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During the transition from childhood to working ages, social causation and health selection are equally weak.
More specifically, research on health service use that takes into account health selection effects is greatly needed.
Estimating the size of health inequalities between hierarchical levels of job status and the contribution of direct health selection to these inequalities for men and women in the private and public sector in Germany.
Health differences which correspond to socioeconomic status (SES) can be attributed to three causal mechanisms: SES affects health (social causation), health affects SES (health selection), and common background factors influence both SES and health (indirect selection).
While the contribution of common background factors remains difficult to assess, this study shows that both social causation and health selection are responsible for health inequalities; however, their relative importance changes with age.
Health selection bias can thus be assessed.
Social causation has received more empirical support than the health selection thesis.
The impact of health selection on the results has been studied but not very extensively.
Health selection can help to explain associations between unemployment and disease.
Differentiation between health selection and social causation could be a particular problem for schizophrenia.
22 Direct health selection is where pre-existing illness increases the risk of unemployment.
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