Survey on Working Conditions indicators? Findings from the Second European How do types of employment relate to health

Study objective—To investigate the associations of various types of employment with six self reported health indicators, taking into account the part played by demographic variables, individual working conditions and four ecological indicators at the country level. Design—Cross sectional survey (structured interview) of a sample of the active population of 15 European countries aged 15 years or over. Main independent variables were nine types of employment categorised as follows: small employers, full and part time permanent employees, full and part time fixed term employees, full and part time sole traders and full and part time temporary contracts. Main outcome measures were three self reported health related outcomes (job satisfaction, health related absenteeism, and stress) and three self reported health problems (overall fatigue, backache, and muscular pains). Logistic regression and multilevel models were used in the analyses. Setting—15 countries of the European Union. Participants—15 146 employed persons aged 15 or over. Main results—Precarious employment was consistently and positively associated with job dissatisfaction but negatively associated with absenteeism and stress (as compared with full time permanent workers). Fatigue, backache and muscular pains also tended to be positively associated with precarious employment, particularly with full time precarious employment. Small employers reported high percentages of stress and fatigue, but absenteeism was relatively low. Sole traders generally reported high percentages of all outcomes, except for absenteeism, which was low. For each type of employment (except temporary contracts), full time workers tended to report worse health outcomes than part time workers. Patterns were generally consistent across countries. Associations persisted after adjustment for individual level working conditions and were not modified by country level variables. Conclusions—This study is the first to examine the relations between various types of employment and six health related indicators for all 15 member states of the European Union. Suggestive patterns worthy of further exploration have been found. Standardised definitions of types of underemployment and health related outcomes, more potent epidemiological designs and the inclusion of socioeconomic information (for example, social security systems, incapacity benefit schemes) at the regional level are proposed for inclusion in further research. (J Epidemiol Community Health 2000;54:494–501) In the two past decades an increasing number of studies have found that unemployment is strongly associated with adverse health indicators such as higher mortality, unhealthy symptoms, unfavourable lifestyles or more psychological problems at both individual and ecological levels. Although unemployment is likely to be one of the major long term social problems that Europe is facing, European countries are increasingly showing new forms of work organisation and flexible employment. These socioeconomic changes are leading to high numbers of various types of underemployment, including involuntary part time employment and insecure employment, together with high unemployment rates. In the European Union (EU), precarious employment (fixed term contracts and temporary work) accounts for 15% of paid employment. The highest percentages are found in Spain (40%) and France (22%) while the lowest levels are found in Luxembourg and Austria (9%). Knowledge of the impact of these new forms of employment on health indicators is very scarce. 7–9 An EU report found that employees with precarious contracts, and particularly temporary workers, were much more exposed to poor working conditions such as vibrations, loud noise, hazardous products or repetitive tasks. For example, temporary workers work more often than permanent workers in painful or tiring positions (57% compared with 42%), are more exposed to intense noise (38% compared with 29%), and perform repetitive tasks more frequently (46% compared with 36%). In addition, preliminary studies at the national level have begun to analyse the eVects of precarious work on some health outcomes and have suggested that new types of contracts may be linked to ill health. In Spain and France, for example, temporary workers showed much higher levels of occupational accidents as compared with permanent workers. 11 Many questions still remain unanswered regarding the potential associations between J Epidemiol Community Health 2000;54:494–501 494 Occupational Health Research Unit, Department of Experimental Sciences and Health, Universitat Pompeu Fabra, Barcelona, Spain F G Benavides J Benach C Roman Division of General Medicine, Columbia Presbyterian Medical Center, Columbia University and Division of Epidemiology, Columbia School of Public Health, New York, USA A V Diez-Roux