Work matters for health directly, as well as underpinning other factors that influence health such as income and social networks
Why work matters for health
Employment, or the lack of it, can have considerable influence on health and wellbeing. Poor health can limit people’s ability to have and sustain work. The nature of people’s work matters for health, but also impacts other factors that influence health, such as having sufficient income and forming social connections.
Explore the different ways in which work can affect health outcomes below.
Unemployment is defined as a situation where people of working age are without a job, but would like to be in employment. It is normally measured by whether a person is without work but actively seeking and available for work.
Unemployment has consistently been found to have a negative impact on a range of health outcomes. Reviews have found links between unemployment and self-rated health, with worse outcomes for men and those who are unemployed due to health reasons. These outcomes improved, however, if individuals had strong social networks. There is a similar relationship between unemployment and mental health, including depression, anxiety and levels of self-esteem.
There is a range of different mechanisms through which unemployment could harm health.
- Unemployment is a source of stress, which can eventually have a physiological impact. This can be because of the stress of losing the structure of work, the difficulties of seeking new work or the stigma associated with unemployment.
- The harm to mental health due to unemployment can result in unhealthy coping behaviours, such as smoking and drinking. Unemployment can also reduce overall financial resources leaving less to spend on such goods, as well as other essential items.
- Unemployment can cause poverty, which itself damages health.
- Unemployment can harm future employment outcomes, leaving people with a lower earning potential and, therefore, lower future resources.
While unemployment is associated with worse health outcomes, not all work is necessarily protective of health. Indeed, some analysis shows that low-quality employment is as bad for health as unemployment. The nature of jobs can vary significantly in terms of pay, the potential hazards, level of security, control and autonomy over the job, and the support offered to the worker.
Traditionally, much of the focus on the health impact of employment has been on hazards in agricultural and industrial workplaces. The risks of fatal and non-fatal injury today are far lower than they were 20 or 30 years ago partly due to improved regulation and safety measures and partly due to changes in composition of industrial sectors in the UK. There are still physical risks linked to work in the UK, experienced by 31% of workers in 2015, but these fall into broader categories, including prolonged sitting and working with screens.
The COVID-19 pandemic has highlighted the workplace itself as a potential source of harm, given the risk of transmission of the virus between employees. A total of 35% of workers attending their workplace in September 2020 had concerns about transmission of the virus in the workplace. Lower paid workers, however, were less likely to raise complaints or raise complaints successfully.
The work environment
Work is both physically and psychologically demanding for employees. Whether these demands eventually manifest as stress that can harm health depends in part on the resources available to people and within their control to meet these demands. This is one of the main insights from the Whitehall II Study, which found a social gradient in health outcomes among the study group of civil servants, with the highest grades having the best health outcomes.
There are two models relating to job strain: the demand-control model and the effort-reward model. The former has a bidirectional relationship between the demands of the job and the decision latitude, or the level of control over tasks and conduct at work with which people can meet these demands. The effort-reward model compares the effort expended at work with the rewards of the job, including remuneration and promotional prospects. There are overlaps in these models, though the employee control is related to specific tasks in the demand-control model and about wider elements of a role in the effort-reward model.
Imbalances in demand-control or effort-reward create job strain, which may stem from, for example, being excluded from decision-making, working with unsupportive colleagues, having low promotional prospects and general job dissatisfaction. Job strain is associated with a range of negative health effects, such as cardiovascular diseases and hypertension, with chronic stress undermining the immune function and increasing susceptibility to a range of conditions. The severity of these depends on other factors, such as social support networks.
Job security, or confidence in the continued existence of a job or hours of work is considered another stressor that can have a significant impact on health. This can include concerns about the loss of particular job functions and an individual’s capacity to resist change. The psychological challenges posed by uncertainty have been categorised as unpredictability (lack of clarity on how to respond) and uncontrollability (powerlessness towards the threat), of which the latter is considered a key part of how insecure work can affect physical and mental health. .
Job insecurity has been linked to reduced wellbeing, job satisfaction and a range of physiological problems. It has also been linked with poorer self-rated health, psychiatric morbidity, hypertension and coronary heart disease. Insecurity can interact with other stressors, such as low control, limited participation in decision-making or concern over job prospects. Several studies have found job insecurity to be a chronic stressor, reducing both short-term and long-term health and becoming more potent as the duration of insecurity increases.
There is some debate on whether it is poor work or unemployment that affects health, or if those with health problems are more likely to be unemployed or in poor work. The main reason that health might affect employment outcomes is because it can lead to either a reduced capacity to work or premature retirement from the labour market. Meta reviews find that while there is evidence of health impacts on employment outcomes, even taking account of health status before a period of unemployment there are significant impacts of unemployment on health.