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