and death and, with the exception of measures such as the absence of disease or the postponement of death, there are only a limited number of statistics which deal with positive aspects of health (Statistics Canada, 1999). The self-related measure of health status used in this study permits some assessment of positive health as more than just the absence of health problems. According to this metric, how healthy are Canadians? In 1996-97, one in four Canadians described his or her health as excellent¹⁸ while another 38% rated it as very good (Statistics Canada, 1999). Only 9% of Canadians described their health as fair or poor (Statistics Canada, 1999).

Who are more likely to say they are healthy? According to CIHI (2002), perceived health status is positively associated with socio-economic status (e.g. younger, more highly educated individuals with higher incomes are more likely to report they are healthy). In a similar vein, Statistics Canada (1999) reports that:

• males are more likely than females to rate their health status as excellent (these gender differences in perceived health are, however, generally confined to younger age groups); and
• there is a definite gradient in self-rated health that corresponds to one's level of income adequacy (i.e. 18% of Canadians in the two lowest income groups rate their health as excellent compared with 33% of Canadians with the highest levels of income; 21% of low-income Canadians state that their health is fair or poor compared with only 5% of Canadians with the highest incomes).

Perceived health data for the total sample are shown in Figure 2.

Figure 2
Perceived Health for Total Sample

Half of the employees in this sample say their health is very good to excellent

Almost half of the respondents to this survey (48.4%) indicated that their health was very good or excellent.¹⁹ This is a significantly lower proportion than reported by Statistics Canada for Canadians aged 12 or older (61% reported health was very good or excellent). While some of this difference might be explained by the age differences in the sample (younger Canadians can be expected to enjoy better health than older Canadians), it is also likely that working conditions and job-related stress are taking their toll on Canadian employees' health status.

Almost one in five employees perceives that his or her health is fair or poor

At the other end of the spectrum are the 16.7% of employees who perceive their health to be fair or poor. This is a higher proportion with poor health than reported by Statistics Canada for a sample which included Canadians aged 12 or older and supports the idea that employment conditions may be having a negative impact on the health of some Canadians. These numbers are also a wake-up call for employers as they support a link between employee health and the organization's bottom line.²⁰

Managers and professionals are more likely than those in "other" positions to perceive they are in very good/excellent health

Perceived health is strongly associated with job type. Respondents in managerial and professional positions, regardless of their gender, were more likely than their counterparts in "other" jobs to describe their health as being very good or excellent. Respondents in "other" positions, on the other hand, were more likely to describe their health as fair or poor. Consider the following:

• 51% of male managers and 52% of female managers described their health as very good/excellent as compared to 45% of males and 46% of females in "other" positions, and
• 15% of male and female managers described their health as fair/poor compared to 19% of male and female respondents in "other" positions.

These findings are consistent with those reported by Statistics Canada and the Whitehall research group (Hemingway et al., 1997; Marmot and Davey, 1997) and support the strong positive association between socio-economic status and "good" health.

Employees without dependent care responsibilities are more likely to perceive they are in good health

Having dependent care responsibilities (i.e. children at home and/or elder care) is negatively associated with perceived health for both men and women. Employees without dependent care responsibilities, regardless of gender, were more likely than those with dependent care responsibilities to rate their health as very good or excellent. Those with child and/or elder care responsibilities were more likely than those without dependent care responsibilities to say their health was good or fair/poor. These differences are most obvious when one compares the mean perceived health scores for the four groups. Men and women without dependent care responsibilities reported a mean perceived health score of 3.5 compared to 3.4 for men and women with dependent care responsibilities. This suggests that combining work and family responsibilities takes its toll on the health of employed men and women.

Employees who work in the public sector are less likely to perceive they are in good health

Men and women who work in the public sector are more likely than those in other sectors to describe their health as fair or poor. One needs to look at the demographic differences between the samples to explain this finding (see Higgins & Duxbury [2002]). Private sector employees are younger than their counterparts in the public and NFP sectors. Employees in the NFP sector (especially the women) are more highly paid than their counterparts in either the public or the private sector. This would suggest that some of the sectoral differences in perceived health can be attributed to either age or socio-economic status. Nevertheless, these data intimate a link between poorer health and working conditions within the sector. Further examination of this link is warranted.

No gender differences in perceived health

Once job type and dependent care status are taken into account, there were no differences in perceived health that could be associated with gender. This is a very important finding as it runs counter to much of what has been reported in the literature (e.g. women make more use of health services than men and report poorer health, albeit only at younger ages). This would suggest that it is life circumstances (e.g. being compressed into lower level jobs within organizations, lower levels of perceived control) rather than gender itself which is associated with the lower levels of perceived health. The finding that dependent care responsibilities (i.e. parenthood, elder care responsibilities) appear to impair the health of both men and women is also worthy of note. These data are consistent with our findings that gender differences in the time spent in child and elder care have disappeared over the past decade as women do less at home than in the past and men do more.²¹ These findings suggest that it is the challenges of combining work with parenting/caregiving that impair health-not being a working mother.

