1 Medical School, University of Tampere, Tampere, Finland
2 Department of General Practice, Pirkanmaa Hospital District, Tampere, Finland
3 Finnish Institute of Occupational Health, Turku, Finland
4 Finnish Institute of Occupational Health, Helsinki, Finland
5 Faculty of Behavioural Sciences, Department of Psychology, University of Helsinki, Helsinki, Finland
6 School of Public Health, University of Tampere, Tampere, Finland
7 Department of Epidemiology and Public Health, University College London, London, United Kingdom
Correspondence to Dr. Pekka Virtanen, Medical School, University of Tampere, FIN-33014 Finland (e-mail: pekka.j.virtanen{at}uta.fi).
Received for publication August 2, 2004. Accepted for publication December 20, 2004.
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ABSTRACT |
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career mobility; employment; health; prospective studies; unemployment
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INTRODUCTION |
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The set of risks that endanger health and well-being differs between nonpermanent and permanent employees. The assumption that the risks associated with nonpermanent jobs may exceed the benefits has given rise to recent research concerning their potential adverse health effects. However, a body of cross-sectional research provides a rather inconsistent picture of this association (29
). The few longitudinal studies mainly concern work-related illness: compared with those in permanent employees, occupational injuries are more common (10
, 11
) or equal (12
, 13
) in nonpermanent employees, whereas their sickness absence rates are the same (4
, 14
) or lower (9
, 15
). A longitudinal study (16
) has demonstrated poorer self-rated health in fixed-term employees in Germany but not in the United Kingdom. The latter finding has been replicated in a recent British study (17
). A register-based prospective study from Finland has shown higher overall mortality in initially fixed-term employees (18
).
In traditional labor markets, dominated by permanently employed men and their clear-cut periods of unemployment, atypical forms of employment were not a major research issue. In the new labor market, however, several sectors are occupied mainly by women, and it is in these areas that workers are expected to be the most flexible (19). This development, taking place in particular in the service industries of both the public and private sectors, means that women are the predominant gender in studies of atypical employment and its associations with well-being and health.
A previous cross-sectional study of Finnish public sector employees found that female fixed-term employees tend to rate their health as better than that of their co-workers with permanent jobs but to perceive higher levels of psychological distress (8). This subsample of women with initially fixed-term contracts formed the cohort that was followed up in the present study. Our aim was to examine whether their career trajectories, as characterized by variations in exposure to unstable employment and in labor market position at the end of the follow-up, were associated with health.
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MATERIALS AND METHODS |
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Labor market trajectories
In the follow-up survey, respondents were asked to report their labor market situation at four points in timeJanuary 1999, January 2000, January 2001, and the present (i.e., spring 2002). The preset response options for those working or seeking a job were permanent employment (including entrepreneurship), fixed-term employment, and unemployment (including short-term employment on government-subsidized contracts). Situations outside the labor force were classified in the following four categories: family reasons (including maternity and child-care leave), studies, retirement, and "other." Retired participants (n = 7) were excluded. Otherwise, these situations were considered "temporary economic inactivity" and were recoded according to most recent employment status. In all, 1,246 respondents completed the question about labor market situation, and each of them was placed in the category of having a permanent job, having a fixed-term job, or being unemployed at each point of the follow-up time.
We described labor market trajectories according to "exposure" to unstable employment during follow-up, "destination" employment status at the end of follow-up, and a variable that combined exposure and destination. The exposure variable was constructed by giving permanent employment, fixed-term employment, and unemployment values of 0, 1, and 2, respectively, for each year from 1998 to 2002 inclusive and by adding the values to obtain a score (range, 19). Respondents receiving scores of 13 (lowest tertile) were classified as having "low" exposure, those with scores of 4 or 5 (middle tertile) "moderate" exposure, and those with scores of 69 (highest tertile) "high" exposure to unstable employment. Destination was classified on the basis of employment status at the end of follow-up in 2002: "permanent," "fixed-term," or "unemployed." Combined mobility comprised six categories formed as follows: the group of respondents with a permanent destination was split at the median of the exposure score (2/3) into those with low and high exposure. Corresponding dichotomization was made for respondents with a fixed-term destination (split value 5/6 exposure points) and for those who were unemployed (6/7 exposure points).
