As mentioned in the discussion of the human capital model there are two main actors involved in the health selection process: employers and employees on the labor market. So far we have looked at the first actor and modified the human capital model from their perspective introducing gender biased subjective performance evaluation as a modifier of labor market rewards determination.
Now, we can take a closer look at the other actor, the employee. Do employees have something to contribute to the discussion of possible gender differences in health effects? I argue that they do. Their health behavior can be an important modifying factor in the human capital model. One main assumption which has been upheld so far will be challenged: Is health always
related to productivity? Especially a gender perspective makes room for doubt to this claim.
In the following we will see why.
The starting point of the argument is an external health shock affecting a worker. What should now be under scrutiny is the worker’s reaction towards this health shock. Two possibilities arise:
1. The worker can reduce her effort and/or working hours to deal with her health condition.
This means accepting a (short-term) reduction of labor market rewards (with possible longterm consequences) in favor of a short-term improvement of the health status.
2. The worker can show the same amount of effort regardless of his health condition. This means accepting a (short-term) reduction of health (with possible long-term consequences) in favor of keeping the labor market rewards.
Which option the worker chooses depends on his preferences (for a related argument, see Johns 2010, Cropanzano, Rupp & Byrne 2003). Preferences for health come into play as well as preferences for career (to have a broad category encompassing preferences for labor income, working hours, etc).
Preferences are mostly generated through socialization processes as discussed in section 2.5.2.
This highlights the role of the parents, school, and early adulthood for later life decisions on health related behavior (Hurrelmann 1994). The stronger the preference for health is, the higher the chance that the person chooses option 1. The higher the preference for career is the more likely the person is to choose option 2. It is important to note that these preferences should be seen in relation to each other. So the higher the preference for subjective health compared to the preference for career the more likely a person is to choose option 1.
In reality options 1 and 2 form a continuum. One pole represents complete focus on recovery, the other complete focus on the job, disregarding recovery. It follows that the higher the preference for career is - relative to preference for health - the more time and energy will be used for the job instead of recovering from a health shock.
If a person chooses to (partially) neglect recovery it can have different consequences. First, it is possible that she fully recovers despite the lack of focus on recovery. In this case one could say the person is lucky. Second, the person needs to borrow energy or health from future points in time or the person needs to externalize other non-labor-market efforts to other persons.
Recovery will take longer. There might even be long-term negative health consequences. This can be directly visible or rather be a cumulative process (which might lead to burn-out or chronic conditions of mental or physical health).
2.6.1. Gender Differences in Health Behavior
The preferences for health and the respective health behavior do not vary randomly within the population. A lot of studies have shown that women put more emphasis on maintain-ing a healthy lifestyle and treatmaintain-ing illnesses or mental problems with more care than men do (Dean 1989, Wickrama et al. 1999, Cockerham, Hinote & Abott 2006, Stefansdottir &
Vilhjalmsson 2007). Men are often considered to be less reactive towards health problems.
The problem is finding evidence not only for gender differences in preference for health, but for health in relation to career. Some empirical findings directly indicate that such particular gender differences exist.
Women see themselves as responsible for matters of health in the family, acquire more knowledge and follow through with the consequences (Faltermaier 2008, 41). Differences in health behavior as an explanatory factor for differences in sickness absence are not uncommon (Zok 2008, 119).
Collins et al. (2005) find that women are more likely to be absent from work given a chronic health condition than men are. Self-reported impairment of work due to a chronic health condi-tion was not gender sensitive. In a study by Fried, Melamed & Ben-David (2002) the results show that women are more susceptible to stress from noise than men are. In a study by Sandanger, Nygard, Brage & Tellnes (2000) women showed absolute higher prevalence of sickness absence given a mental health problems, but relatively to the prevalence of mental health problems a lower prevalence of sickness absence than men. This could either be interpreted as women reacting less to mental health problems or men recognize or report fewer mental health problems.
2.6.2. Consequences of Differences in Health Behavior on Health Effects
Let us say we accept the assumption that men have lower preference for health than women.
It follows from the argument in section 2.6 that we should expect less reaction in form of recovery and at the expense of work effort from men than from women. If you do no adjust your effort after a health shock then your labor market success should not be affected. Labor market success becomes thereby invariant to health. The association between health and labor market success is reduced the stronger the preference for career is (relative to preference for health). Since men have a higher preference for career than women, their health should have a lower effect on their labor market success than women’s health has.
I assume that there are no gender specific learning processes with growing age. I make this assumption to rule out the possibility that men and women adapt over time in their reactions to health behavior. The adaption could lead to a possible convergence of health behaviors or to a divergence depending on success and preferences. This assumption could be relaxed if age
specific analyses10 were possible. However, the number of observations even in the SOEP is too small for such an analysis.
Again we can easily show a formalized version of the argument above. We simply assume that effort is only a function of health for women, but not for men:
ef =e(H, EN LM) (2.15)
em =e(EN LM)⊥H (2.16)
Jumping to the calculation of marginal effects of effort on health we get for women:
1
(ef(H, EN LM)∗τf)(1−σ)αtσ (2.17)
and for men:
1
(em(EN LM)∗τm)(1−σ)αtσ (2.18)
The equation shows that health does not play a role for LMR in the case of men, but it does for women. This is a theoretical conclusion that is matched by findings in the literature (McDonough & Amick 2001, 136).