Working conditions, chronic diseases, and inequalities: what the research tells us

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Poor employment and poor working conditions contribute substantially to inequalities in chronic diseases across Europe. Dr Courtney McNamara from the Centre for Global Health Inequalities Research explains the latest evidence. She argues that to avoid even greater inequalities in health, post-COVID recovery plans should target these harmful conditions and promote social protection policies that enable all workers to thrive.

Estimated reading time: 4 minutes

The association between occupation and health has been widely documented. In Europe, workers on lower rungs of the occupational ladder report higher rates of Non-Communicable diseases (NCDs) than those above them. Does this mean that jobs done by those in lower occupational classes are more health damaging? And if so, what are the occupational characteristics that produce these inequalities?

Employment conditions, inequalities, and NCDs: the latest analysis

In a recent analysis, we found evidence that suggests non-standard employment conditions, like working part-time or under a temporary contract, are a main contributor to inequalities in NCDs across Europe. Specifically, we analysed countries in different regions of Europe and found that when we accounted (statistically controlled) for non-standard employment conditions, inequalities in NCDs were reduced, sometimes dramatically. For countries in Western and North-Western regions of Europe (i.e. Austria, Belgium, France, Germany, Ireland, Netherlands, Switzerland and the U.K.) for example, we observed reductions in the range of 41-69% for women and 66-95% for men.

We also looked at what happened to inequalities in NCDs after accounting for different poor working conditions. Poor working conditions can be related to harmful ergonomic exposures – like painful work positions, or to dangerous physical hazards –  such as loud noises. Again, reductions were substantial. For the same set of Western and North-Western European countries, we found relative inequalities in NCDs were reduced by 10–66%.

Employment structures and working conditions

Our work corroborates other studies that have also found employment and working conditions to contribute substantially to health inequalities. Unlike many of these studies however, we also looked at what happened when we accounted for both non-standard employment and poor working conditions simultaneously. Accounting for both type of conditions simultaneously is important. This is because workers with precarious employment conditions are also likely to have greater exposure to poor working conditions. As such, not taking both types of conditions into account risks underestimating the role of occupational conditions in health inequalities. When we accounted for both types of conditions we found particularly large reductions in inequalities in depression and obesity. Reductions were in the range of 60-99% for both women and men. We found this in almost all regions of Europe.

We argue that our results call for a greater focus on employment and working conditions in addressing NCDs. This is a departure from standard NCD prevention strategies that focus on nudging people away from behaviours like smoking or drinking too much alcohol.

However, our results take on new significance in the context of COVID-19. Since early in the pandemic, it has been clear that people suffering from NCDs are at greater risk of becoming severely ill or dying from the virus. The results of our work suggest that a focus on improving occupational conditions could be an important strategy, not just in limiting inequalities in NCDs, but also in limiting inequalities in COVID-19 outcomes.

Beyond the pandemic towards economic recovery

Over time it has also become clear that the economic fall-out of the pandemic is disproportionately impacting precarious workers by generating greater employment and financial insecurity among people in low-paid, low-skilled jobs. In this context, our results caution that if we fail to act on these employment conditions, COVID-19 is likely to lead to an even greater burden of NCDs among people already suffering the most during the pandemic.

We therefore urgently need effective action to eliminate precarious employment and its harmful health impacts. Previous research has shown us that social protection policies are an important tool that can safeguard health in times of economic crisis. Emerging research is showing us that these policies are also important in protecting vulnerable workers during the pandemic.  As economic recovery strategies from COVID-19 are debated, policy makers should aim beyond a “return to normal”. They should seek to eliminate harmful employment and promote social protection policies that enable all workers to thrive.

Dr Courtney L. McNamara
Dr Courtney L. McNamara
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Dr. McNamara is a Senior Researcher at the Centre for Global Health Inequalities Research (CHAIN). Her work focuses on how health and health equity are affected when global processes, related for example to international trade or COVID-19, generate labour market vulnerabilities like unemployment or financial insecurity.

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