Health outcomes
Self-rated health was measured with a single question offering five options and was dichotomized into optimal (excellent or fairly good) and nonoptimal (average, fairly poor, or poor) in the standard manner (20). Psychological distress was assessed with the 12-item version of the General Health Questionnaire (21
), and those respondents scoring more than three points were classified as suffering psychological distress.
Covariates
We measured gender, age, marital status, and occupation as baseline covariates. Marital status was dichotomized on the basis of whether the respondent was living with a partner at baseline. Occupations were classified according to the International Standard Classification of Occupations (ISCO) (22) into nonmanual (major groups 14) and manual (groups 59).
Statistical analysis
The effect of health at baseline on subsequent career development was assessed with multinomial logistic regression analysis. To explore the association between labor market trajectories and self-rated health or psychological distress at follow-up, we used binary logistic regression. The reference categories were moderate exposure to unstable employment, fixed-term destination, and the combination of low exposure and fixed-term destination. Analyses were adjusted for age, marital status, and occupational status, and, additionally, to assess changes during follow-up in self-rated health and psychological distress, for the baseline value of the outcome of interest.
To study whether there were significant trends toward poorer health and higher distress in the more peripheral trajectories, we gave the destination variable values of 1 (permanent), 2 (fixed-term), and 3 (unemployment). Correspondingly, the exposure variable was given values of 13 and the combined trajectory values of from 1 (permanent with low exposure) to 6 (unemployment with high exposure). These values were treated as continuous variables in the regression analysis (23).
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RESULTS |
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Labor market trajectory and changes in self-rated health
As shown in table 2, both ending up unemployed and having high exposure to unstable employment were associated with higher risk of nonoptimal health at follow-up than remaining in a fixed-term job and having moderate exposure to instability. Those who achieved a permanent position and experienced high employment stability did not have a significantly decreased risk. However, an inverse association between greater employment instability and poorer health was found across all of the labor market trajectories. Adjustments for initial health confirmed that the observed health differences were not due to preexisting differences in ill health but to changes during follow-up.
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DISCUSSION |
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For practical and ethical reasons, genuine experiment is impossible in studies aiming to examine the health risks of potentially adverse social circumstances. Of observational designs, the prospective cohort study is the best for questions on the etiology of ill health. However, such a design cannot escape the issue of health-related selection. In our study, the methodology used to analyze the career trajectories drew on ideas from life-course models (25), although, as identified by Hallqvist et al. (26
), disentangling accumulation of exposure- and outcome-related social mobility is problematic in such studies. Adjustment of the regression models for initial health diminishes the possibility of reverse causation (27
), and controlling for both health and labor market status at baseline may be considered an essential strength of our design.
Earlier findings on unemployment suggest that poor physical health is a cause (28) and poor mental health a consequence (29
) of unemployment. In accordance with these studies, we found that nonoptimal self-rated health at baseline increased the probability of becoming unemployed but that psychological distress was not associated with unemployment. In subsequent analyses of associations between trajectories and changes in health, this selection was controlled by adjustments. Of course, poor health postbaseline will have continued to exert selective effects on labor market trajectories during follow-up. However, we believe that our results cannot be attributed merely to health-related selection.
The follow-up period of our study was relatively short, and the results to date should be classified as short-term associations. However, they indicate that we are likely to see more pronounced associations over a longer period. Moreover, in some of the cells of the tables, the small numbers of participants suggest that the large odds ratios observed would probably reach statistical significance if we had greater numbers.
