Director, McMaster Health Forum
Canada Research Chair in Evidence-Informed Health Systems
Dissertation Title: "An Inquiry into the Links between Labour-Market Experiences and Health"
In the first of three papers I developed a research framework with which to conceptualize and plan research on the health consequences of labour-market experiences. The first half of the framework comprises a typology of labour-market experiences and the second half comprises the range of possible health and economic outcomes of these experiences. Using the framework I identified the most serious gaps in the research literature: limited attention to interactions between experiences and between experiences and the context for these experiences; limited or no attention to some increasingly prevalent experiences; and no simultaneous measurement of health and economic outcomes.
In the second paper I examined the relationship between unemployment and mortality in 2868 male household heads followed for up to 25 years and 2676 male household heads followed for up to 16 years as part of the Panel Study of Income Dynamics. I used annual measures of unemployment as time-varying variables in Cox regression analyses and controlled for annual measures of potential confounders (race, marital status, income, education, and employment grade). Men who were unemployed one or more times on the day of the annual survey had a higher hazard of death while in the labour force than men who were working on the day of the survey (hazard ratio 3:23 [1.61-6.48]). Men who experienced longer unemployment spells died earlier while in the labour force or retirement than those who experienced shorter (or no) unemployment spells (hazard ratio1.03 [1.00-1.05] for a one week change in the duration of unemployment). No clear relationship emerged between the number of unemployment spells and mortality.
In the third paper I developed a conceptual framework to identify institutional innovations or policy changes in Canada and the United Kingdom which may have come about, at least in part, because of the determinants-of-health synthesis and to determine the role that these ideas played in the politics associated with these developments. Elite interviews and reviews of primary and secondary sources suggested that the policy-relevant ideas embodied in the determinants-of-health synthesis played strategic, rather than instrumental, roles in any institutional innovation or policy change.