Marcelo Amable

Associations between temporary employment and occupational injury: what are the mechanisms?

Objective: To determine whether observed higher risks of occupational injury among temporary workers are due to exposure to hazardous working conditions and/or to lack of job experience level. Methods: Data systematically recorded for 2000 and 2001 by the Spanish Ministry of Labour and Social Affairs on fatal and non-fatal traumatic occupational injuries were examined by type of employment and type of accident, while adjusting for gender, age, occupation, and length of employment in the company. In the study period there were 1500 fatal and 1 806 532 non-fatal traumatic occupational injuries that occurred at the workplace. Incidence rates and rate ratios (RR) were estimated using Poisson regression models. Results: Temporary workers showed a rate ratio of 2.94 for non-fatal occupational injuries (95% CI 2.40 to 3.61) and 2.54 for fatal occupational injuries (95% CI 1.88 to 3.42). When these associations were adjusted by gender, age, occupation, and especially length of employment, they loose statistic significance: 1.05 (95% CI 0.97 to 1.12) for non-fatal and 1.07 (95% CI 0.91 to 1.26) for fatal. Conclusions: Lower job experience and knowledge of workplace hazards, measured by length of employment, is a possible mechanism to explain the consistent association between temporary workers and occupational injury. The role of working conditions associated with temporary jobs should be assessed more specifically.

The Employment Precariousness Scale (EPRES): psychometric properties of a new tool for epidemiological studies among waged and salaried workers

Background Despite the fact that labour market flexibility has resulted in an expansion of precarious employment in industrialised countries, to date there is limited empirical evidence concerning its health consequences. The Employment Precariousness Scale (EPRES) is a newly developed, theory-based, multidimensional questionnaire specifically devised for epidemiological studies among waged and salaried workers. Objective To assess the acceptability, reliability and construct validity of EPRES in a sample of waged and salaried workers in Spain. Methods A sample of 6968 temporary and permanent workers from a population-based survey carried out in 2004–2005 was analysed. The survey questionnaire was interviewer administered and included the six EPRES subscales, and measures of the psychosocial work environment (COPSOQ ISTAS21) and perceived general and mental health (SF-36). Results A high response rate to all EPRES items indicated good acceptability; Cronbachs α coefficients, over 0.70 for all subscales and the global score, demonstrated good internal consistency reliability; exploratory factor analysis using principal axis analysis and varimax rotation confirmed the six-subscale structure and the theoretical allocation of all items. Patterns across known groups and correlation coefficients with psychosocial work environment measures and perceived health demonstrated the expected relations, providing evidence of construct validity. Conclusions Our results provide evidence in support of the psychometric properties of EPRES, which appears to be a promising tool for the measurement of employment precariousness in public health research.

Employment precariousness and poor mental health: evidence from Spain on a new social determinant of health.

Background. Evidence on the health-damaging effects of precarious employment is limited by the use of one-dimensional approaches focused on employment instability. This study assesses the association between precarious employment and poor mental health using the multidimensional Employment Precariousness Scale. Methods. Cross-sectional study of 5679 temporary and permanent workers from the population-based Psychosocial Factors Survey was carried out in 2004-2005 in Spain. Poor mental health was defined as SF-36 mental health scores below the 25th percentile of the Spanish reference for each respondents sex and age. Prevalence proportion ratios (PPRs) of poor mental health across quintiles of employment precariousness (reference: 1st quintile) were calculated with log-binomial regressions, separately for women and men. Results. Crude PPRs showed a gradient association with poor mental health and remained generally unchanged after adjustments for age, immigrant status, socioeconomic position, and previous unemployment. Fully adjusted PPRs for the 5th quintile were 2.54 (95% CI: 1.95–3.31) for women and 2.23 (95% CI: 1.86–2.68) for men. Conclusion. The study finds a gradient association between employment precariousness and poor mental health, which was somewhat stronger among women, suggesting an interaction with gender-related power asymmetries. Further research is needed to strengthen the epidemiological evidence base and to inform labour market policy-making.

