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Although the above eight studies found a healthy-worker effect, thirteen of the reviewed
studies, with a total of 11,552 participants from five different countries, concluded that a
converse relationship between health and employment actually exists, with employment
improving health. One reason to suspect that the healthy-worker effect is not the only way that
employment and health are associated is that even though people with physical disabilities are
less likely to be employed than those without disabilities, people with physical disabilities are
also five times more likely to be involuntarily unemployed, suggesting health is not the only
reason for unemployment (Turner & Turner, 2004). Furthermore, the relationship between
unemployment and depression is greater for individuals with physical disabilities, which may be
explained by the lower occurrence of employment for individuals with physical disabilities.
Further supporting this hypothesis, regression analyses controlled for functional limitations,
demonstrating that the relationship between unemployment and depression was not due to a
functional limitation. There was very little overlap between the adverse effects of physical
disabilities and the adverse effects of employment, suggesting that unemployment has an effect
on the health of people with physical disabilities that goes beyond their disability (Turner &
Turner, 2004).
Employment and Health 9
Again, longitudinal studies are one useful way to determine the direction of a
relationship. Just as longitudinal studies were used to demonstrate a healthy-worker effect,
longitudinal studies have also been used to demonstrate that employment precedes good health
and unemployment precedes poor health. For example, when researchers studied the
employment and health of 101 British men (Layton, 1986) and 1150 British youth (17 yrs old)
(Warr, Banks, & Ullah, 1985), changes in health were typically observed only after changes in
employment,...
