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Findings suggest that reductions in job insecurity should be a point of intervention for government policies aimed at improving population health and reducing health inequalities.
Job insecurity and its effect on health is now an important topic within social epidemiology.1–5 Some time time ago, a few papers began to appear in Australia,6,7 and the UK8 suggesting that poor job quality might affect mental health almost as much as job loss. This possibility was pursued in path breaking work using the UK Whitehall II study of health in London based civil servants.9 Ferrie and her colleagues were able to follow changes in health measurements in a subgroup of men and women whose civil service department was sold to the private sector. In this way, they could take account of possible health differences between those who did and did not experience increasing insecurity before the onset of job change or unemployment. The nature of the reorganisation also meant that to a large extent, civil servants had been “randomised” into the group experiencing greater upheaval in their work situations.
Research in this area has advanced quickly at a time when, according to many measures, the numbers of secure jobs in the economies of industrialised nations are falling, to be replaced by a variety of more “flexible” types of employment contract.10 Perhaps public health advocates are at least as much influenced by the feeling that working conditions are regarded as something that can easily be sacrificed to the gods of economic productivity.11
The paper by Artazcoz et al adds to this growing literature in important ways. The authors are well aware of the dangers that people with a tendency towards depression or anxiety may perceive their jobs as less secure.12 They are able to show that the relation of less secure employment conditions to health depends on several other factors. One of these is sex. The other is social class (manual or non-manual). Not every kind of insecurity is associated with poorer psychosocial health. The highest excess risk is experienced by those whose contracts have no fixed term, or who have no formal employment contract at all: more or less a “dose-response relation”.
Several recent meta-analyses13,14 have confirmed the effect of work insecurity on health. Whereas continued insecurity has been found to be a health risk, secure re-employment outside of a declining heavy industrial environment has been found actually to improve health.15 Several papers have now concluded from their findings that reductions in job insecurity should be a point of intervention for government policies aimed at improving population health and reducing health inequalities.11,16,17
Findings suggest that reductions in job insecurity should be a point of intervention for government policies aimed at improving population health and reducing health inequalities.