The evidence
The quality of jobs

Evidence shows that stress at work plays an important role in contributing to the large differences in health, sickness absence and premature death that are related to social status. Several workplace studies in Europe show that health suffers when people have little opportunity to use their skills or influence their working lives.

   Having little control over one’s work is particularly strongly related to an increased risk of low back pain, sickness absence and cardiovascular disease. These risks have been found to be independent of the psychological characteristics of the people studied. In short, they seem to be related to the work environment.

   Studies have also examined the role of demands at work. Some show an interaction between demands and control. Jobs with both high demand and low control carry special risk. Some evidence indicates that social support in the workplace may reduce this effect.

   Further, receiving inadequate rewards for the effort put into work has been found to be associated with increased cardiovascular risk. Rewards can take the form of money, status or self-esteem. Current changes in the labour market may profoundly affect a person’s opportunities and make it harder for people to get appropriate rewards.

   These results suggest that the psychosocial environment at work is an important contributor to the social gradient in ill health.

  

Unemployment

Unemployment puts health at risk. Evidence from a number of countries show that, even after allowing for other factors, unemployed people and their families suffer a substantially increased (more than 20%) risk of premature death including suicide. The health effects of unemployment are linked to both its psychological consequences and financial problems, especially debt.

The effects start when people first feel their jobs are threatened, even before they actually become unemployed. This shows that anxiety about insecurity is also detrimental to health. Job insecurity has been shown to adversely effect mental health (particularly anxiety and depression), self-reported ill health, heart disease and risk factors for heart disease. Because unsatisfactory or insecure jobs can be as harmful as unemployment, merely having a job cannot protect physical or mental health. Job quality is important.

   During the 1990s, changes in the economies and labour markets of industrialised countries have in-creased feelings of job insecurity. As job insecurity continues, it acts as a chronic stressor whose effects on health, sickness absence and use of health services increase with length of exposure.

 

Implications for regional and local policies

 

There is no trade-off between health and productivity at work. A virtuous circle can be established: improved conditions of work will lead to a healthier work force; this will lead to improved productivity, and hence to the opportunity to create a still healthier, more productive workplace.

   Appropriate involvement in decision-making is likely to benefit employees at all levels of an  organisation. Redesigning practices in offices and other workplaces – to enable employees to have more control, greater variety and more opportunities for development at work – benefits health.

Work that does not provide appropriate rewards – in terms of money, self-esteem and status – damages

health.

   Workplaces must be appropriate ergonomically as well as in the organisation of work to reduce the

burden of musculoskeletal disorders.

 

South West Policies should aim to:

To equip people for the work available, high standards of education and good retraining schemes are 

important. For those out of work, unemployment benefits set at a higher proportion of wages are likely

to have a protective effect. Further, credit unions may be beneficial by reducing debt and increasing

social networks.

 

Local data to illustrate the link between unemployment and ill health 

 

The measures of ill health presented here — self-reported illness and musculoskeletal disease — can

be the cause of or caused by poor quality jobs or unemployment. The table shows how self-reported

long-term limiting illness is more common in some areas than others.

Map 8 pin-points these areas.
   Musculoskeletal disease includes back pain, spinal disc problems and arthritis. The burden of disease caused by these disorders is calculated in disability adjusted life years (DALYs) which combines years lost due to early death and years lived with a disability. A significant part of the total burden of disease in each health district is caused by musculoskeletal disease.

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