Pekka Virtanen

Employment security and health

Objective: To study the relation of contractual and perceived employment security to employee health. Design: Cross sectional survey. Setting: Municipal sector employees in eight Finnish towns. Participants: 5981 employees with a permanent contract and 2786 employees with a non-permanent contract (2194 fixed term contract, 682 government subsidised contract). Outcome measures: Poor self rated health, chronic disease, and psychological distress. Results: Compared with permanent employees, fixed term men and women had better self rated health (men odds ratio 0.70; 95% confidence intervals 0.50 to 0.98, women 0.70 (0.60 to 0.82) and less chronic disease (men 0.69; 0.52 to 0.91; women 0.89; 0.79 to 1.02), but women had more psychological distress (1.26; 1.09 to 1.45). The only difference between subsidised employees and permanent employees was the high level of psychological distress in women (1.35; 1.09 to 1.68). Low perceived employment security was associated with poor health across all three indicators. The association of low perceived security with psychological distress was significantly stronger in permanent employees than among fixed term and subsidised employees, indicating that perceived security is more important for mental health among employees with a permanent contract. Conclusions: Contractual security and perceived security of employment are differently associated with health. It is therefore important to distinguish between these aspects of employment security in studies of labour market status and health. Such studies will also need to control for health selection, which is unlikely to operate in the same way among permanent and non-permanent employees.

Sickness absence as a risk factor for job termination, unemployment, and disability pension among temporary and permanent employees

Objectives: This study examined sickness absence as a risk factor for job termination, unemployment, and disability pension among temporary and permanent workers. Methods: Prospective cohort study with data on employment contract and sickness absence in 1996, job termination by 1997, and employment status in 1997 and 2000 for 19 093 temporary and 41 530 permanent public sector employees. Results: For women aged 40 years or less and for women over 40, a high sickness absence increased the risk of job termination among temporary employees (OR 1.52 (95% CI 1.36 to 1.71) and OR 1.70 (95% CI 1.36 to 2.13) respectively). High absence was not associated with job termination among men in temporary employment. Among permanent employees, high sickness absence predicted job termination among older, but not among younger employees. Temporary employees with high sickness absence were at the highest risk of immediate unemployment and unemployment three years later. Among older permanent employees, high sickness absence was associated with subsequent work disability pension. Conclusions: A high rate of sickness absenteeism increases the risk of job termination and unemployment among women in temporary public sector jobs. For permanent employees, secure employment provides protection against unemployment even in the case of high sickness absence.

Workplace as an origin of health inequalities.

OBJECTIVE: To investigate the effect of the workplace on the socioeconomic gradient of sickness absence. DESIGN: Comparison of the relation between socioeconomic status and employee sickness absence in three different towns. SETTINGS: The towns of Raisio, Valkeakoski, and Nokia in Finland. They are equal in size and regional social deprivation indices, located in the neighbourhood of a larger city, and produce the same services to the inhabitants. SUBJECTS: All permanent local government employees from Raisio (n = 887), Valkeakoski (n = 972), and Nokia (n = 934) on the employers registers during 1991 to 1993. MAIN OUTCOME MEASURES: Rates of short (1-3 days) and long (> 3 days) spells of sickness absence, irrespective of cause, and separately for infection, musculoskeletal disorder, and trauma. RESULTS: In blue collar male and female workers, compared with the same sex higher grade white collar workers, the age adjusted numbers of long sick leaves were 4.9 (95% CI 4.2, 5.8) and 2.8 (2.6, 3.1) times higher, respectively. The risk varied significantly between the towns, in men in relation to long sick leaves irrespective of cause and resulting from musculoskeletal disorders, and in women in relation to long leaves resulting from infection. The numbers of long sick leaves were 3.9 (95% CI 2.8, 5.4) times higher in blue collar male workers than in higher grade white collar male workers in Raisio, 4.9 (95% CI 3.8, 6.3) times higher in Valkeakoski, and 5.8 (95% CI 4.5, 7.5) times higher in Nokia. Sickness absence of blue collar employees differed most between the towns. The rates of long sick leaves in blue collar men were 1.46 times greater (95% CI 1.25, 1.72) in Valkeakoski and 1.85 times greater (95% CI 1.58, 2.16) in Nokia than in Raisio. In men, no significant differences were found between the towns as regards the numbers of long sick leaves of higher grade white collar male workers. The socioeconomic gradients differed more between the towns in men who had worked for four years or more in the same employment than in men who had worked for shorter periods. No consistent health gradients of socioeconomic status were evident for short sick leaves among either sex. CONCLUSIONS: In men and to a lesser extent in women, the workplace is significantly associated with health inequalities as reflected by medically certified sickness absence and the corresponding socioeconomic gradients of health.