Employment Precariousness in Spain: Prevalence, Social Distribution, and Population-Attributable Risk Percent of Poor Mental Health

As a consequence of labor market flexibilization, nonstandard employment has expanded and standard employment has declined. In many cases, these transformations are best described as an evolution toward precarious employment, which is considered a major determinant of health and health inequalities. Using the Employment Precariousness Scale (EPRES), this study aims to determine the prevalence of precarious employment in the waged and salaried workforce in Spain, to describe its distribution across social groups defined by occupational class, gender, age, and immigrant status, and to estimate the proportion of cases of poor mental health potentially attributable to employment precariousness. Data are from the Psychosocial Work Environment Survey conducted in 2004–5 on a representative sample of the Spanish workforce. Findings indicate a high prevalence of employment precariousness, affecting nearly 6.5 million workers, with almost 900,000 of them exposed to high precariousness. These estimates are higher than the proportion of fixed-term employment reported in regular statistical sources but may today be an underestimation, given the current economic crisis. Additionally, a significant proportion of cases of poor mental health are potentially attributable to employment precariousness. Both the proportion of cases of poor mental health attributable to and the prevalence of employment precariousness were highly unequally distributed across the study sample, indicating that this may be a significant contributor to social inequalities in mental health.

Extending a model of precarious employment: A qualitative study of immigrant workers in Spain

BACKGROUND Since the 1980s, changes in the labor market have modified power relations between capital and labor, leading to greater levels of precarious employment among workers. Globalization has led to a growth in migration, as people leave their countries in search of work. We aimed to describe the dimensions of precarious employment for immigrant workers in Spain. METHODS Qualitative study using analytic induction. Criterion sampling was used to recruit 129 immigrant workers in Spain with documented and undocumented administrative status. Data quality was ensured by triangulation. RESULTS Immigrant workers reported that precarious employment is characterized by high job instability, a lack of power for negotiating employment conditions, and defenselessness against high labor demands. They described insufficient wages, long working hours, limited social benefits, and difficulty in exercising their rights. Undocumented workers reported greater defenselessness and worse employment conditions. CONCLUSIONS This study allowed us to describe the dimensions of precarious employment in immigrant workers.

Las clases sociales y la pobreza

Las clases sociales y la pobreza son determinantes sociales fundamentales que influyen en la aparicion de muchas enfermedades y la presencia de desigualdades en salud. En los anos noventa se produjo en Espana una notable oscilacion en la desigualdad y la pobreza. Esta aumento a mediados de la decada, cuando aparecieron nuevas formas de marginacion y de exclusion, tasas elevadas de desempleo y notables dificultades de acceso al mercado laboral, muy especialmente entre los trabajadores con menos recursos. La sociedad actual sigue caracterizandose por su clara estratificacion y la existencia de clases sociales donde predominan unas tasas elevadas de subempleo y precariedad laboral. Ademas, en Espana la pobreza sigue siendo un problema social endemico, claramente por encima de la media europea. La disminucion de las desigualdades en salud y la mejora de la calidad de vida dependeran en gran medida de la reduccion de los niveles de pobreza y la mejora en la equidad de oportunidades y la calidad en el empleo. El conocimiento de como la clase social y la pobreza afectan a la salud publica requiere mejorar la calidad de la informacion y la investigacion, y que los responsables de la planificacion o la toma de decisiones politicas tengan en cuenta estos determinantes en la realizacion de acciones preventivas y de promocion de la salud.

La precariedad laboral ¿un nuevo problema de salud pública?

