Commentary
The health effects of employment Pekka Virtanen A large body of research has accumulated about the health effects of the occurrence of and exposure to unemployment, projecting these events and episodes as being stressful. Hence, logically, resuming employment can be assumed to be a process that, although accompanied by a wide variety of work-related physical and psychosocial risks, is predominantly positive and enhances well-being and health. Questions as to whether this is in fact the case have generated a considerable body of longitudinal studies and also enabled meta-analyses as reported in the review by van der Noordt et al.1 The carefully conducted and clearly reported review provides convincing evidence of the beneficial effects of employment on mental health and demonstrates the knowledge gap as regards the effects on somatic health and mortality. Moreover, the review gives an impetus for elaborations with respect to further studies. There are four topics of particular relevance. First, the enduring depression that began at the downturn of the global economy in the late 2000s has revived scholars from the end of the past millennium who were predicting the emergence of a postmodern, less work-based, social order in the Western world,2 even an ‘end of the work’.3 Indeed, the number of unemployed citizens in the European Union member states has grown from 15.9 to 26.3 million between 2008 and 2013. On the other hand, empirical evidence does not support the most radical prophecies: despite the changes in attitude towards work4 there is no declining trend in the employment rate, which, according to the OECD statistics5 has fluctuated between 60% and 65% for decades. Nevertheless, the turmoil of the labour market during the past 5 years has provided conditions where discouragement, hard core unemployment and contingent employment have been established as more or less inherent properties of national labour markets.5 The turmoil has also provided plenty of opportunities for discriminating practices against employees with poor employability, such as the youngest, the oldest and the less educated ones, in Correspondence to Dr Pekka Virtanen, Institute of Advanced Social Research (School of Health Sciences), University of Tampere, Tampere 33014, Finland; pekka.j.virtanen@uta.fi
particular if they have problems of somatic or mental health. Although there have been, on the other hand, plenty of entries to work, their consequences on health effects may have changed less beneficially. Second, in almost all of the reviewed1 studies the pre-employment period is unemployment, that is, a status deviating from norms of the society and which also more or less conflicts with the value set of the individual. Although we may assume that more normative periods of the life course, such as studying or parental leave, are associated with a higher level of baseline health, there is reason to study the health effects of transitions from such positions to work. Positive health effects can be assumed to be referring—as the authors of the review seem to do—to Jahoda’s6 theory of job deprivation, which suggests that, in addition to the manifest material earnings, work contributes to well-being through five ‘latent functions’: time structure, social contacts, collective purpose, social identity and status, and activity. Third, health scientists could reproduce the approach of those sociologists and economists who study periods of nonemployment in terms of the ‘scars’ to a future occupational career and labour market attachment and associated ‘wage penalties’. The wounds, if any, of non-employment may be transient, but the recovery may be incomplete or there may be mental or physiological processes that manifest themselves following a delay. Moreover, there may be phases in the life course, such as early adulthood, when a period of unemployment may be more likely to scar future health. In the health research domain, a lot of population cohorts have been followed up for decades and it would be important to scrutinise the data sets, such as, for example, from Strandh et al,7 with respect to employment-related life course epidemiological research. Fourth, in contrast to the relatively clearcut categories of the labour market status prior to employment, after the work entry there is a lot of variation, in terms of the contractual strength of labour market attachment and the perceived job insecurity. Prototype (re-)employment, or immediate entry to open-ended contract as a wage or salary earner, is relatively rare and various fixed-term contracts and probation periods and even ‘zero-hour contracts’ are common. Moreover, there are ‘atypical’
jobs, such as agency work and selfemployment as entrepreneur or freelancer. Potential confounding due to divergent employment should be taken into account in studies comparing population cohorts. Nevertheless, the health effects of entries to atypical jobs deserve also to be studied separately. Of particular importance and interest in this respect are the transitional labour markets. The transitional labour market8 points to the active labour market policy (ALMP) measures that are located between overt unemployment and employment in the open labour market. In Western societies, it is generally difficult to ‘survive’ as unemployed without participating in measures that range from short courses aimed at promoting job seeking skills, to longterm occupational training with integrated periods of work and to state subsidised job creation schemes. Studies concerning ‘indirect employment effects’ of the ALMP measures, or the health effects of ‘interrupted unemployment’, are excluded from the review of van der Noordt et al1 The current body of such research is scarce,9 10 and rather than allowing unequivocal conclusions, the evidence gives some reason to recommend carefully designed prospective studies that make use of the natural experiments provided by various ALMP measures. Finally, the recommendation of Metcalfe et al11 to study the health effects of frequent job change seems not to have stimulated further research. Would the most common employment event, or instantaneous entry to another workplace, not also deserve attention as regards the well-being and health of employees? Competing interests None. Patient consent Obtained. Provenance and peer review Not commissioned; internally peer reviewed.