The Work Environment in Fixed-Term Jobs: Are Poor Psychosocial Conditions Inevitable?

Following the transformation of the working environment, researchers attempting to conceptualize the world of work have been forced to adopt new approaches. At least in industrialized Western societies, the crisis of massproduction, the call for flexibility, the de-skilling of labour, the new contradictions of the labour process, and even discussions about the approaching end of wage labour, are concepts that have preoccupied work sociologists since the 1970s. Temporary employment, however, tends to have fallen outside the focus of these discussions. As Campbell and Burgess (2001: 172) point out, in the recent past there was a time in which most forms of temporary employment were dismissed ‘as historical relics’ on the path to a modern and rationalized system of working life. The path has, however, led in just the opposite direction: the clear increase in temporary employment has raised its status on the research agenda. Currently, temporary employment is a concept which embraces many of the core contents of the ‘modern classic’ themes concerning the sociology of work. The concept is a combination of old and new; it is new if we look at the titles and keywords of recent publications, old if we direct attention to the subject matter, or, as summarized by Kalleberg et al. (2000: 256) in their recent analysis of atypical forms of work, ‘[a] recurring theme in the sociology and

Exposure to temporary employment and job insecurity: a longitudinal study of the health effects

Objective This study analysed interactions between job insecurity and temporary employment and health. We tested the violation hypothesis (whether permanent employment increases the health risk associated with job insecurity) and the intensification hypothesis (whether temporary employment increases the health risk associated with job insecurity) in a longitudinal setting. Previous research on this topic is scarce and based on cross-sectional data. Methods A population cohort (n=1071) was surveyed at age 30 and age 42. Exposure to temporary employment during this 12-year period was elicited with a job-time matrix and measured as the score of 6-month periods. Exposure to job insecurity was measured according to the perceived threat of unemployment. Health at follow-up was assessed as optimal versus suboptimal self-rated health, sleep quality and mental health. In addition to sociodemographics and baseline health, the analyses were adjusted for exposure to unemployment, non-employment and self-employment during the 12-year period. Results 26% of participants had been exposed to temporary employment. The effect of job insecurity on health was the same in the exposed and unexposed groups, that is the violation hypothesis was not supported. Non-significant interactions between the exposures and all health outcomes also indicated null findings regarding the intensification hypothesis. Conclusions These findings suggest that perceived job insecurity can lead to adverse health effects in both permanent and temporary employees. Policies should aim to improve work-related well-being by reducing job insecurity. Efforts towards ‘flexicurity’ are important, but it is equally important to remember that a significant proportion of employees with a permanent contract experience job insecurity.

Is temporary employment related to health status? Analysis of the Northern Swedish Cohort

Aims: The aim of this study was to investigate whether temporary employment was related to non-optimal self-rated health and psychological distress at age 42 after adjustment for the same indicators at age 30, and to analyze the effects of job insecurity, low cash margin and high job strain on this relationship. Methods: A subcohort of the Northern Swedish Cohort that was employed at the 2007 follow-up survey (n = 907, response rate of 94%) was analyzed using data from 1995 and 2007 questionnaires. Results: Temporary employees had a higher risk of both non-optimal self-rated health and psychological distress. After adjustment for non-optimal self-rated health at age 30 and psychological distress at age 30 as well as for sociodemographic variables, the odds ratios decreased but remained significant. However, after adjustment for job insecurity, high job strain and low cash margin the odds ratio dropped for non-optimal self-rated health but remained significant for psychological distress. Conclusions: Temporary employment may have adverse effects on self-rated health and psychological health after adjustment for previous health status and sociodemographic variables. Our findings indicate that low cash margin and job insecurity may partially mediate the association between temporary employment and health status.

Stressful life events and the onset of asthma

The status of stressful life events as a risk factor for asthma is unclear and may be dependent on pre-existing allergic rhinitis. This study examined whether exposure to stressful life events predicted the onset of asthma in adults. This is a prospective, population-based cohort study of 16,881 males and females, aged 20–54 yrs and free of diagnosed asthma at the beginning of the follow-up (January 1, 2004). Data about stressful life events were gathered with a postal survey. The onset of asthma was ascertained through national registers until December 31, 2005. During the follow-up period, 192 incident cases of asthma were identified. High total exposure to stressful life events, as indicated by a cumulative severity score, predicted the onset of asthma (hazard ratio 1.96, 95% CI 1.22–3.13). This association was robust to adjustment for demographics, smoking and having a cat/dog at home and it was observed both among those with and without allergic rhinitis at baseline. Of the 10 most stressful life events, the illness of a family member, marital problems, divorce or separation and conflicts with a supervisor were associated with the onset of asthma. Our study suggests that stressful life events may increase the onset of asthma.