E n las últimas décadas, el desarrollo del modo de producción capitalista ha generado profundas transformaciones en el mundo laboral. En la primera mitad de los años setenta comienza a manifestarse la crisis de crecimiento de una etapa histórica del capitalismo caracterizada por el régimen de acumulación fordista1. Se cuestiona entonces la producción de bienes orientada a mercados masificados y el rol de los asalariados como consumidores para impulsar la demanda2. La delimitación del uso del trabajo asalariado se configura a través de las normas reguladoras del mercado laboral, hasta ese momento caracterizadas por una negociación salarial centralizada a largo plazo, jornadas laborales completas y estabilidad en el puesto de trabajo3. Estas características definen lo que se ha dado en llamar el «empleo tradicional» en contraposición a las nuevas modalidades de empleo. A finales de los años setenta comienzan a emerger nuevas formas de organización de la producción. Así, la incorporación de nuevas tecnologías combinadas con una nueva organización del trabajo transforman el mundo productivo. La «flexibilidad» responde a la profunda reorganización social y económica que implica la nueva etapa de crecimiento4, constituyéndose en el criterio fundamental que organiza la producción5-7. Se usan sistemas técnicos flexibles, horarios flexibles, la flexibilidad funcional y salarial, e incluso se valora la «flexibilidad» como un rasgo positivo del carácter de los trabajadores8. En cuanto al empleo, su objetivo será adaptar el volumen de trabajadores a las fluctuaciones de la demanda del mercado9 y sus dos principales consecuencias, la aparición de formas atípicas de empleo, como el trabajo a domicilio, el tele-trabajo o el trabajo a demanda, y el incremento del empleo informal, el trabajo autónomo, el trabajo a tiempo parcial o el empleo temporal. Durante los años ochenta el empleo inestable aumenta notablemente en Europa hasta representar en 1997 el 12% del total de asalariados, desde sólo el 2% en Luxemburgo hasta un máximo del 34% en el caso de España10. En nuestro país, las sucesivas reformas legales11 han permitido e incentivado un elevado crecimiento del empleo temporal que ha aumentado desde el 15% en 1987 al 35,3% en 1995, estabilizándose desde entonces en alrededor de un tercio de los asalariados. Entre ellos, las mujeres y los jóvenes son los colectivos más afectados. Así, en 1999 el índice de temporalidad fue de un 35% entre las mujeres y un 31% en los hombres12. Entre los jóvenes, en 1995 la temporalidad fue del 87% en el grupo de 16 a 19 años y del 74% entre quienes tenían 20 a 24 años13. Para muchos de ellos, la contratación temporal representa una situación carente de alternativas y un antecedente escasamente valorado en el mercado que impide romper el círculo de la inestabilidad14. Por ejemplo, la tasa de desempleo entre quienes tuvieron una relación laboral temporal fue casi 4 veces superior a la de quienes tuvieron una relación fija15. Una explicación podría encontrarse en la simplicidad de las tareas en las que intervienen, que impiden la incorporación de una formación laboral que sólo se adquiere a través de la experiencia. Un conocimiento, propio de la experiencia laboral, que es fundamental en el desarrollo de las identidades individuales y colectivas8,16,17. La utilización de los contratos temporales responde a una lógica económica determinada que aumenta la capacidad de disciplinar la fuerza de trabajo y repercute en la calidad de vida de los trabajadores. Ante la incertidumbre de la demanda del mercado, el empresario externaliza el riesgo hacia los trabajadores a través del contrato temporal. Por lo tanto, la decisión sobre la contratación temporal está en manos de las empresas, y depende de su posición estratégica en la cadena de proveedores y clientes18. Los trabajadores temporales tampoco controlan su futuro contractual a partir de su rendimiento y esfuerzo personal, debido a la falta de reglas claras que recompensen dicho esfuerzo19. Las características del empleo temporal cuestionan al propio trabajo en su doble vertiente de empleo y de actividad subjetiva y socialmente valorada. Genera una movilidad muy alta en el mercado de trabajo y cambios permanentes en la condición de actividad de los individuos. Los trabajadores con contratos temporales, lejos de abandonar la inseguridad del desempleo, la extienden a su ocupación. Durante 1998, para el 24% de los trabajadores temporales la duración de los contratos no superaba los tres meses, y el 34% poseía un contrato que se extendía entre 4 y 6 meses12. Con la temporalidad se rompe la vieja dicotomía entre empleo y deLa precariedad laboral ¿un nuevo problema de salud pública?

