Chapter 3: Lecture 4
at a very minimum
-at the very minimum, work provides people with necessary income and benefits that profoundly shape the ability to live healthy lives
job insecurity
-big problem -precarious work is much more widespread in canada -unemployment insurance often leads to precarious work
Health Effects of Employment Insecurity
Contract and Temporary Employment Poorer working conditions, more stressed, and less healthy than the rest of the working population A review of 93 studies of contingent work and occupational health in various countries found that a substantial majority of studies showed a negative association between precarious employment and health. Why? more difficult working conditions higher levels of job insecurity lower levels of control over working conditions and arrangements Experience poorer quality social interactions exposed to particular demands associated with their employment arrangements
Job Insecurity and Health
Job-level insecurity—or downsizing—has been associated with increased sickness absence Downsizing has been linked to increased workplace fatalities, workplace accidents, musculoskeletal injuries, and psychiatric disorders Perceived job insecurity has negative effects on workers' marital relationships, parenting effectiveness, and their children's behaviour
What is Security
Sense of well-being or control, or mastery over one's activities and development, as well as the enjoyment of certain self-esteem. Inversely, insecurity involves anxiety and uncertainty
neighbourhood deprivation
calculated as combnination of income, education and unemployment rates
unionization and collective bargaining assosciated with
child poverty
percieved job insecurity
comes to have negative effects on marital relationships, parenting effectiveness and children's behavior.
job strain developed by robert karasick
high demand vs low demand, high control vs low control
high demand and little control
high strain job
social gradient of health
the social structure is characterized by a finely graded scale of advantage and disadvantage, with individuals differing in terms of the length and level of their exposure to a particular ffactors and in terms of the number of factors they are exposed tol
union vs non union
unionized workers better pensions
uneployment rates 2008-2009
up everywhere
Four social determinants of health that are especially important
- Income - Education - Employment Security - Working Conditions since these 4 influence the amount of economic resources available, they influence other social determinants of health such as early child development, food security, housing and social exclusion they usually cluster together
two ways
-education itself leads to better health -allows access to economic and social resourcecs -low education might not be bad if more social programs implemented
Recomendations
-fair trade rather than free trade? -research and education -balacning power between employee and employer
ways of conceptualizing it
-first by actual amount of income recived by an individual or family. This oculd be used to study how and why levels fof individual and family income come to be so strongly related to health outcomes -second through distribution of income across population. This provides a measure of inequality in economic resources
change in family income 2000-2005
-higher for rich especially in toronto and van
ontario studies
-illustrate adult onset diabetes and first time heart attack admitting rates
Recomendations
-increasing minimum wage -more assistance for those unable to work =child benefits -faireer rax system
findings
-life expectancy systematical differs as a function of neighborhood income -death rates from various afflictions are also a function of neighborhood deprivation 0overall death rate was 28% higher in the most neighborhood deprived compared to the least -suicide rates also a function of neighborhood conditions
Toronto study
-low birth weights, readiness of school and teen live births were all correlated with neighbourhood income
Recommendations
-need more surveys -government must intervne to help shape and improve workplace conditions -make it easier for workers to organize -equalize the balance between emplyers and employees
effects of uneomployment on health
-reduction of income and benefits -stressful event assosciated with lower self esteem, loss of daily structure and rouitene and increase in chronic anxiety -leads to a greater incidence of adverse health related coping behaviors such as tobacco use and problem drinking
Importance of public policy in shaping income inequality
-strongly correlated -measures include minimum wae, unemployment benefits, easier to form unions -tax system -progressive tax system
labour movement
-unionized workers earn higher wages and have more benefits
dimensions of work
1) job and employment security 2) physical conditions at work 3) work pace and stress 4) working time 5) opportunities for self expression and individual development at work, participation in work and work life balance
job control
4 in 10 said htey had a lot of freedom -men have more control -longer work weeks
Active Jobs
Active jobs are associated with high level of psychological demand and a high decision latitude Examples of active jobs include: Electrical Engineer and Teacher Active jobs are typically 'high-level' jobs
Good Jobs Promote Health
Appropriate rewards Support system Pay Benefits Safe and healthy environment Meaningful work Decision-making opportunity
high strain assosciated with
Chronic heart disease
"Indirect selection"
Factor ------------------------> poor health + X ------------------------> unemployment
Employment Insecurity and Health
Health effects of job insecurity appear to be moderated by the prevailing level of labour-market opportunities Job insecurity can be less harmful when there are other employment opportunities available to workers. Research suggests that there are also negative health impacts of underemployment In Canada, certain vulnerable groups tend to have a higher exposure to underemployment visible minorities younger individuals Negative health outcomes vary across different age and gender groups
High-Strain Jobs
High-Strain jobs are associated with a high level of psychological demands with a low decision latitude Examples of high-strain jobs include: Telephone Operator and Waiter
Unemployment as a stimulus to unhealthy behaviours Health-Related Behaviours
Important in context of longer term development - is associated with previous behaviours prior to unemployment but also stimulated by loss of employment > smoke, > low weight, > problem drinking > suicide rate, related to adverse life events associated with unemployment such as loss of home and marriage breakdown
Extent of Precarious Employment
In Canada, not counting those who are unemployed, only half of all Canadians have a single, full-time job that has lasted six months or more (Lowe, 1999). Composition of Canadian labour force: 16% (14%) self-employed workers; 10% (10%) temporary workers; 18% (11%) regular part-time workers; 6 % employed in their current job for less than six months; 5% (2%) are employed in more than one job. % in ( ) represent figures presented in 1st edition of this text
What is Job Security
In order to assess an individual's relative insecurity or security, the following measures would be of interest: the likelihood of losing one's job, the likelihood of finding another, the value of the current job, and the value of the future job or period of unemployment
The Pathways to Illness & Disease For Those Not Working
Lack of economic resources Lack of support Psychological deprivation Psychosocial stress
Income Insecurity and Health
The health impacts of employment insecurity and inadequacy are affected by the perceived adequacy and security of income. Financial strain explains a significant portion of the relationship between employment status and subsequent depression. Income insecurity and ill health are not equally distributed. Women and people of colour are more likely to: work in low-income jobs less likely to have benefits more likely to live in poverty One in six full-time workers in Canada earn less than $10 per hour in 2000, and this fraction has not changed since 1980. This is largely due to firms shifting risk to workers in the face of pressures from globalization This leaves large segments of society struggling to make ends meet.
