Health effects of job insecurity Updated

Job insecurity and choice

In an uncertain world there are few jobs that do not carry with them some degree of insecurity. Indeed, insecurity can be thought of as a disamenity, or an unpleasant disadvantage of a job, in much the same way as having to work in harsh physical conditions. If workers could choose the level of insecurity they are prepared to accept, those who greatly dislike risk would shun insecure jobs, while risk-lovers would opt for the insecure jobs. With the risk-averse in the large majority, insecure jobs would acquire a premium that compensates for the disamenity of the insecurity. Although the insecurity may pose a health risk for the risk-lovers in the insecure jobs, their higher pay could compensate for this. As an illustration, few people would suggest that the insecurity faced by modern football managers should be a matter for public policy measures, given their relatively very high salary levels.

While trade-offs between pay and risk are widespread, the choice typically facing those in insecure jobs is not between more-secure or less-secure jobs, but between insecure or no jobs. Constraints on choice arise because people's circumstances change, for example through their employers’ fortunes, or more generally through varying macroeconomic circumstances. The phenomenon of employees finding themselves in jobs with far less security than they would choose can become especially widespread in times of recession.

It is mainly the workers themselves whose mental and/or physical health may be affected when their insecurity is raised. But the effects of insecurity go beyond the individual. Of particular interest are the “survivors” of company downsizing. If the health and, consequentially, the effectiveness of these workers are impaired, their organizations also lose out. In addition, the families of insecure workers experience the effects of potential income loss and stress, and so do societies more broadly, in that they must provide care through health and unemployment security systems. Job insecurity is therefore a wider issue than simply a matter for individual choice.

How job insecurity can affect mental and physical health

Whether or not employees’ fears of losing their jobs are justified, their feeling of job insecurity may nevertheless have detrimental effects on their health, for a number of reasons. The economic reason is that a high probability of job loss indicates a likely period of unemployment and lower income in the future. A person's expected long-term income, averaged out over a period of years, is thus lowered as a result of the insecurity. In addition, those with few savings to fall back on may be seriously compromised by the loss of income following job loss. Since income is related to health, the loss of expected income that derives from insecurity could therefore be expected to lead to impaired health.

However, economic deterioration may be less important than the psychological loss of identity and meaning attached to jobs. Studies of unemployment have found that its impact on health is much greater than could be explained simply by the loss of income resulting from unemployment. An important psychological aspect of job insecurity is the stress associated with the uncertainty. High or prolonged stress has detrimental effects on both physical and mental health. Job insecurity also helps to explain why bullying is a significant cause of work-related ill-health.

In addition, other side effects have been hypothesized: for example, that high levels of job insecurity prompt low motivation and compliance with safety efforts, hence a higher number of workplace injuries.

Empirical evidence linking insecurity to types of ill-health

There is a considerable amount of evidence to show that, on average, employees in jobs perceived to be insecure tend to have worse health. One recent study combines several smaller studies from Denmark, Finland, the US, Sweden, Germany, the UK, and Belgium [3]. The study finds a link between the perception of job insecurity and the subsequent experience of coronary heart disease: on average, those with high job insecurity have a 32% greater risk of heart disease than those in highly secure jobs. However, the authors of the study also find that the people who were more insecure were, in any case, disproportionately drawn from groups with a high risk of heart disease. For example, people with high job insecurity were found to take less physical exercise and to have a higher prevalence of hypertension. Once these and other confounding factors were taken into account, the average elevated risk was reduced to 19%. Because insecurity is often measured rather imprecisely, this association may be an underestimate. However, the constituent studies are all cross-sections, and it is not claimed that this estimate shows a causal impact of insecurity on heart disease.

Another recent study shows that across 16 European countries there is a robust statistical association between insecurity and poor health among older employees [4]. The study finds that employees who reported that their “job security was poor” were 39% less likely to report that their health was good or very good (as opposed to fair, poor, or very poor). Looking at how the effects vary across individual countries, the study finds significant detrimental effects of insecurity on health in the Czech Republic, Denmark, Germany, Greece, Hungary, Israel, the Netherlands, Poland, and Russia. In two countries, Belgium and Sweden, no effect was found.

Despite the wide scope of this study and its application to quite large representative samples in each country, in keeping with other cross-sectional studies it does not claim that the association was causal. The problem is that the insecurity may be “endogenous,” that is, affected by some other relevant factor(s), so that associations cannot be interpreted as causal. It might be the case that for some reason it is the less healthy individuals who are channelled into the less secure jobs (“reverse causality”). Hence, there is an association between health and insecurity but the direction of causality is not clear cut. Or it could be that there is some unknown factor surrounding workplaces and employees that simultaneously makes them both less healthy and less secure.

