Social, economic, commercial and environmental conditions are the strongest determinants of people’s health. This includes people’s access to homes that are safe, stable and warm; the availability of an adequate financial safety net; access to healthy, affordable food; and the quality of their work.
This long read presents new analysis exploring changes in one of these wider determinants of health: the labour market. This includes the quantity and quality of employment over the last 10 years, the implications of these changes for health, and what they mean for public policy. It is the first in a series addressing changes in the wider determinants of health and what they mean for health inequalities.
Since the 2008 recession, the UK labour market has performed well in terms of generating employment. Employment is at record high levels. Unemployment poses a range of risks for health and wellbeing, so on the face of it, high employment rates are good news.
However, this interpretation overlooks the levels of low-quality work experienced by workers in the UK, which can also pose a risk to health. And while much of the debate on low-quality jobs has focused on insecurity and zero-hours contracts, low-quality employment goes beyond insecurity.
Recent political developments have thrown this debate on low-quality jobs into sharper relief: given the UK has left the EU, and the most recent withdrawal agreement bill did not include clauses protecting EU-derived employment rights. Instead, the Queen’s Speech has promised an employment bill, promising to ‘protect and enhance workers’ rights as the UK leaves the EU’. This presents an opportunity to take a fresh look at what we mean by employment and how the quality of work can affect health.
- Work is a key influence on health. Work matters for health directly, as well as underpinning other factors that influence health such as income or social networks.
- The UK’s high employment level means that attention should shift from the association between unemployment and health, to the impact that the quality of work has on health.
- Job insecurity (for example, zero-hours contracts) receives a lot of policy and media attention. However, this is only one aspect of low-quality work. A job can be secure and still be considered low quality.
- This piece presents a broader measure of low-quality work, which incorporates subjective indicators of low levels of autonomy, negative emotions associated with a job, security and satisfaction, and other aspects of job quality from survey data, as well as low pay. The more of these factors that people experience in their work, the more likely they are to have worse health.
- Using the broader measure, over one-third (36%) of employees report being in low-quality work. Of these, 15% report experiencing poorer health – which is twice as high than for those with no negative job aspects, at 7%.
- Half of those in low-quality work in 2010/11 were still in low-quality work in 2016/17. Spending longer in low-quality work is associated with worse health outcomes. Low-quality work can trigger stress, and the damage stress does to the body builds over time.
- Low-quality work is unequally distributed across society, both in terms of geography and demography, reflecting broader inequalities. Certain groups are more likely to be in low-quality work including younger adults, people in more routine occupations, and members of black and minority ethnic groups.
- High employment levels have not resulted in better job quality. There has been little change in the extent to which people report low job quality since 2010/11. With the UK’s employment law set for review as it leaves the EU, action is needed to improve job quality. Beyond regulatory fixes, employers should give greater consideration to job security, job design, management practices and the working environment to boost job quality.