Ill-prepared for the labour market: health status in a sample of single mothers on welfare.

• Author: Worth, Heather B.

Abstract

This paper present the results of a survey of the health of a group of lone mothers receiving the Domestic Purposes Benefit who were not exempt from work test for any reasons related to their health, to introduce a discussion of the potential ramifications of work activation policy for the health and wellbeing of lone mothers on welfare. The survey data indicate that the self-reported health status of those women who took part in the survey is very low in comparison with national data for New Zealand women. The results not only bring into question the basis on which fitness for work is assessed by welfare agencies, but, perhaps more importantly, necessitate a consideration of the potential of work activation policies to exacerbate the discrepancy in health outcomes between lone mothers and the rest of the population.

INTRODUCTION

An increasing insistence on welfare support being attached to conditions of work training and readiness has been accompanied by a discourse that both emphasises individualised notions of responsibility, and views this responsibility as a marker of a good relationship between all citizens and the state. "Welfare to work" or "activation" policies targeting sole mothers are also promoted on the grounds that the transition from welfare receipt to paid employment will be good for the state as well as good for the women themselves.

While impediments to sole mothers' participation in the labour market are recognised, the framing of those terms is usually limited to the discussion of financial barriers and lack of child support. The extremely poor health status of sole mothers in particular, and long-term welfare recipients in general, is given inadequate consideration. The most recent discussion of sole-parent employment patterns in New Zealand (Goodger and Larose 1999), for instance, does not mention that health status may be a contributory factor.

The existence of persisting health inequalities in New Zealand has been clearly documented (Pomare 1995, Ministry of Health 1999a, Howden-Chapman and Tobias 2000). Poor health outcomes are not only associated with unemployment, low income, and low levels of education, but the evidence that the health experience of New Zealanders is divided along ethnic lines has been steadily accruing over the past 20 years (Pomare 1995, Howden-Chapman and Tobias 2000, Te Puni K6kiri 2000). The National Advisory Committee on Health and Disability has concluded that income is the single most important determinant of health in New Zealand (National Health Committee 1998). The current government has provided official recognition that the gap between rich and poor, measured in terms of a variety of economic and social, educational and health indicators, has been steadily widening. Moreover, these disparities are at risk of becoming firmly entrenched. (2)

While New Zealand women continue to have a higher life expectancy than men, they are more likely than men to experience or report more long-term illness or disability such as depression, arthritis and diabetes, poorer mental health, and higher access to health and disability services. The poorest health is likely to be experienced by women on low incomes and of low socio-economic status, particularly Maori and Pacific women (Ministry of Women's Affairs 1999).

The data gathered by the New Zealand Ministry of Health's Taking the Pulse: The 1996/7 New Zealand Health Survey (using the SF-36 health status questionnaire, which is discussed later in this paper) indicate that women scored slightly (but statistically significantly) lower on all scales of self-reported health except general health. The differences were more pronounced for scales more closely associated with mental health. Further analysis of that data (Sarfati and Scott 2001) clearly identifies lone mothers as a vulnerable group in need of special consideration if inequalities in health are to be addressed. The study found that lone mothers had lower physical health scores than partnered mothers, but these differences were largely explained by differences in socio-economic status. However, lone mothers had significantly worse mental health scores. Lone mothers have a higher risk of social isolation and high demands placed on them as main provider and caregiver, which can adversely affect health, both directly and through higher rates of health risk behaviours.

Other overseas studies also indicate that sole mothers on pensions have poorer health than other groups in the population. In the United States, Edin and Lein (1996) conducted multiple qualitative in-depth interviews with 379 low-income mothers in four cities to investigate the factors affecting their survival on welfare benefits and decisions to enter paid work. One-third of respondents indicated that temporary health problems experienced by themselves or their children were factors in delaying entry into employment. Short and Freedman (1998), analysing nationally representative American panel interview data (n=44,000), also demonstrated that having insufficient funds or insurance for medical problems was a key factor in discouraging single mothers from working, confirming findings from previous economic studies.

In Australia, a group of female sole-parent pensioners who reached the end of their benefit eligibility as a result of their youngest child reaching the age of 16 was studied by Shaver et al. (1994). Reasons cited for not undertaking job training included their own ill health or disability (30%), caring for an elderly, disabled or sick adult (4%), and caring for a sick or disabled child (3%). In another Australian study (Wolcott and Glezer 1995), 10% of a sample of sole mothers indicated in interviews that ill health was a factor in their preference for part-time instead of full-time work, with a further 4% citing care of sick relatives as an impediment.

A longitudinal (1987-94) interview study of 300 single mothers in Ontario, half of whom were on social assistance, also showed the close links between health status perceptions of mothers and their children (Gorlick 1995). More recent Canadian research (reported in Browne 2000) claims to demonstrate that welfare mothers with serious mental health problems are more likely to have children with a behavioural disorder or developmental delay, thereby compounding their difficulties in managing the transition into paid work outside the home.

A major policy assumption embedded within most welfare-to-work programmes is that the health of female beneficiaries could be improved by paid employment. Recent research in the United Kingdom casts doubt on this belief. Through a self-completion questionnaire, Baker et al. (1999) researched lone mothers (n=719) and a comparison group of partnered women (n=8,779). Logistic regression analysis showed no significant independent association between paid work and improvement in health status for lone mothers, especially for mental health. The study also suggested that global indicators of long-term health must be made more precise, as the relationship between paid work and health may be condition-specific. Furthermore, it drew attention to the need to understand more fully how changes in the family life cycle--such as those related to preschool children--affect the health-employment relationship. Finally, the study suggests that health status will remain a major factor in influencing whether beneficiaries can remain in paid work after gaining employment.

The population targeted by the study reported on in this paper consisted of lone mothers who were welfare beneficiaries and whose welfare support was subject to work "activation" schemes. At the time of this study New Zealand Domestic Purposes Benefit (DPB) regulations required that a "work test" be carried out several times a year after the recipient's youngest child reached the age of six. Among the exemption criteria were "health reasons". The data in this paper are derived from a sample of those female DPB...