Christophe Vanroelen

Precarious Employment: Understanding an Emerging Social Determinant of Health

Employment precariousness is a social determinant that affects the health of workers, families, and communities. Its recent popularity has been spearheaded by three main developments: the surge in flexible employment and its associated erosion of workers employment and working conditions since the mid-1970s; the growing interest in social determinants of health, including employment conditions; and the availability of new data and information systems. This article identifies the historical, economic, and political factors that link precarious employment to health and health equity; reviews concepts, models, instruments, and findings on precarious employment and health inequalities; summarizes the strengths and weaknesses of this literature; and highlights substantive and methodological challenges that need to be addressed. We identify two crucial future aims: to provide a compelling research program that expands our understanding of employment precariousness and to develop and evaluate policy programs that effectively put an end to its health-related impacts.

Welfare states, flexible employment, and health: A critical review

OBJECTIVESnThe aim of this literature review is to identify whether differences between welfare regimes can manifest diverse consequences for the health effects of insecure and precarious employment, as well as to address challenging issues and implications for future research.nnnMETHODSnBy searching PubMed, PsychINFO, Stork Social Science Citation Index, and Index Lilac, from 1988 to June 2010, a total of 104 original articles were selected (65 on job insecurity; 39 on precarious employment).nnnRESULTSnAfter classifying selected empirical studies according to a six-regime welfare state typology (Scandinavian, Bismarckian, Southern European, Anglo-Saxon, Eastern European, and East Asian), this systematic review reveals that welfare regimes may be an important determinant of employment-related health. Precarious workers in Scandinavian welfare states report better or equal health status when compared to their permanent counterparts. By contrast, precarious work in the remaining welfare state regimes is found to be associated with adverse health outcomes, including poor self-rated health, musculoskeletal disorders, injuries, and mental health problems.nnnCONCLUSIONSnFuture research should be conducted by employing conceptual models that specify how macro-economic processes, country-level welfare factors, and individual employment histories and environments relate to employment-related health inequalities.

Employment relations, social class and health: A review and analysis of conceptual and measurement alternatives

Employment relations, as a theoretical framework for social class, represent a complementary approach to social stratification. Employment relations introduce social relations of ownership and control over productive assets to the analysis of inequalities in economic (e.g., income), power (occupational hierarchy), and cultural (e.g., education) resources. The objectives of this paper are to briefly clarify the theoretical background on socio-economic indicators used in social epidemiology and to conduct a review of empirical studies that adopt relational social class indicators in the socio-epidemiological literature. Measures of employment relations in social determinants of health research can be classified within two major conceptual frameworks: 1) Neo-Weberian, like the National Statistics Socio-Economic Classification (NS-SEC) which is widely used in the United Kingdom; and 2) Neo-Marxian, like Erik O. Wrights social class indicators, which are being used by social epidemiologists in the Americas and Europe. Our review of empirical findings (49 articles found) reveals that the relation between employment relations and health does not necessarily imply a graded relationship. For example, small employers can exhibit worse health than highly skilled workers, and supervisors can display worse health than frontline workers. The policy implications of employment relations research are therefore different, and complement those of income or education health gradient studies. While the latter studies tend to emphasize income redistribution policy options, employment relations implicate other factors such as workplace democracy and social protection. Our analysis confirms that the current transformation of employment relations calls for new social class concepts and measures to explain social inequalities in health and to generate policies to reduce them.

Psychosocial working conditions and self-reported health in a representative sample of wage-earners: A test of the different hypotheses of the Demand-Control-Support model

PurposeThis paper presents an in-depth examination of the demand–control–support–model (DCS-model). Each hypothesis of the DCS-model is tested: the main effects of job demands, job autonomy, task variation and social support; the additive effects of job strain, active learning and iso-strain; and the interactive buffer-effects of job autonomy, task variation and support on job demands.MethodsData from a representative cross-sectional sample of 11,099 male and female wage-earners are investigated using log linear methods. The outcome measures are self-reported persistent fatigue, musculoskeletal complaints and emotional well-being.ResultsThere is some support for each of the hypotheses. Quantitative job demands and superior support have the strongest effects. The job autonomy and buffer hypotheses are only partially supported.ConclusionsThe strong effects of job demands, support, job strain and active learning are suggesting that a policy aimed at improving psychosocial working conditions should focus on a bearable level of job demands and the quality of social relationships at work.