Local Management of Global Values: Community-Based Wildlife Management in Zimbabwe and Zambia

Community-based natural resources management (CBNRM) is being increasingly promoted as the solution to problems of nature conservation, and some national programs like the Zimbabwean CAMPFIRE and Zambian ADMADE 1 have been championed as models for others to imitate. The approach seeks to fuse two very different kinds of agendas--preservation of nature based on biocentric premises, and decentralized rural development based on anthropocentric premises--into a win-win combination. However, as the implementation strategy relies on pragmatic reasoning, where economic rationality constitutes the main criterion, it fails to take into account the various noneconomic values involved. While individual success stories are on record, the experience this far does not provide replicable models for either decentralized resource management or efficient conservation of biodiversity.

How does unemployment affect self-assessed health? A systematic review focusing on subgroup effects

BackgroundAlmost all studies on the effect on health from unemployment have concluded that unemployment is bad for your health. However, only a few review articles have dealt with this relation in recent years, and none of them have focused on the analysis of subgroups such as age, gender, and marital status. The objective of our article is to review how unemployment relates to self-assessed health with a focus on its effect on subgroups.MethodsA search was performed in Web of Science to find articles that measured the effect on health from unemployment. The selection of articles was limited to those written in English, consisting of original data, and published in 2003 or later. Our definition of health was restricted to self-assessed health. Mortality- and morbidity-related measurements were therefore not included in our analysis. For the 41 articles included, information about health measurements, employment status definitions, other factors included in the statistical analysis, study design (including study population), and statistical method were collected with the aim of analysing the results on both the population and factor level.ResultsMost of the studies in our review showed a negative effect on health from unemployment on a population basis. Results at the factor levels were most common for gender (25 articles), age (11 articles), geographic location (8 articles), and education level (5 articles). The analysis showed that there was a health effect for gender, age, education level, household income, and geographic location. However, this effect differed between studies and no clear pattern on who benefits or suffers more among these groups could be determined. The result instead seemed to depend on the study context. The only clear patterns of association found were for socioeconomic status (manual workers suffer more), reason for unemployment (being unemployed due to health reasons is worse), and social network (a strong network is beneficial).ConclusionsUnemployment affects groups of individuals differently. We believe that a greater effort should be spent on specific groups of individuals, such as men or women, instead of the population as a whole when analysing the effect of unemployment on health.

Unemployment, depressiveness and disability retirement: a follow-up study of the Finnish HeSSup population sample

BackgroundDisability retirement because of depression is increasingly common in Finland. The rise of such retirement coincided with the rise of unemployment in the second half of the 1990s. In this study we sought potential connections between these two epidemics. We assumed that depressiveness incurs a higher risk of disability retirement among the unemployed than among the employed population.MethodsData were derived from HeSSup Study, which follows a large population sample. A total of 14,487 participants responded in 1998 and in 2003 in postal surveys about their employment status. Their depressiveness was measured in 1998 with Beck’s depression inventory. Labour market status in 1998 was classified as employed, short-term unemployed and long-term unemployed. In 2003 the status was dichotomised into disability retired or not.ResultsA total of 329 participants (2.3%) retired during the 5-year follow-up. The retirement percentage was 1.9 among the employed, 4.8 among short-term unemployed and 6.7 among long-term unemployed. The percentage for the employed ranged from 1.4 (no depressiveness) to 7.1 (severe depressiveness), for the short-term unemployed, the range was from 3.3 to 17.9% and for the long-term unemployed the range was from 2.6 to 14.2%. Retirement was more probable among unemployed participants than among employed (OR 2.24 [95% CI 1.50–3.36] for short-term and OR 2.82 [95% CI 1.93–4.13] for long-term unemployed), when employment status was adjusted by sociodemographic background and somatic comorbidity and interaction term employment status with depressiveness was taken into account. Moreover, the interaction of employment status and depressiveness with the probability of disability retirement was significant. Our final analysis also revealed that disability retirement was particularly common among the short-term unemployed with severe depressiveness. Among the long-term unemployed, in contrast, retirement was more common in the mildly depressed than in the severely depressed.ConclusionsOur results suggest that high level of unemployment may mean high level of premature exit from the work-force due to disability retirement. The epidemic of depression-related disability contributes significantly to this general trend. In future, it will be important to find ways to support depression patients to hold on to their jobs and to develop services, combined with health policy and employment policy, can interrupt the vortex of deteriorating mental well-being, prolonged unemployment and marginalisation from health care.