Nevertheless, the breadth and strength of such cross-sectional findings should not be ignored. Many other cross-sectional studies, with varying indicators of poor health or low well-being, present the same picture, often taking into account several confounding factors. Meta-analyses which combine the results of multiple independent studies confirm the negative effect of insecurity on mental health.

In the relatively few studies in which researchers have been able to investigate causal effects more adequately, the negative implications for health reported by the cross-sectional studies are not always found to be robust, but generally they are.

A striking recent study finds one way around the problem of insecurity being endogenous [5]. In a multi-country European study the researchers find that job insecurity is associated with some specified ill-health conditions—namely backache, muscular pain, headaches or eyestrain, stomach ache, depression or anxiety, overall fatigue, and insomnia. However, they are rightly concerned that these cross-sectional associations might not be due to a causal process. To address this, they take advantage of the fact that countries have different laws about employment protection. The authors argue that perceptions of job insecurity increase in countries or regions where employment protection is at a low level, and that this especially matters in industries known (from external evidence) to have high dismissal rates. Their study examines the effects on health of the insecurity that arises from low employment protection. Their approach depends on the assumption that individual employees cannot alter the regulations pertaining to them.

Remarkably, the study finds that job insecurity has substantial causal effects on headaches, eyestrains, and skin problems. Moreover, it does not find that, for these outcomes, the cross-sectional associations are underestimating the causal effects. It also finds that job insecurity stimulates a low level of overall (self-reported) health, though the authors are less confident of this finding because it carries an especially wide margin for error, including the possibility of a zero effect.

Finally, by contrast, the authors find that job insecurity, when stimulated by low employment protection, is not the cause of the other possible outcomes (including cardiovascular disease, depression, muscular pain, and insomnia) with which it is associated in the cross-section. Of course, job insecurity can arise for reasons other than low employment protection, so the authors caution that their study does not rule out the potential impacts of job insecurity on these other health outcomes.

The value of longitudinal studies in determining causality

Another way of partially accounting for hidden factors that make job insecurity endogenous is by using longitudinal data, that is, data gathered over long time periods, which look at how the health of a particular group of individuals changes when their job insecurity changes. This method sidesteps those hidden characteristics of individuals that do not change over time, such as personality traits that lead them to give unduly optimistic or pessimistic reports about their health and working conditions.

One longitudinal study examines the effect of job transitions on mental health in four countries: Australia, Canada, Switzerland, and the UK [6]. In every country it was found that moving from a secure to an insecure job results in a substantial increase in mental distress. This was the case whether the job was a standard one (full-time and with a permanent contract) or a non-standard one. Similarly, when individuals moved from a state of non-employment into employment the effects on their mental health depended greatly on whether the new job was perceived to be secure. Where the job was thought to be very secure, it led to a significant reduction in mental distress. At the opposite extreme, if the new job was perceived to be very insecure, its positive effects on mental health were much reduced or even zero. In the case of unemployed men in Australia, the new job that was very insecure even increased mental distress—in other words, Australian men were better off, from the perspective of their mental health, not being employed than being employed in a very insecure job.

To a considerable extent, the perception of insecurity is associated with the type of contract, with those on temporary contracts inevitably feeling more insecure. Moving from non-employment into a job with a temporary contract was found to be beneficial for mental health in Australia and the UK, but not at all beneficial in Switzerland.

In another longitudinal study from Italy there is further evidence that temporary contracts are a source of ill-health [7]. Nevertheless, the association between contract status and security differs across countries, depending on employment regulations and whether temporary contracts are regularly renewed. Temporary jobs may also differ in other ways from jobs with permanent contracts, usually for the worse—for example, they tend to have lower degrees of autonomy. Thus, unless these other facets of job quality can be taken into account, the relationship between temporary contracts per se and health cannot be considered as decisive evidence for the effect of insecurity on mental health.