Methods for the Study of Employment Relations and Health Inequalities in a Global Context

The authors describe the major methods and sources of information used in the EMCONET study for researching global, employment-related health inequalities. A systematic review of the literature provides valuable knowledge for research in this area. However, the limited number of studies, the poor quality of methods used, and a lack of theories or concepts have produced inconsistent results. To minimize bias from these limitations and to reach a comprehensive understanding of the complexity and health effects of global employment conditions, this article outlines key strategies for a synthetic, comprehensive, participatory approach: adapting transdisciplinary knowledge acquisition, building a theoretical model, employing multiple sources for data collection, and using a variety of methods (qualitative/quantitative studies and narrative knowledge). This approach provides solutions to important research and policy needs regarding the global context of key employment relations, social mechanisms, and health inequalities. The strategies are adapted to synthesize input from several disciplines (epidemiology, sociology, and political science), social actors, and institutions. The studys main sources of information are a variety of digital, bibliographic databases; the authors reviewed the scientific literature from 1985 to 2008 and books, reports, and other documents from 2000 to 2008.

Incidencia de incapacidad permanente en una cohorte de trabajadores afiliados a la Seguridad Social, 2004-2007

OBJECTIVE To describe the incidence of permanent disability, both work-related and non-work-related, by several socioeconomic and geographical variables. METHODS We performed a retrospective study of a cohort of 768,454 workers covered by the General Social Security Regimen, followed-up from 2004 to 2007. This study was based on the Continuous Working Life Survey. In the 4 years of follow-up, 7,749 cases in 1,937,921 workers-years were identified. Incidence rates and crude and adjusted rate ratios were estimated by Poisson regression models. RESULTS The incidence of non-work-related permanent disability was 10 times greater than that of work-related disability (36.3 versus 3.7 per 10,000 workers-years). The incidences for both non-work-related and work-related disability were higher in men and increased with age and lower education level. For non-work-related permanent disability, the region with the highest incidence was Asturias and that with the lowest was Madrid (56.7 vs. 23.3). For work-related permanent disability, the highest incidence was found in Asturias and the lowest in Navarre (7.8 vs. 1.4). This differential was maintained for work-related and non-work-related permanent disability for Asturias, after adjustment was made by sex, age, educational level, company size and economic activity. CONCLUSIONS In this study, we observed substantial differences in the incidences of permanent disability by demographic, social and geographical characteristics, which should be analyzed in greater depth, especially the differences observed by regions.

Cuestionario básico y criterios metodológicos para las Encuestas sobre Condiciones de Trabajo, Empleo y Salud en América Latina y el Caribe

El objetivo de este trabajo es presentar un cuestionario basico y criterios metodologicos minimos, para ser considerados en futuras Encuestas sobre Condiciones de Trabajo, Empleo y Salud (ECTES) en America Latina y el Caribe. Para ello, se llevo a cabo un proceso de consenso, tanto virtual como presencial, con la participacion de un grupo internacional de expertos que, para definir la propuesta, partieron de las encuestas disponibles en la region hasta 2013. El cuestionario final incluyo 77 preguntas agrupadas en seis dimensiones: caracteristicas sociodemograficas del trabajador y la empresa; condiciones de empleo; condiciones de trabajo; estado de salud; recursos y actividades preventivas; y caracteristicas familiares. Entre los criterios metodologicos minimos destacan el domicilio de la persona entrevistada como lugar de la entrevista y los relacionados con la calidad del trabajo de campo. Estos resultados pueden ayudar a mejorar la comparabilidad de las futuras ECTES en America Latina y el Caribe, lo que contribuiria a mejorar la informacion en salud laboral en la region.