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Background
Characteristics of the work environment have recently come into
prominence as an explanation of socio-economic inequalities in ill-health
and mortality. The Whitehall II Study, a prospective cohort of civil
servants, found that, among the factors examined, low control at
work made the largest contribution to the socio-economic gradient
in coronary heart disease frequency. In line with general population
trends, other data from the study have also shown that the socio-economic
gradient in ill-health and mortality widened during the 1990s. Concurrently,
job security has decreased as governments and business have espoused
the flexible labour market. The resulting increases in part-time
and temporary work, self-employment and fixed-term contracts mean
that another work characteristic, job insecurity, is high and rising.
Adverse effects
on health of job insecurity associated with workplace closure have
been documented, but hardly any work has examined the contribution
of job insecurity to socio-economic inequalities in health and none
has examined the contribution of job insecurity to widening socio-economic
gradients in ill-health and mortality.
Aims and
Objectives
The aim of the study is to examine the contribution of job insecurity
to health inequalities. Its objectives are to determine:
- the factors
which influence people's perceptions of job insecurity and the
factors which modify or mediate the impact of job insecurity on
health, such as the degree of control individuals have over their
work;
- the contribution
of job insecurity to the socio-economic gradients and gender differences
in mental health, physical health and health-related behaviours;
- whether the
apparent widening of the socio-economic gradient in morbidity
has continued and whether it can be explained by increasing job
insecurity.
Study Design
This study will be carried out in stages and will use a combination
of qualitative and quantitative methods.
In the initial
phase, the distribution of job insecurity by gender and social position
will be determined for all Whitehall II respondents still in employment.
This analysis will be followed by in-depth interviews with 40 women
and men to determine the relative contribution of material and psycho-social
factors to perceptions of job insecurity and to socio-economic and
gender differences in health.
Hypotheses developed
from the qualitative arm of the study will be tested quantitatively
using the Whitehall II dataset. The power of identified predictors
of job insecurity and of job insecurity itself to explain the social
gradient in health will be determined. Gradients in health for different
self-reported and clinical health status measures will be compared
for consecutive phases of the Whitehall II study and the contribution
of job insecurity to widening gradients will be determined.
The study will
generate new measures and models which could be incorporated into
future research and contribute to the interpretation of results
from other datasets in which health data are related to social position
in working populations.
Policy Implications
Job insecurity is currently widespread in both the public and private
sectors. Results from the proposed study will feed into current
debates on the changing nature of work and its implications for
society. In particular, the results will be of use to all sectors
with an interest in employment issues. The study is relevant to
policies aimed at reducing inequalities in health, with a specific
focus on priorities identified in the government's public health
strategy and policies relating to the work environment, particularly
for women who are forming an increasing proportion of the workforce.
Project Summary
Studies like the Whitehall II Study have highlighted how psycho-social
factors related to the organisation of work play a role in determining
health inequalities. A range of psycho-social factors have been
identified, including control over the pace and content of work.
However, one aspect of the modern labour market has received little
attention: the increase in job insecurity and its contribution to
the socio-economic gradient in health.
The project
focused on this neglected issue. Job insecurity was defined subjectively,
in terms of the discrepancy between the level of security a person
experiences and the level s/he prefers. No study has specifically
investigated the effects of loss or gain of perceived job security
over time and its role in explaining socio-economic gradients in
morbidity and cardiovascular risk factors.
The project
was based on the Whitehall II study of over 10000 civil servants,
a prospective cohort study of London-based office staff working
in 20 civil service departments. The Whitehall II cohort was first
studied in 1985-88 (baseline survey), with the most recent wave
of data collection in 1997-99 (Phase 5) when the participants were
between their mid-forties and mid-sixties. By this stage, 54% of
the cohort had left the civil service, of which 19% were working
elsewhere and 3% were unemployed or long-term sick. Civil Service
employment grade provides a finely-graded measure of occupational
position and the project used this measure to examine socio-economic
differences in job insecurity and its health effects.
The project
involved both an indepth qualitative study of the job security-health
relationship and quantitative analysis of data from Phases 1, 3,
4 and 5 of the study.
Key findings
- Steep employment
gradients were observed at Phase 5 for most measures of morbidity
and cardiovascular risk. Employment grade gradients increased
slightly over the 11 years of follow-up, with marked increases
in the gradient for minor psychiatric morbidity (GHQ score and
depression) in both sexes and in cholesterol for men.
- Levels of
job insecurity were high, both among those still employed in the
Civil Service and among those working elsewhere at Phase 5. There
were steep grade gradients in job insecurity, with steeper gradients
observed for financial insecurity.
- The in-depth
interviews indicated that job insecurity had disrupted career
paths which respondents had originally selected for their structure
and security. The qualitative data also indicated that job insecurity
had negative effects on health and well-being. Its effects appeared
to be explained by personality factors and attitudes, by other
characteristics of the work environment, by material factors and
life events and by coping mechanisms. A conceptual framework has
been developed from the qualitative data and tested using the
quantitative data.
- Loss of job
security had adverse effects on self-reported morbidity which
was not entirely reversed by regaining security. Workers reporting
repeated exposure to job insecurity had the poorest self-reported
health.
- Job insecurity
partly attenuated the grade gradient in depression for those still
in paid employment.
- For other
health measures, adjustment for job insecurity had little effect
on gradients in morbidity. Financial insecurity, however, contributed
substantially to health inequalities. Adjustment for financial
insecurity attenuated the grade gradients in self-rated health
and depression among employed and non-employed men and among non-employed
women. This suggests that the specific effects of job insecurity
in this cohort may be less important than the more general effects
of financial insecurity in determining health inequalities.
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