"Causation"
Unemployment ---------------> poor health
Job Stressors
Workload - How fast and How hard Job Complexity - Task variation, number of parallel tasks Responsibility for people & things Role Ambiguity - clarity of job objectives and responsibility Length of Service - inexperience Level of Education - qualifications needed vs those attained
too many demands or too many hours
about one third -women more stressful
high demand and high control
active job
nonstandards work hours
also related to health issues -exsessive work hours cause physiological and psychological disease
levels of income and education on one hand
and employment security and quality of working ocnditions onthe other are strongly related to each other
income avaialble is an excellent indicator individual health
and income inequality is an excellent indicator of health of the population. leads to material deprivation and social exclusion
material and social deprivation
are experienced with lower absolute incomes
downsizing
assosciated with increased workplace fatalities, workplace accidents, musculo skeletal injuries and psychiatric disorders
inequality
descrbes the gap between teh rich and poor and provides a context for considering how public policy appraoches to income security predict the overall health and the extent of inequalities in health outcomes -income inequalities has proven to be one of the best predictors of the overall ealth of the oscoety
business community
directly influences income distribution through the wages and benefits its provides to employees and through influence on government al rgulation
low socioeconomic status and second language students
do poorly -children whose parents iddn't go to high school do poorly
education recomendations
early childhood development -improve education system for oyoung people and develop effective adult education and training system -adults need access to a variety of literacy and learning opportunities in their home communities important
Siegrist's Effort Reward Imbalance Model
efforts shouldn't be greater than reward
wealth equality
even worse
low income families as %
going up
employment insecurity
has been on teh increase in Canada only 50% of Canadian workers had a single full time job that had been held for 6 months or more
Dr. Nathalie Auger and Carolyne Alix of the Quebec Minister of Health
have documented how income is related to health ourcomes in Quebec
high strain jobs
high demands but little lattitude -more women affected
income gap
highest in toronto and van
education
highly correlated with health
Organization for Economic Development(OECD)
identified Canada as one of two wealthy nations whose income inequality increased between 1990's to mid 2000 -employed Ginni index
health - work connections
includes death and injury on the job -continue to rise in canada but accidents and injuries declining -might be underreported -increase in repetitetive strain and other soft tissue injuries in Canada along with muskuloskeletal pain and chronic back problems
material deprivation
includes food, clothig and housing
effort - reward imbalance
incongruence between effort and reward is reflected in health problems
recessions
increase income inequality
insecure employment
is usually intensified work and is assosciated with higher rates of stress, injuries, back, next and shoulder pain -intensification of work is assosciated with headaches, sore muschlesm fatique and nausea
amount of income available to an individual or family is a primary social determinant of health becasuse
it shapes overall living conditions, influences, psychological functioning and dedtermines in large part health related behaviors such as teh quality of diet, extent of physical activity, tobacco use and excessive alcohol use. Also determines other social determinants of health
Poverty
levels of benefits link to financial problems effects are immediate adaptation made by lowering expectations and increased alienation and cynicism
Unemployment as stressful event
loss of esteem- self and by others loss of daily structure and routine effects similar in UK and Scandinavian nations associated with presence of chronic anxiety
low demand and high control
low strain job
more
more canadian workers believe that their job puts their health and safety at risk, higher than other industrialized countries
income
most important social determinant of health
Mechanisms by Which Unemployment Leads to Poor Health
next
income and income distribtion
next
karasek's job strain model
next
other dimensions that are important
organizational justice, work hours, work life conflict, precarious work and status inconsistency
women and precarious forms of work
overrepresented in precarious work -make up only 40% of full time workers
low demand and low control
passive job
"Direct selection"
poor health---------------------> unemployment
Ginni index
provides a summary measure of inequality based on a perfect income equality coefficient of .00. If one person recieves all the income available the coefficient would be 1.0
emplyment
provides income, sense of identity and well being and helps people to structure day to day life
rent vs income
rent has gone up but income has not
Ann curry stevens
showes that teh bottom 60 percent of canadian families experienced an actual decline in market incomes in constant dollars. -middle class decreaseing
if absent
th-material and social deprivation, psychological stress and the adoption of health threatening coping behaviors -assosciated with a host of physical and mental problems
working conditions and their importance for health
very important because the experience of work dominates our lives -lower incomes especially vulnerable
Canada's ginni
was .28 in the mid 1980's -now .32 ranking 18th out of 30 OECD countries
income is especially important in society
where governments provide very little social services