Differential exposure and differential vulnerability as counteracting forces linking the psychosocial work environment to socioeconomic health differences

Background In this article, the link between (1) psychosocial working conditions (job demands, job autonomy, task variation, social support), (2) self-reported health (persistent fatigue, musculoskeletal complaints, emotional well-being) and (3) socioeconomic position (skill levels, occupational status) is explored. The two theoretical pathways linking the psychosocial work environment to socioeconomic differences in health are explored: differential exposure and differential vulnerability. Previously, the focus has often been on social inequalities in exposure to the stressors. The pathway of differential vulnerability in different socioeconomic positions is often neglected. Methods In a representative cross-sectional sample of 11u2009099 Flemish (Belgian) wage earners, 16–65u2005years of age (47.5% women), logit modelling is applied. Results Higher exposure to psychosocial occupational stressors is associated with a higher prevalence of adverse health outcomes. Lower skill levels and subordinate occupational positions show a higher prevalence of musculoskeletal complaints, but not of persistent fatigue or emotional well-being. High demands, job strain and iso-strain are more common in higher-skilled, supervisory and managerial positions, but have the strongest health-damaging effects in lower socioeconomic positions. Low control is more prevalent in lower-skilled and subordinate positions, while having stronger adverse health effects in higher socioeconomic positions—the same holds for social support, although it has no clear socioeconomic distribution. Conclusion Differential exposure and differential vulnerability constitute two counteracting forces in constituting the association between the psychosocial work environment and socioeconomic differences in self-reported health complaints among wage earners.

Labour market trajectories and early retirement due to permanent disability: a study based on 14 972 new cases in Spain

BACKGROUNDnTo analyse the impact of labour market trajectory indicators on early retirement, measured by age at onset of permanent disability (PD).nnnMETHODSnFour labour market trajectory indicators were reconstructed in 14 972 new cases of PD recognized between 2004 and 2010: (1) number of employment contracts, (2) number of unemployment periods, (3) number of periods without social security affiliation and (4) percentage of time spent in inactivity. The outcome was measured as the age at onset of PD. Median differences and 95% confidence intervals (95%CI) were compared using a median regression. Analyses were stratified by sex and adjusted for occupational category and total time elapsed between the beginning of working life and the age at onset of PD: separately for each labour market indicator, and adjusted for each other.nnnRESULTSnIn men, the age at the onset of PD for workers with 15 or more employment contracts decreased by 4.8 years; and for workers with five or more periods without affiliation it decreased by 4.6 years. In women, the corresponding decreases were 5.8 years for 15 or more contracts and 7.2 years for five or more unaffiliated periods. The results for four indicators slightly changed when they were mutually adjusted.nnnCONCLUSIONSnPoor employment conditions, such as having a high number of periods without affiliation, a high number of contracts (in men) and a higher percentage of inactive time (in women) are associated with early retirement due to PD.

The clustering of health-related occupational stressors among contemporary wage-earners

In this study, it is investigated whether a typology can be imposed upon a sample of wage-earners, based on their exposure to a broad number of occupational stressors: quantitative, emotional, and physical demands, repetitive movements, atypical schedules, low job control, relationships with superiors, job insecurity, and bullying behaviour. Also associations between this typology and measures of emotional problems (EP) and musculoskeletal complaints (MC) are tested. Logistic regression and a latent class cluster analysis are performed on a representative sample of 10,074 Flemish (Belgian) employees. Five clusters are revealed: “low stress”, “high stress”, “manual-passive”, “human contact”, and “high demand”. These clusters are showing a clear socioeconomic distribution and distinct associations with EP and MC—with the “high stress cluster” being the most problematic. Health-damaging occupational stress clusters are prevalent at both higher and lower socioeconomic positions. This is suggesting a complex relationship between occupational stressors and socioeconomic health variations.

Social security status and mortality in Belgian and Spanish male workers

OBJECTIVEnTo assess differences in mortality rates between social security statuses in two independent samples of Belgian and Spanish male workers.nnnMETHODSnStudy of two retrospective cohorts (Belgium, n=23,607; Spain, n=44,385) of 50-60 year old male employees with 4 years of follow-up. Mortality rate ratios (MRR) were estimated using Poisson regression models.nnnRESULTSnMortality for subjects with permanent disability was higher than for the employed, for both Belgium [MRR=4.56 (95% CI: 2.88-7.21)] and Spain [MRR=7.15 (95% CI: 5.37-9.51)]. For the unemployed/early retirees, mortality was higher in Spain [MRR=1.64 (95% CI: 1.24-2.17)] than in Belgium [MRR=0.88 (95% CI: 0.46-1.71)].nnnCONCLUSIONnMRR differences between Belgium and Spain for unemployed workers could be partly explained because of differences between the two social security systems. Future studies should further explore mortality differences between countries with different social security systems.