Some of our findings lead us to conclude that the association between labor market trajectory and health is not always so straightforward. For example, when examining combined trajectories, we found no difference between fixed-term low exposure to instability and fixed-term high exposure. Furthermore, the health risk was smaller for the unemployed with high exposure than for those with low exposure, especially when we looked at the values for self-rated health. The reason for this finding may be that, in the former cohort, nonoptimal health at baseline was already considerably more common than in the other cohorts (table 1). Because a person's self-rated health seldom improves, only a relatively small proportion of the cohort could be expected to change their health status category. Another paradoxical finding was the relatively high odds ratio for nonoptimal self-rated health in stabilizing careers. The finding suggests a healthy-worker effect; that is, if health problems occur, the career trajectory takes a turn toward the periphery less easily for employees in permanent jobs than for those whose labor market status is more contingent.
Much of the previous work in this field has been limited by designs that compare permanent employees of unknown tenure with temporary employees for whom health selection into the workforce is likely to be a recent event. With the design applied in this study, we were able to more easily evaluate the health effects of atypical employment. We restricted the study to those in fixed-term employment at baseline and chose the "immobile" employees, that is, those with fixed-term contracts throughout the 4-year follow-up, as the reference cohorts. This procedure enabled us to discern core- and periphery-directed trajectories and their associations with health.
The baseline population was gathered with the help of employers who ensured that employees with a nonpermanent contract received the baseline postal questionnaire. Of the respondents, we selected all those who reported having a fixed-term contract. There is no reason to suspect reporting bias regarding the type of employment contract. The response rate was satisfactory enough to argue that the respondents represent the personnel who have fixed-term contracts. Retrospective inquiry regarding the yearly employment situations may have reduced the validity of the information obtained in the follow-up survey, but this issue applies similarly to all respondents and does not bias the classification of labor market trajectory. The decision to attribute previous employment status to respondents who, at the follow-ups, were economically inactive was based on the concept that, as a "labor market citizen" (30), a person is carrying the stigma of his or her last (un)employment situation until a new one is assumed.
We cannot rule out the possibility that health-related nonresponse affected the results. Moreover, part of the exit from the population register, as deaths, was related to health, and persons in the exit group probably had the most unusual employment trajectories. Consequently, the cohorts studied were "normalized." Thus, it is likely that sample attrition led to an underestimation rather than an overestimation of the observed associations between labor market trajectories and health.
Longitudinal studies of the association between unemployment and health have so far failed to specify the type of employment contract lost. In demonstrating that loss of a fixed-term job may also be a health risk, our study sheds new and significant light on questions of well-being in the new labor market. However, any single study concerning the effects of nonpermanent employment has to consider the context specificity of the results. In addition to national and cultural distinctions, the association with well-being and health may depend on the stage of macroeconomic affairs and the segmentation of the labor market. This study concentrated on full-time, fixed-term, paid employment, the most common type of nonpermanent job in Western labor markets, and on women who, more often than men, had a fixed-term contract. The annual figures on employment status indicate that many participants were "on a bridge" to permanent employment and only a few were "in a trap" between unemployment and fixed-term jobs. The results may also be seen as indicators of the macroeconomic context. At the time of the present study, the Finnish national economy was recovering from a deep recession and gathering momentum once more, and employers were taking on new personnel. Thus, our findings describe the health of employees during a period of improving employment prospects and rapid economic growth.
As far as we know, this is the first longitudinal study that has simultaneously examined exposure to unstable employment and destination labor market position at the end of follow-up. The results offer novel evidence about health differences between employees on a trajectory toward a permanent job and those on a trajectory of fixed-term contracts or toward the periphery of the labor market. However, we should be cautious about generalizing the evidence. Although the findings accord with previous research that has examined the effects of exposure to adverse socioeconomic positions and downward socioeconomic mobility over the life course (3135
), much more work is required on the health effects of work careers in general and work careers in the new labor market in particular.
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References |
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