Welfare states, flexible employment, and health: a critical review

Objectives: The aim of this literature review is to identify whether differences between welfare regimes can manifest diverse consequences for the health effects of insecure and precarious employment, as well as to address challenging issues and implications for future research.

Methods: By searching PubMed, PsychINFO, Stork Social Science Citation Index, and Index Lilac, from 1988 to June 2010, a total of 104 original articles were selected (65 on job insecurity; 39 on precarious employment).

Results: After classifying selected empirical studies according to a six-regime welfare state typology (Scandinavian, Bismarckian, Southern European, Anglo-Saxon, Eastern European, and East Asian), this systematic review reveals that welfare regimes may be an important determinant of employment-related health. Precarious workers in Scandinavian welfare states report better or equal health status when compared to their permanent counterparts. By contrast, precarious work in the remaining welfare state regimes is found to be associated with adverse health outcomes, including poor self-rated health, musculoskeletal disorders, injuries, and mental health problems.

Conclusions: Future research should be conducted by employing conceptual models that specify how macro-economic processes, country-level welfare factors, and individual employment histories and environments relate to employment-related health inequalities.