Kjetil A. van der Wel

A balancing act? Work–life balance, health and well-being in European welfare states

BACKGROUND Recent analyses have shown that adverse psychosocial working conditions, such as job strain and effort-reward imbalance, vary by country and welfare state regimes. Another work-related factor with potential impact on health is a poor work-life balance. The aims of this study are to determine the association between a poor work-life balance and poor health across a variety of European countries and to explore the variation of work-life balance between European countries. METHODS Data from the 2010 European Working Conditions Survey were used with 24,096 employees in 27 European countries. Work-life balance is measured with a question on the fit between working hours and family or social commitments. The WHO-5 well-being index and self-rated general health are used as health indicators. Logistic multilevel models were calculated to assess the association between work-life balance and health indicators and to explore the between-country variation of a poor work-life balance. RESULTS Employees reporting a poor work-life balance reported more health problems (Poor well-being: OR = 2.06, 95% CI = 1.83-2.31; Poor self-rated health: OR = 2.00, 95% CI = 1.84-2.17). The associations were very similar for men and women. A considerable part of the between-country variation of work-life balance is explained by working hours, working time regulations and welfare state regimes. The best overall work-life balance is reported by Scandinavian men and women. CONCLUSION This study provides some evidence on the public health impact of a poor work-life balance and that working time regulations and welfare state characteristics can influence the work-life balance of employees.

Educational inequalities in health in European welfare states: A social expenditure approach

A puzzle in comparative health inequality research is the finding that egalitarian welfare states do not necessarily demonstrate narrow health inequalities. This paper interrogates into this puzzle by moving beyond welfare regimes to examine how welfare spending affect inequalities in self-rated across Europe. We operationalise welfare spending in four different ways and compare both absolute and relative health inequalities, as well as the level of poor self-rated health in the low education group across varying levels of social spending. The paper employs data from the EU Statistics of Income and Living Conditions (EU-SILC) and includes a sample of approximately 245,000 individuals aged 25-80+ years from 18 European countries. The data were examined by means of gender stratified multilevel logistic regression analyses. The results show that social expenditures are associated with lower health inequalities among women and, to a lesser degree, among men. Especially those with primary education benefit from high social transfers as compared with those who have tertiary education. This means that lower educational inequalities in health - in absolute and relative terms- are linked to higher social spending. The four different operationalisations of social spending produce similar patterns.

How do macro-level contexts and policies affect the employment chances of chronically ill and disabled people? Part II: The impact of active and passive labor market policies.

The authors investigate three hypotheses on the influence of labor market deregulation, decommodification, and investment in active labor market policies on the employment of chronically ill and disabled people. The study explores the interaction between employment, chronic illness, and educational level for men and women in Canada, Denmark, Norway, Sweden, and the United Kingdom, countries with advanced social welfare systems and universal health care but with varying types of active and passive labor market policies. People with chronic illness were found to fare better in employment terms in the Nordic countries than in Canada or the United Kingdom. Their employment chances also varied by educational level and country. The employment impact of having both chronic illness and low education was not just additive but synergistic. This amplification was strongest for British men and women, Norwegian men, and Danish women. Hypotheses on the disincentive effects of tighter employment regulation or more generous welfare benefits were not supported. The hypothesis that greater investments in active labor market policies may improve the employment of chronically ill people was partially supported. Attention must be paid to the differential impact of macro-level policies on the labor market participation of chronically ill and disabled people with low education, a group facing multiple barriers to gaining employment.

All Part of the Job? The Contribution of the Psychosocial and Physical Work Environment to Health Inequalities in Europe and the European Health Divide

This study is the first to examine the contribution of both psychosocial and physical risk factors to occupational inequalities in self-assessed health in Europe. Data from 27 countries were obtained from the 2010 European Working Conditions Survey for men and women aged 16 to 60 (n = 21,803). Multilevel logistic regression analyses (random intercept) were applied, estimating odds ratios of reporting less than good health. Analyses indicate that physical working conditions account for a substantial proportion of occupational inequalities in health in both Central/Eastern and Western Europe. Physical, rather than psychosocial, working conditions seem to have the largest effect on self-assessed health in manual classes. For example, controlling for physical working conditions reduced the inequalities in the prevalence of “less than good health” between the lowest (semi- and unskilled manual workers) and highest (higher controllers) occupational groups in Europe by almost 50 percent (Odds Ratio 1.87, 95% Confidence Interval 1.62–2.16 to 1.42, 1.23–1.65). Physical working conditions contribute substantially to health inequalities across “post-industrial” Europe, with women in manual occupations being particularly vulnerable, especially those living in Central/Eastern Europe. An increased political and academic focus on physical working conditions is needed to explain and potentially reduce occupational inequalities in health.

Work, health, and welfare: the association between working conditions, welfare states, and self-reported general health in Europe.

This article is the first to examine the association between self-reported general health and a wide range of working conditions at the European level and by type of welfare state regime. Data for 21,705 men and women ages 16 to 60 from 27 European countries were obtained from the 2010 European Working Conditions Survey. The influence of individual-level sociodemographic, physical, and psychosocial working conditions and of the organization of work were assessed in multilevel logistic regression analyses, with additional stratification by welfare state regime type (Anglo-Saxon, Bismarckian, Eastern European, Scandinavian, and Southern). At the European level, we found that “not good” general health was more likely to be reported by workers more exposed to hazardous working conditions. Most notably, tiring working positions, job strain, and temporary job contracts were strongly associated with a higher likelihood of reporting “not good” health. Analysis by welfare state regime found that only tiring or painful working conditions were consistently associated with worse self-reported health in all regimes. There was no evidence that the Scandinavian welfare regime protected against the adverse health effects of poor working conditions. The article concludes by examining the implications for comparative occupational health research.