4.2 Impact of Work-Life Conflict on Perceived Health

As was established in the second report in this series, work-life conflict in its various forms is a problem for many Canadian employees. Just under 60% of the respondents to the 2001 survey reported high levels of role overload; 28% reported high work to family interference; 10% reported high family to work interference while another 32% reported moderate levels of interference, and just under one in four experienced what can be considered to be high levels of caregiver strain. In this section, we examine what impact each of these forms of work-life conflict has on perceived health. The data discussed in this section are shown graphically in Figure 3 and can be found in Appendices C and D.

Figure 3
Impact of Work-Life Conflict on Perceived Health
(a) Percent who say health is very good/excellent

Figure 3
Impact of Work-Life Conflict on Perceived Health
(b) Percent who say health is fair/poor

High conflict between work and life impairs health

High conflict between work and life impairs health High work-life conflict is associated with lower levels of perceived health, regardless of how we conceptualize work-life conflict. Similarly, employees who are more able to balance competing work and non-work demands feel that they are in better health than those who cannot.

Relative risk of poorer health is highest for role overload

What impact does work-life conflict have on perceived health? Consider the following:

• employees with high role overload are 2.9 times more likely to say their health is fair/poor than employees with low role overload,
• employees with high work to family interference are 2.4 times more likely to say their health is fair/poor than employees with low work to family interference,
• employees with high family to work interference are almost twice as likely to say their health is fair/poor than employees with low family to work interference, and
• employees with high caregiver strain are 1.7 times more likely to say their health is fair/poor than employees with low caregiver strain.

In other words, employees with high levels of conflict are substantially more likely to report that their health is fair/poor. Assuming that this is an accurate portrayal of their actual health status (an assumption that Statistics Canada assures us is a sound one), we can expect that this group of employees will be more likely to use prescription drugs, take advantage of their employer's benefit plan, be absent from work, and seek help from Canada's health care system. In other words, high levels of work-life conflict are likely to have a negative impact on employers' bottom lines and increase demands on Canada's health care system.

It is also worthwhile looking at the other side of the coin. If we could lower work-life conflict, what would happen to the health of Canadian employees. The data indicate that it would improve substantially. For example:

• employees with low role overload are 1.6 times more likely to say their health is very good/excellent than employees with high role overload,
• employees with low work to family interference are 1.5 times more likely to say their health is very good/excellent than employees with high work to family interference,
• employees with low family to work interference are 1.4 times as likely to say their health is very good/excellent than employees with high family to work interference, and
• employees with low caregiver strain are 1.3 times more likely to say their health is very good/excellent than employees with high caregiver strain.

In other words, if we can make it easier to help people balance work and life we can measurably improve the health of Canadian employees.

4.3 Summary: Perceived Health

While approximately half (48%) of the employees who answered the survey indicated that their health was very good or excellent, almost one in five (17%) described his or her health as fair or poor. Managers and professionals and employees without child care or elder care responsibilities were more likely to enjoy good health. Employees in "other" positions, public sector employees, employed parents and employees with elder care responsibilities, on the other hand, were more likely to perceive their health as fair or poor. These findings are consistent with those reported by Statistics Canada and support the strong positive association between socio-economic status, higher levels of perceived control and good health.

Once job type and dependent care status were taken into account, there were no differences in perceived health that could be associated with gender. This is a very important finding as it runs counter to much of what has been reported in the literature (e.g. women make more use of the health care system). This would suggest that it is life circumstances (e.g. being compressed into lower level jobs within organizations, lower levels of perceived control) rather than gender itself which is associated with ill health. The finding that dependent care responsibilities (i.e. parenthood, elder care responsibilities) appear to impair the health of both men and women is also worthy of note as it suggests that it is difficulties in combining parenting, caregiving and work that impair health-not being a working mother.

Work-life conflict in its various forms is a problem for many Canadian employees. The data reviewed in this report support the following conclusion: high work-life conflict is associated with lower levels of perceived health for working Canadians, regardless of how we conceptualize work-life conflict. Employees who are more able to balance competing work and non-work demands feel that they are in better health than those who cannot.

The data suggest that employers and governments who wish to improve the health of their workforce need to pay particular attention to two aspects of work-life conflict: role overload and work to family interference. Both measures are strongly associated with heavy work demands, longer hours at work, high amounts of unpaid overtime, greater amounts of work-related travel and a culture of face time (i.e. emphasis is on "presenteeism" as opposed to outputs and deliverables). They also present higher levels of relative risk with poorer physical health. Perhaps most importantly, however, is that these are the two most prevalent forms of work-life conflict and as such pose the most problems in terms of absolute risk²² as well as relative risk.

Finally, these numbers offer a wake-up call to employers and governments for several reasons. First, they suggest that a substantive proportion of their workforce (almost one in five) is more likely to engage in behaviours (e.g. purchasing prescription medicine, being absent from work) that can negatively impact the bottom line. This may affect Canada's ability to compete globally. Second, they indicate that combining work and family responsibilities takes its toll on the health of employed Canadians, regardless of their gender (i.e. this is no longer a women's issue). Finally, these findings support the population health model which links lower socio-economic status and ill health, and suggest that workplace health efforts and interventions such as paid personal leave and health promotion activities need to be targeted to this level of the organization.

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