The role of increasing job strain in deteriorating fitness-for-work and rising incapacity benefit receipt.

Over the past three decades, the number of incapacity benefit claimants in the UK has trebled. Conventional wisdom argues that this rise cannot reflect ‘real’ incapacity; Britons are perceived to have got healthier and jobs to have become less physically demanding. Yet self-reported work-limiting disability (WLD) grew over the 1990s. Moreover, some working conditions deteriorated, with ‘job strain’ (the combination of high job demands and low job control) rising sharply. In this thesis, I investigate the possibility that rising job strain partly explains the rise in WLD and incapacity benefit receipt through four pieces of empirical research. First, different surveys appear to conflict on whether job strain has risen. Given that trends in job strain are of paramount importance, I systematically review the available trend data across 44 individual datasets. Second, I look at whether self-reported demands and control predict WLD and healthrelated job loss. Using the Whitehall II cohort, I look longitudinally at whether baseline job strain predicts WLD/health-related job loss at the following wave. I also look at the extent to which WLD mediates any relationship between job strain and health-related job loss. Third, the Whitehall II analysis is limited to civil servants and is based on self-reports. I therefore complement this analysis by looking at average job strain in particular occupations and imputing this into the nationally representative BHPS. I then relate job strain to later WLD and incapacity benefit receipt in parallel fashion to the Whitehall II analyses. Finally, the quantitative analyses leave unanswered questions about the meaning of ‘fitness-for-work’, the processes through which working conditions affect incapacity benefit receipt, and how these impact differently on different people. These are explored in a qualitative analysis of 32 interviews with people with health problems, culminating in a conceptual model of job strain, WLD, and incapacity benefit receipt.