To cite Virtanen P. Occup Environ Med 2014;71:665– 666. Received 19 March 2014 Revised 4 July 2014 Accepted 29 July 2014 Published Online First 13 August 2014
▸ http://dx.doi.org/10.1136/oemed-2013-101891 Occup Environ Med 2014;71:665–666. doi:10.1136/oemed-2014-102143
Virtanen P. Occup Environ Med October 2014 Vol 71 No 10
665
Commentary REFERENCES 1
2 3
4
666
van der Noordt M, Ijzelenberg H, Droomers M, et al. Health effects of employment: a systematic review of prospective studies. Occup Environ Med 2014;71:730–6. Bauman Z. The individualized society. Cambridge: Polity Press, 2001. Rifkin J. The end of work. The decline of the global labor force and the dawn of the post-market era. New York: Putnam’s Sons, 1995. Twenge J. A review of the empirical evidence on generational differences in work attitudes. J Bus Psychol 2010;25:201–10.
5 6
7
8
OECD StatExtracts. http://stats.oecd.org/index.aspx? r=792351 Jahoda M. Employment and unemployment—a social-psychological analysis. Cambridge: Cambridge University Press, 1982. Strandh M, Winefield A, Nilsson K, et al. Unemployment and mental health scarring during the life course. Eur J Public Health 2014;24:440–5. Schmid G. Towards theory of transitional labour markets. In: Schmid G, Gazier B, eds. The dynamics of full employment—social integration through
9
10
11
transitional labour markets. Cheltenham: Edward Elgar, 2002:151–95. Andersen S. The short-and long-term effects of government training on subjective well-being. Eur Soc Rev 2008;24:451–62. Audhoe S, Hoving J, Sluiter J, et al. Vocational interventions for unemployed: effects on work participation and mental distress. A systematic review. J Occup Rehabil 2010;20:1–13. Metcalfe C, Smith GD, Sterne JA, et al. Frequent job change and associated health. Soc Sci Med 2003;56:1–15.
Virtanen P. Occup Environ Med October 2014 Vol 71 No 10
The health effects of employment Pekka Virtanen A large body of research has accumulated about the health effects of the occurrence of and exposure to unemployment, projecting these events and episodes as being stressful. Hence, logically, resuming employment can be assumed to be a process that, although accompanied by a wide variety of work-related physical and psychosocial risks, is predominantly positive and enhances well-being and health. Questions as to whether this is in fact the case have generated a considerable body of longitudinal studies and also enabled meta-analyses as reported in the review by van der Noordt et al.1 The carefully conducted and clearly reported review provides convincing evidence of the beneficial effects of employment on mental health and demonstrates the knowledge gap as regards the effects on somatic health and mortality. Moreover, the review gives an impetus for elaborations with respect to further studies. There are four topics of particular relevance. First, the enduring depression that began at the downturn of the global economy in the late 2000s has revived scholars from the end of the past millennium who were predicting the emergence of a postmodern, less work-based, social order in the Western world,2 even an ‘end of the work’.3 Indeed, the number of unemployed citizens in the European Union member states has grown from 15.9 to 26.3 million between 2008 and 2013. On the other hand, empirical evidence does not support the most radical prophecies: despite the changes in attitude towards work4 there is no declining trend in the employment rate, which, according to the OECD statistics5 has fluctuated between 60% and 65% for decades. Nevertheless, the turmoil of the labour market during the past 5 years has provided conditions where discouragement, hard core unemployment and contingent employment have been established as more or less inherent properties of national labour markets.5 The turmoil has also provided plenty of opportunities for discriminating practices against employees with poor employability, such as the youngest, the oldest and the less educated ones, in Correspondence to Dr Pekka Virtanen, Institute of Advanced Social Research (School of Health Sciences), University of Tampere, Tampere 33014, Finland; pekka.j.virtanen@uta.fi
particular if they have problems of somatic or mental health. Although there have been, on the other hand, plenty of entries to work, their consequences on health effects may have changed less beneficially. Second, in almost all of the reviewed1 studies the pre-employment period is unemployment, that is, a status deviating from norms of the society and which also more or less conflicts with the value set of the individual. Although we may assume that more normative periods of the life course, such as studying or parental leave, are associated with a higher level of baseline health, there is reason to study the health effects of transitions from such positions to work. Positive health effects can be assumed to be referring—as the authors of the review seem to do—to Jahoda’s6 theory of job deprivation, which suggests that, in addition to the manifest material earnings, work contributes