A further, large-scale longitudinal study examines the effects of job insecurity on mental health and life satisfaction in Australia [8]. The indicator of insecurity used in this study is the probability of job loss as estimated by workers themselves, which is a measure other studies have validated. The advantage of this measure is that it provides confidence that the probability of job loss is not being mixed up with any wider sense of insecurity concerning a person's status at work. The study finds that an increase in the probability of job loss stimulates a notable fall in both the mental health scale and in life satisfaction. Mental health, in this study, is measured on a 0−100 scale derived using a subset of items from the Short-Form Health Survey (SF-36). Those responding with low values on this scale are more likely to be experiencing depression. The Illustration and Figure 1 show the values on this scale of various states, relative to being in a secure job and being fully employable. Accordingly, the loss of mental health from being partially insecure (i.e. having a 50% chance of job loss within a year), while remaining fully employable (i.e. being sure of getting an equally good job), was close to the loss incurred through actually being unemployed. The effect is around an eighth of a standard deviation of the mental health scale, indicating a significant effect on the numbers suffering mental depression. A similar effect of insecurity is found for German workers, again using longitudinal data [9].

A recent study on insecurity in Denmark combines the advantages of longitudinal data with data from administrative sources of known objective sources of insecurity, namely firm downsizing [10]. The study looks at the effects of insecurity arising from such downsizing, which (similar to [5]) goes a long way to avoiding the problem of insecurity being endogenous. But it also allows, through the longitudinal approach, for any hidden but stable individual characteristics that might be affecting their perceived health. Strikingly, the results strongly confirm the detrimental health effects of job insecurity, and also show negative effects of job status insecurity.

While studies using longitudinal data are generally the most convincing ones for understanding causal processes, studies of successive cross-sections are also useful if one is aiming to understand changes in the health and well-being of a population over time. Such studies are rare owing to data shortages, but have come more into the spotlight following the great recession in 2008, with consequent concerns that job loss would be accompanied by deteriorating health. One study has shown that job-related well-being fell in the UK either side of the great recession (between 2006 and 2012), and that this is attributable, in part, directly to rising job insecurity, an increase in the pace of workplace change, and to changing work effort and workplace participation [11].

How the effects of insecurity might be reduced or counterbalanced

Policymakers at this time of pandemic can make a contribution to the health of populations by limiting the extent of job insecurity through proactive macroeconomic stabilization policies. Accepting, however, the reality of macroeconomic failures and the likelihood that even with good macroeconomic policies an increased level of unemployment and insecurity resulting from the pandemic is almost inevitable, what can health policymakers, employment policymakers, or other social partners do to mitigate the health effects of insecurity?

Notwithstanding the evidence that, overall, job insecurity has substantive effects on health, not everyone is likely to be affected to the same extent. One study shows, for example, that workers whose personalities are high on “introversion” or “neuroticism”—two of the so-called “big five” personality factors—are more vulnerable to adverse mental health effects following job insecurity [12]. While personality is hardly amenable to intervention, the support of the health services, including awareness of job-security-induced stress and ill-health, and strategies for dealing with these, should be an evident concern of health ministers. In addition, however, there are policies and approaches that other actors can consider. Three broad evidence-supported areas are promising.

First, it has been shown that re-employability can go a long way toward mitigating the effects of insecurity. While the prospect of a new equally good job might not be quite as desirable as keeping one's current job, it can prevent the loss of income and go a long way to ameliorating the psychological loss. A study using Australian data has shown, for example, that the mental health cost of job insecurity for a woman who is sure of finding a new equally good job is lower by as much as two-thirds, compared with a woman who has no hope of finding a new job (see the Illustration) [8]. In Germany it is found that, while low job security has substantial negative effects on mental health, this is especially exacerbated in the case of women who have poor job prospects [9]. Re-employability is also a factor effecting mental health in Denmark [10]. Thus, macroeconomic and microeconomic policies to stimulate individuals’ chances of re-employment would be beneficial. Welfare policies that reduce the income loss from unemployment also reduce the economic risks. Combined with active labor market policies and skills policies that enhance employability this ensemble has been termed “flexicurity” policy.

Second, social support, either from within the workplace or from outside, has a beneficial impact on well-being and workers’ mental health. Moreover, it can be of particular importance at times of insecurity. Support can be psychological, thus diminishing the threats to workers’ sense of identity when faced with insecurity; it might also be economic or industrial relations support. Studies have identified both unions and families as potential sources of social support at times of insecurity. A good social network enables workers to develop better coping strategies for the stresses of insecurity.

Third, the ill-health effects of negative shocks and job insecurity can be mitigated within organizations by making jobs better for workers’ health in other ways. One recent study showing negative effects of low job security on workers’ well-being also confirms at the same time that granting workers more discretion over carrying out tasks, higher pay, safer working conditions, or less highly intensive work could each counterbalance the effects of job insecurity. Forms of participation that allow full two-way communication with affected workers also facilitate a sense of fairness and procedural justice, which have been shown to be related to well-being, especially where companies are downsizing.