The onward march of non-communicable disease (NCD) incidence and prevalence is preoccupying almost every nation, the UN system and major economic development agencies such as the OECD, IMF and World Bank [
1]. It has become a focal point for debate in the setting of Sustainable Development Goals as the Millennium Development Goal process draws to a close [
2]. The now near universality of this particular health transition is encouraging the search for the ‘causes of the cause’ behind the persistence of a handful of health risks and behaviours – obesity, unhealthy eating, insufficient physical activity, smoking and alcohol abuse – responsible for the major NCDs including Type 2 diabetes, cancers, cardio-vascular disease.
As part of this effort, researchers are turning their attention to charting the temporal nature of societal changes that might be associated with the rapid rise in NCDs [
3,
4]. In addition to the temporal dimension to analyses typically deployed by epidemiologists (e.g. age, life stage and length of exposure/birth cohort), the social science notion of ‘historical time’, or “the point in history of the society” in which cohort effects are observed [
5] (p 86), is proving to be critical to understanding health transitions. Identifying the events which shape socio-cultural and socio-economic conditions becomes indispensable when seeking to understand the question of ‘why now’ do we see disease emergence? The answers to this question throw light on where to intervene to prevent the future spread of health compromising conditions [
6].
The concept of time is not simply central to epidemiology and the social sciences. Notions of ‘the harried worker’, work-life balance and time management have entered the public lexicon. The experience of time and its allocation are themselves becoming acknowledged as a key individual and societal resource and capacity [
7‐
9]. Within public health, time is considered a mediator of basic health behaviours, including healthy eating and physical activity [
10], which require careful scheduling and appropriate time allocation [
11,
12]. If the practice of these health behaviours change when the time economies of individuals and households change, there will be significant flow on effects for chronic disease [
13].
In this interdisciplinary study, we seek to produce a systematic analysis of the behavioural health dimensions, or ‘health time economies’, that may accompany labour market transitions of the last 30 years (the period in which so many NCDs have risen sharply). ‘Health time economies’ refers to the quantity and quality of time necessary for the practice of health behaviours.
Deregulation and labour moderisation
For more than forty years, research has linked adverse health outcomes to particular working time arrangements – permanent work, no work, precarious work, time limited or short-term work. In its evidence synthesis reports The Employment Conditions Network (EMCONET) of the WHO Commission on the Social Determinants of Health identified the strong links to cardiovascular disease of workplace stress, which was more likely to occur among workers with high workplace demands over long hours and few rest breaks [
14]. Long work hours were also associated with occupational injuries and accidents, psychological ill-health, muscoloskeletal disorders and unhealthy behaviors. Increased work intensity (having to do more in less time) raises the risk of anxiety and depression among women workers [
14]. However, it is not simply having too much work to do that is a health hazard. Job insecurity and downsizing have also been shown to be linked to poor psycho-social health outcomes. The EMCONET noted that precarious work did not simply negatively impact on the employee’s health but that of family members [
14].
While the links between work and health are clear, it is widely recognised that our labour markets are in a state of flux [
14‐
17]. Secure labour force participation, with a high degree of employee control, decent income and social status are all changing. In many OECD countries, since the 1980s, systems of employment regulation have shifted from centralized and collective standards towards workplace and individual bargaining [
18]. While labour market deregulation takes a number of concrete forms, at its core is the removal of rules and laws that control the actions of individuals and groups who are ‘party to the production of goods and services’ [
19,
20]. Hence, deregulation is seen as the removal of external protections for workers, pursued mainly through changes to award systems [
21]. Instead of population wide industrial relations provisions administered by government institutions, a proliferation of specific conditions have been negotiated by market actors and employee representatives. Provisions that regulated working time, such as overtime pay rates for long hours of work, penalty pay rates for unsociable hours of work (evenings, weekends and public holidays) and even holidays have been bargained away. Aided by technology and motived by global competition, the focus of managerial control is increasingly on output not hours. This has loosened the upper limits on work time and uncoupled hours worked from wages, further undermining regulatory influence. This aspect of deregulation also changes other dimensions of work time, including the intensity (having to work faster and compress time to meet deadlines), and unpredictability as labour and work hours is fitted closely to demands, which can fluctuate [
22]. The concurrent changes in workforce regulation over the last 30 years have combined with the rapid increases in women’s participation rate in many OECD countries to generate households which are labour market active but time poor.