to well-being through five ‘latent functions’: time structure, social contacts, collective purpose, social identity and status, and activity. Third, health scientists could reproduce the approach of those sociologists and economists who study periods of nonemployment in terms of the ‘scars’ to a future occupational career and labour market attachment and associated ‘wage penalties’. The wounds, if any, of non-employment may be transient, but the recovery may be incomplete or there may be mental or physiological processes that manifest themselves following a delay. Moreover, there may be phases in the life course, such as early adulthood, when a period of unemployment may be more likely to scar future health. In the health research domain, a lot of population cohorts have been followed up for decades and it would be important to scrutinise the data sets, such as, for example, from Strandh et al,7 with respect to employment-related life course epidemiological research. Fourth, in contrast to the relatively clearcut categories of the labour market status prior to employment, after the work entry there is a lot of variation, in terms of the contractual strength of labour market attachment and the perceived job insecurity. Prototype (re-)employment, or immediate entry to open-ended contract as a wage or salary earner, is relatively rare and various fixed-term contracts and probation periods and even ‘zero-hour contracts’ are common. Moreover, there are ‘atypical’
jobs, such as agency work and selfemployment as entrepreneur or freelancer. Potential confounding due to divergent employment should be taken into account in studies comparing population cohorts. Nevertheless, the health effects of entries to atypical jobs deserve also to be studied separately. Of particular importance and interest in this respect are the transitional labour markets. The transitional labour market8 points to the active labour market policy (ALMP) measures that are located between overt unemployment and employment in the open labour market. In Western societies, it is generally difficult to ‘survive’ as unemployed without participating in measures that range from short courses aimed at promoting job seeking skills, to longterm occupational training with integrated periods of work and to state subsidised job creation schemes. Studies concerning ‘indirect employment effects’ of the ALMP measures, or the health effects of ‘interrupted unemployment’, are excluded from the review of van der Noordt et al1 The current body of such research is scarce,9 10 and rather than allowing unequivocal conclusions, the evidence gives some reason to recommend carefully designed prospective studies that make use of the natural experiments provided by various ALMP measures. Finally, the recommendation of Metcalfe et al11 to study the health effects of frequent job change seems not to have stimulated further research. Would the most common employment event, or instantaneous entry to another workplace, not also deserve attention as regards the well-being and health of employees? Competing interests None. Patient consent Obtained. Provenance and peer review Not commissioned; internally peer reviewed.
To cite Virtanen P. Occup Environ Med 2014;71:665– 666. Received 19 March 2014 Revised 4 July 2014 Accepted 29 July 2014 Published Online First 13 August 2014
▸ http://dx.doi.org/10.1136/oemed-2013-101891 Occup Environ Med 2014;71:665–666. doi:10.1136/oemed-2014-102143
Virtanen P. Occup Environ Med October 2014 Vol 71 No 10
665
Commentary REFERENCES 1
2 3
4
666
van der Noordt M, Ijzelenberg H, Droomers M, et al. Health effects of employment: a systematic review of prospective studies. Occup Environ Med 2014;71:730–6. Bauman Z. The individualized society. Cambridge: Polity Press, 2001. Rifkin J. The end of work. The decline of the global labor force and the dawn of the post-market era. New York: Putnam’s Sons, 1995. Twenge J. A review of the empirical evidence on generational differences in work attitudes. J Bus Psychol 2010;25:201–10.
5 6
7
8
OECD StatExtracts. http://stats.oecd.org/index.aspx? r=792351 Jahoda M. Employment and unemployment—a social-psychological analysis. Cambridge: Cambridge University Press, 1982. Strandh M, Winefield A, Nilsson K, et al. Unemployment and mental health scarring during the life course. Eur J Public Health 2014;24:440–5. Schmid G. Towards theory of transitional labour markets. In: Schmid G, Gazier B, eds. The dynamics of full employment—social integration through
9
10
11
transitional labour markets. Cheltenham: Edward Elgar, 2002:151–95. Andersen S. The short-and long-term effects of government training on subjective well-being. Eur Soc Rev 2008;24:451–62. Audhoe S, Hoving J, Sluiter J, et al. Vocational interventions for unemployed: effects on work participation and mental distress. A systematic review. J Occup Rehabil 2010;20:1–13. Metcalfe C, Smith GD, Sterne JA, et al. Frequent job change and associated health. Soc Sci Med 2003;56:1–15.
Virtanen P. Occup Environ Med October 2014 Vol 71 No 10