Social inequalities in "sickness": does welfare state regime type make a difference? A multilevel analysis of men and women in 26 European countries.

In comparative studies of health inequalities, public health researchers have usually studied only disease and illness. Recent studies have also examined the sickness dimension of health, that is, the extent to which ill health is accompanied by joblessness, and how this association varies by education within different welfare contexts. This research has used either a limited number of countries or quantitative welfare state measures in studies of many countries. In this study, the authors expand on this knowledge by investigating whether a regime approach to the welfare state produces consistent results. They analyze data from the European Union Statistics on Income and Living Conditions (EU-SILC); health was measured by limiting longstanding illness (LLSI). Results show that for both men and women reporting LLSI in combination with low educational level, the probabilities of non-employment were particularly high in the Anglo-Saxon and Eastern welfare regimes, and lowest in the Scandinavian regime. For men, absolute and relative social inequalities in sickness were lowest in the Southern regime; for women, inequalities were lowest in the Scandinavian regime. The authors conclude that the Scandinavian welfare regime is more able than other regimes to protect against non-employment in the face of illness, especially for individuals with low educational level.

Employment Inequalities Through Busts and Booms The Changing Roles of Health and Education in Norway 1980-2005

In this article, we study trends in employment by education and longstanding illness (LSI), and discuss whether the findings are compatible with business cycle fluctuations or postindustrial labour market developments. Our analyses are based on data on the working age population (aged 25—66 years) from the Norwegian Survey of Living Conditions (1980—2005). We find increasing differences in employment between those reporting LSI and those who do not, while gender differences are getting smaller. Interaction terms from logistic regression analyses between time and LSI and time and education indicate that people with lower education and those reporting LSI are more often found outside the labour market over time. While the 1980s recession did not have much impact on employment inequalities, the more severe 1990s recession coincided with widening employment inequalities by education and health. Periods of economic recovery did not lessen these inequalities. The study concludes that health and educational inequalities in employment have been rising in Norway since 1980. As business cycle changes alone could not account for the development, elements of the postindustrial labour market are discussed and considered.

Long-term effects of poor health on employment: the significance of life stage and educational level

Previous research has found the employment consequences of poor health to be of increased magnitude in low qualified groups. The purpose of this study is to investigate if this relationship varies within different stages of the life course when focusing on long term associations with non-employment. An expectation of the article is that stronger effects of poor health may be found in young adults compared to middle aged people. The article considers two possible explanations: normative change and life stage resources. Using three-wave panel data from the Norwegian county of Nord-Trøndelag, the HUNT study allows the study of respondents over two decades. Two narrow cohorts have been selected for comparison, and health was measured by self-reported longstanding limiting illness. For the analyses, cross tabulations, logistic regression, and fixed effects logistic regression techniques are used. The article concludes in favour of the resource explanation; young adulthood is a critical period in relation to long term employment consequences of poor health, and especially so among people with fewer educational resources. Cohort differences in the employment consequences of poor health are not likely to be caused by poorer work ethics among younger cohorts.

Who knows the risk? A multilevel study of systematic variations in work-related safety knowledge in the European workforce

Objectives Health and safety instructions are important components of occupational prevention. Albeit instruction is mandatory in most countries, research suggests that safety knowledge varies among the workforce. We analysed a large European sample to explore if all subgroups of employees are equally reached. In a comparative perspective, we also investigated if country-level determinants influence the variance of safety knowledge between countries. Methods We used data on 24 534 employees from 27 countries who participated in the 2010 European Working Conditions Survey. Safety knowledge was measured as self-assessed quality of safety information. Country-level determinants were added from Eurostat databases (gross domestic product) and the European Survey of Enterprises on New and Emerging Risks (ESENER) study (% companies with A: safety plan or B: a labour inspectorate visit). Associations between knowledge, sociodemographic, occupational characteristics and macrodeterminants were studied with hierarchical regression models. Results In our sample, 10.1% reported a low degree of health and safety knowledge. Across all countries, younger workers, lower educated workers, production workers, private sector employees, those with less job experience or a temporary contract, or those who work in small businesses were more likely to report low levels of information. Moreover, low information prevalence varied by country. Countries with a high proportion of companies with a safety plan and recent labour inspectorate on-site visits had higher proportions of informed workers. Conclusions A vast majority reported to be well informed about safety risks but systematic inequalities in the degree of knowledge between subgroups were evident. Further efforts on the workplace, the organisational and the political level are needed to universally implement existing occupational safety regulations.

Health related social exclusion in Europe: a multilevel study of the role of welfare generosity

IntroductionThe aim of this paper was to investigate the association between health, social position, social participation and the welfare state. Extending recent research on the social consequences of poor health, we asked whether and how welfare generosity is related to the risk of social exclusion associated with combinations of poor health, low education and economic inactivity.MethodsOur analyses are based on data from the European Social Survey, round 3 (2006/7), comprising between 21,205 and 21,397 individuals, aged 25–59 years, within 21 European welfare states. The analyses were conducted by means of multilevel logistic regression analysis in STATA 12.ResultsThe results demonstrated that the risk of non-participation in social networks decreased as welfare generosity increased. The risk of social exclusion, i.e. non-participation in social networks among disadvantaged groups, seldom differed from the overall association, and in absolute terms it was invariably smaller in more generous welfare state contexts.ConclusionsThe results showed that there were no indications of higher levels of non-participation among disadvantaged groups in more generous welfare states. On the contrary, resources made available by the welfare state seemed to matter to all individuals in terms of overall lower levels of non-participation. As such, these results demonstrate the importance of linking health related social exclusion to the social policy context.