Key elements of fair employment and decent work
One section of the report ‘Closing the gap in a generation: Health equity through action on the social determinants of health’ issued by the Commission on Social Determinants of Health and published by the World Health Organization focuses on the issues of fair employment and decent work. It examines a range of issues related to working conditions and presents a series of recommendations on how to improve factors relevant to achieving fair employment and decent work.
The report, Closing the gap in a generation: Health equity through action on the social determinants of health (7.29Mb PDF), issued by the Commission on Social Determinants of Health in 2008, states that:
Employment and working conditions have powerful effects on health and health equity. When these are good they can provide financial security, social status, personal development, social relations and self-esteem – each important for health.
The report sets out a range of issues related to working conditions that are relevant to decent work and fair employment such as:
- atypical and precarious working;
- conditions of work and work quality;
- working arrangements;
- work–life balance.
The Commission on Social Determinants of Health recommends that:
Full and fair employment and decent work should be made a shared objective of international institutions and a central part of national policy agendas and development strategies, with strengthened representation of works in the creation of policy, legislation, and programmes relating to employment and work.
Atypical and precarious working
The report cites a range of studies that demonstrate the link between precarious and atypical employment (including informal work, temporary work and contract work) and poorer physical and mental health status. It notes in particular that:
- poor mental health outcomes are associated with precarious employment (for example, Artazcoz et al, 2005; Kim et al, 2006);
- workers who perceive work insecurity experience significant adverse effects on their physical and mental health (Ferrie et al, 2002).
Although much of the focus of this report is on the world’s poorest economies, it nevertheless states that in high-income countries such as EU Member States, there has been a growth in job insecurity and precarious employment (such as informal work, temporary work, part-time work and piecework), job losses and a weakening of regulatory protection, particularly since the early 1990s.
The Commission on Social Determinants of Health’s recommendation to national governments is that they use policy and legislation to reduce insecurity among people in precarious work arrangements to ensure that wages are based on the real cost of living, social security and support for parents.
In particular, the report states that more policy and legislation is needed in areas such as downsizing, subcontracting and outsourcing, including supply chain regulation. Outsourcing and subcontracting in particular are singled out as practices that are central to production in the global economy:
Modern business practice, especially among large corporations, depends heavily on the outsourcing of production of goods and services to other firms or distant locations (including internationally).
The report states that international studies have found that subcontracting may lead to a deterioration of occupational health and safety due to risks such as:
- financial pressures on subcontractors;
- the disorganisation or fracturing of occupational health and safety management;
- inadequate regulatory controls.
Although the response of national governments to these issues has been varied, some governments have begun to explore supply chain regulation. The Commission on Social Determinants of Health believes that, ideally, responsibility for the management of occupational health and safety should be focused at the top of the supply chain, and that regulation in this area needs to be supported internationally, as subcontracting and outsourcing is often international in nature. The Commission cites the example of relatively new legislation in the UK, dating from 2006, which introduced a statutory licensing system covering labour supply agencies (‘gangmasters’) in the agriculture, horticulture and food processing sectors (Williams, 2009).
Work quality and working conditions
The report states that poor work quality and working conditions can affect mental health almost as much as loss of work. For example, work-related stress, which can be the result of a variety of elements, including poor working conditions, lack of job control and poor relationships at work, is associated with a 50% excess risk of coronary heart disease (Marmot, 2004; Kivimäki et al, 2006) and there is ‘consistent evidence’ that high job demand, low control, and effort-reward imbalance are risk factors for mental and physical health problems (Stansfeld and Candy, 2006).
The Commission on Social Determinants of Health recommends that occupational health and safety policy and programmes be applied to all workers – formal and informal – and that the range be expanded to include work-related stressors and behaviours as well as exposure to material hazards.
Work–life balance is characterised by the report as a way of organising work to ensure that employees are not overworked and that there is a good balance between an employee’s work life and their private life. It states that:
Rebalancing work and private life requires government policy and legislative support that provides parents the right to time to look after children and the provision of childcare regardless of ability to pay, plus work provisions such as flexible working hours, paid holidays, parental leave, job share, and long-service leave.
These types of policies are beginning to emerge in high-income countries, such as the EU Member States, although the report notes that informal workers are excluded from these provisions.
The Commission on Social Determinants of Health therefore calls on governments, with the participation of workers, to develop incentives to promote work–life balance policies and supportive social protection policy with clear mechanisms for financing and accountability.
This is an interesting and comprehensive report that examines the issue of health and employment. It sets out the prerequisites for the existence of fair employment and decent work, which rest on elements such as good working conditions and good quality work, curbs on precarious work, and an acceptable work–life balance. While much of the focus of this report is on the low-income economies of the world, the higher-income economies, such as the EU Member States, can draw valuable lessons from the research cited in the report and the recommendations of the Commission on Social Determinants of Health.
Artazcoz, L., Benach, J., Borrell, C. and Cortes, I., ‘Social inequalities in the impact of flexible employment on different domains of psychosocial health’, Journal of Epidemiology and Community Health, Vol. 59, 2005, pp. 761–767.
Commission on Social Determinants of Health, Closing the gap in a generation: Health equity through action on the social determinants of health, Final report, Geneva, World Health Organization, 2008, available online at http://www.who.int/social_determinants/thecommission/finalreport/en/index.html.
Ferrie, J.E., Shipley, M., Stansfeld, S. and Marmot, M., ‘Effects of chronic job insecurity and change of job security on self-reported health, minor psychiatry morbidity, psychological measures, and health related behaviours in British civil servants: the Whitehall II study’, Journal of Epidemiology and Community Health, Vol. 56, 2002, pp. 450–454.
Kim, I.-H., Muntaner, C., Khang, Y.-H., Paek, D. and Cho, S.-I., ‘The relationship between nonstandard working and mental health in a representative sample of the South Korean population’, Social Science and Medicine, Vol. 63, 2006, pp. 566–574.
Kivimäki, M., Virtanen, M., Elovainio, M., Kouvonen, A., Väänänen, A. and Vahtera, J., ‘Work stress in the aetiology of coronary heart disease – a meta-analysis’, Scandinavian Journal of Work and Environmental Health, Vol. 32, 2006, pp. 431–442.
Marmot, M., The status syndrome: how your social standing affects your health and life expectancy, London, Bloomsbury, 2004.
Stansfeld, S. and Candy, B., ‘Psychosocial work environment and mental health – A meta-analytic review’, Scandinavian Journal of Work and Environmental Health, Vol. 32, 2006, pp. 443–462.
Williams, C.C., Gangmaster licensing awareness campaign, United Kingdom, Dublin, European Foundation for the Improvement of Living and Working Conditions, 2009, available online at /ef/observatories/eurwork/case-studies/tackling-undeclared-work-in-europe/gangmaster-licensing-awareness-campaign-united-kingdom.
Andrea Broughton, Institute for Employment Studies (IES)