Like other OECD countries, the Australian context in which this study is embedded has seen a move away from ‘rigid’ standards. The centerpiece of marketing efforts to sell the benefits of a deregulated environment has been to frame less rigid workplace arrangements as offering ‘flexibility’. Broadly, work flexibility refers to the ability of workers to make choices influencing when, where, and for how long they engage in work-related tasks [
23]. However, the term is also used to reflect the loosening of hiring and firing terms, as well as the expansion of ordinary hours which do not attract penalty rates [
24]. This ‘flexible labour’ is thought to enable globally competitive market places. Internationally, flexible labour has been growing for several decades [
17,
18,
25,
26]. Across Canada, Japan and most European countries flexible labour now accounts for as much as 30% of total employment [
26] and around 15% in Australia. The trend towards flexible labour is set to continue, with new flexibility provisions in place in industrial relations legislation in many countries, Australia included [
26].
Flexibility tends to be described as wholly positive – for employers, employees and the economy [
27]. However, the positive rhetoric of workplace flexibility is not backed-up by the research. In a meta review of flexibility studies, Allen [
28] found that flextime
and flexiplace policies were more likely to create work interference with home – suggesting a privileging of work activities over other responsibilities and demands. Flexibility appears to facilitate a shift of more time to work activities [
29,
30]. For example, flexibility in the form of greater schedule control can further erode boundaries between work and home: “
employers now have the flexibility and control to prioritize, scale up and unbind work obligations so that work can impinge on all aspects of employees’ non-work time” [
31]. As Shore and Wright argue, flexibility has seen the “re-invention of professionals… as units of resource whose performance and productivity must constantly be audited so that it can be enhanced” [
32] (p 559).
Overall, deregulation has led to a more fragmented labour market characterized by unequal wage growth, work intensification and pockets of ‘precarious’ workers [
20,
21,
33,
34]. In the Australian context, there has been a marked departure from the design of industrial awards based on the needs of employees to those awards based on the economic performance needs of the industrial sector [
35]. This shift to sectoral needs has entailed the introduction of numerous forms of unequal treatment across the workforce: for example, provisions permit the uptake of flexible working time conditions by some workers (parents) and not others, and award entitlements like sick leave and annual leave are awarded to some groups of employees (tenured and some contract, Australian citizens) while not extending the same provisions to others (casual, special work visa categories). Even where good working conditions are present, there appears to be a reluctance to take up the workplace entitlements - sick leave, annual leave, career leave and engaging in industrial disputes [
36].
Despite this growing interest in labour market change and population health outcomes, little is known about how contemporary labour market shifts are affecting the health time economies – the amount and quality of time devoted to health related behaviours – of individuals, households, peers and other social groupings. What we do know is that ‘working time’ is a major impediment to time for healthy eating, physical activity and regular, sufficient sleep which has itself been linked to obesity [
37,
38]. Ulker finds that non-standard hours are linked to self reports of inferior health through in part negatively impacting on exercise and smoking [
39], while long hours and high pressure is known to impact leisure and exercise. Emerging research suggests that time poverty may be more important than income poverty as a barrier to regular physical activity [
40,
41]. Time poverty has also been linked to poor eating habits [
42], with work time ‘spill over’ associated with lower fruit and vegetable intake [
43]. Job stress and long work hours cause individuals to seek out convenience food, which is usually less healthy than food prepared at home [
44].
We contend that time is a key mechanism through which particular forms of labour market policies impact health. The labour market flexibility agenda appears to be operating as a time re-distributive device: it has supported the removal of regulations that governed ‘the when’ of working time and removed limits over the amount of working time, thus extending by many hours the notion of the ‘standard’ working week and forcing employees to adapt their shared or social times as well as their time for health. This study seeks to unpack the impact of the dilution of working time regulations and the reduction in the workforce covered by regulations (including access to paid leave and holidays, the extensions to the standard day and week) on the health of the nation.