Job insecurity contributes to poor health – BMJ. This is subversive to right wingers in the Tory Party FG and elsewhere.

Ray Moynihan, author and senior research fellow, Bond University, Australia

How do we create jobs that don’t do more harm than good?

We’ve known for some time of the unhealthy impacts of insecurity in
work, thanks to those who study the social determinants of health.
Britain’s famous studies of civil servants showed that losing job
security harms health, and chronic insecurity is even more dangerous.1
More recently, a study across 16 European countries confirmed the
association, finding that the “public health impact of job insecurity
is likely to be substantial.”2 As nations continue to wrestle with
mass unemployment and search for ways to boost jobs, this evidence
becomes ever more salient.

“Insecurity is one of the big issues for the contemporary economy,”
argues the Australian National University associate professor Lyndall
Strazdins. “Some jobs are corrosive to health,” she told the BMJ
recently, “and insecurity is part of that.” Strazdins is involved with
a team of antipodean researchers who’ve helped produce the growing
body of evidence on the connection between poor quality work and poor

In 2003 the team published a study of almost 1200 professionals, which
found that job insecurity was associated with significant increases in
self reported poor health, depression, and anxiety.3 Although the size
of those increases was small in absolute terms, “a small change to a
lot of people can have a big effect,” said Strazdins.

By 2006 the group based at the Australian National University was
producing data showing that a bad job was just as bad for a person’s
health as no job at all. In a study of almost 2500 middle aged
Australians, the researchers found that health outcomes among the
unemployed—including rates of depression and poor physical health—were
worse than among employees. Yet when the unemployed were compared with
people in the worst jobs—jobs with low autonomy, high strain, and
insecurity—health outcomes were similar. 4 The team concluded, “Paid
work confers health benefits, but poor quality jobs which combine
several psychosocial stressors could be as bad for health as being
unemployed. Thus, workplace and industrial relations policies that
diminish worker autonomy and security may generate short-term economic
gains, but place longer-term burdens on the health of employees and
the health-care system.”

By 2011, results from a longitudinal study of over 7000 people were
being reported, enabling assessment of the effects of moving in and
out of jobs of high or low quality.5 Poor jobs were defined by a suite
of characteristics including high demands, low control, unfair pay,
and insecurity. The results showed that when people moved from
unemployment to a good job there were beneficial effects on their
health, but that moving from unemployment to poor jobs was actually
detrimental on some health measures. “We find that jobs with poor
psychosocial attributes are no better,” wrote the team, “and may have
even more adverse effects on mental health, than unemployment.”

The problem of job insecurity was highlighted by a recent inquiry
funded by the Australian Council of Trade Unions, which estimated that
40% of Australians were now in some form of insecure work and that a
fifth were employed casually.6 The inquiry’s report cited one case of
a Sydney manufacturing plant where the “entire staff were employed as
casuals,” with workers notified by a text message every afternoon to
tell them whether and when they’d be required the next day, without
any information on how long their shift would be. That report included
a range of recommendations, including allowing casual employees to
accumulate entitlements over time and a call for more research into
the effects on health and the social costs of insecure work.
Significantly, it also urged reform of an outdated social security
system, to provide ongoing income security to people operating within
the much more flexible employment realities of the 21st century.

In Europe the word “flexicurity” has been used for a decade or more to
describe the combined concept of flexibility for employers with
security for employees, through strengthened income support systems
and enhanced training opportunities. It is unclear how the
“flexicurity” approach, adopted as a formal principle of labour market
policy by the European Union before the global financial crisis,7 will
survive in these times of austerity and widespread unemployment.
Similarly it’s also unclear how “flexicurity” might affect the health
of the workforce—though it is no doubt a rich area for future

As Strazdins pointed out, behind the people that doctors see in their
surgeries every day are events that “neither the clinician nor the
person have any control over.” She said that these events “are
intractable—but around the cabinet table they may be modifiable.”
Reducing workers’ conditions to maximise employment “may not deliver
the best health outcomes,” she said, arguing that health impacts
should be weighed more carefully in broader economic policy
deliberations: “If we’re going to create jobs, we want to create good

To some, the harmful effects of insecure and poor quality work will be
seen as an unavoidable side effect of an increasingly globalised and
sometimes brutal marketplace. To others, the growing body of evidence
about these connections will boost arguments that employers’ need for
flexibility and employees’ need for security must somehow become more

Cite this as: BMJ 2012;345:e5183

Thanks to Melissa Sweet for early discussions on this article.


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Australian Council of Trade Unions. Lives on hold: independent
inquiry into insecure work in Australia. 21 May 2012.

Council of the European Union. Council conclusions on flexicurity
in times of crisis: 2947th Employment, Social Policy, Health and
Consumer Affairs Council meeting, Luxembourg, 8 June 2009.

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