Is any job better than no job at all? Studying the relations between employment types, unemployment and subjective health in Belgium

In Western capitalist societies, the quality of employment conditions and relations has changed considerably in recent decades due to an extensive focus on labour market competitiveness and flexibility [1]. Also in Belgium, the transformation from a Fordist society based on industrial mass production to a Post-Fordist service economy went hand in hand with an erosion of the previously dominant, highly regulated model of full-time, lifelong employment in a fixed organisation [2, 3]. Apart from the growth of non-standard or atypical forms of work, employment also became more flexible in terms of working hours, opportunities for career progression and employment relations, thus altering various aspects of the employment experience [4]. Although an increasing body of recent literature provides evidence on the potential health effects of flexible or atypical employment forms, few researchers have used a multidimensional approach to study the health effects of employment quality [5]. Research including several employment quality features at once does find clear relations with employees’ health and well-being. Scott-Marshall & Tompa have studied the health consequences of precarious employment experiences by simultaneously including several key aspects of work-related precariousness (contract type, working hours, union coverage, income and benefits, supervisory responsibility and risk of exposure to physical hazards) in logistic regression analyses. They show that exposure to these aspects results in adverse consequences for general and functional health [6]. Research also used multidimensional scales to operationalise employment quality, such as the Employment Precariousness Scale (EPRES). This scale contains six dimensions: temporariness, disempowerment, vulnerability, wages, rights and exercising rights. A study using the EPRES shows that employment precariousness is related to poor mental health among Spanish employees [7]. Another example of a multidimensional measurement approach towards the quality of employment consists of the construction of job types based on information about key employment features. A recent study based on this approach shows clear associations between five ideal-typical employment arrangements on the one hand and self-perceived mental and general health on the other hand [8]. Adverse health outcomes are more often reported by employees holding a ‘precarious’ job, illustrating that precarious employment situations – characterised by the accumulation of ‘low quality’ job features – are an important determinant of health and well-being [8‐10].

At the same time, individuals who did not succeed in finding a job – and experience unemployment as a result of that – also show lower scores for health and well-being indicators [11]. Thanks to a longstanding and extensive body of research, the health effects of exposure to unemployment are exceptionally well documented and explained. Jahoda was one of the first authors to write about the importance of employment for people’s health [12]. Warr also wrote a thorough review of the health effects of both (paid) employment and unemployment. He concludes that – while several characteristics of employment are potentially damaging to health – transitions from employment into unemployment are generally accompanied by deteriorating health outcomes for the persons involved [13]. Generally, recent studies confirmed these harmful effects of unemployment for both mental [14‐16] and general health [17, 18], but some studies relate this to a health selection effect and thus doubt the causal link from unemployment to poor health [19]. Other studies have demonstrated the positive health effects of (re-)employment, while focussing at the same time on the observation that poor quality jobs are associated with worse health than good quality jobs [20].

Employment quality and unemployment are rarely investigated simultaneously since most studies either compare the health status of the unemployed versus the employed or examine the health status of employed individuals. Studies that do include both aspects tend to use the stability of employment as a benchmark to differentiate between types of jobs [21, 22]. Those studies do not entirely grasp the fact that the combination of several employment features determines the quality of a job. This article aims to fill this gap by providing an overview of general and mental health associations of labour market positions in Belgium, differentiating between employment and unemployment, but also between several types of jobs among the employed. Information on five dimensions representing the quality of employment conditions (employment stability, material rewards, workers’ rights and social protection, working time arrangements and employability opportunities) will be used to identify different types of waged employment in Belgium, using a latent class approach [8, 23].

The individual labour market situation tells only part of the story. Its health impact depends on the wider social context individuals are embedded in [24]. Precarious job features such as a low income or flexible/irregular working hours are likely to have a different impact depending on the household situation of the worker involved [24, 25]. Following this reasoning, unemployment or precarious types of employment could be assumed to lead to more (health) problems for those individuals (with dependents) living in a household without other income-earners or in a household combining multiple precarious jobs. Vosko uses the term “precarious households” to describe this phenomenon [26]. The observation that precarious labour market positions tend to coincide with precarious living arrangements compels the need to study the ‘net health associations’ of labour market positions [24].

The aim of this article is thus twofold. In first instance, it seeks to examine the relations between labour market position (type of employment or unemployment) and general and mental health in Belgium. In second instance, this study aims to investigate the role of the household context and social support in the relation between labour market position and health.

Results for the relations between the labour market typology and poor general health are shown in Table 3. The results from the first model – controlled for sex and age – show that unemployment and precarious jobs are associated with significantly higher odds to report poor general health than the standard job type. The introduction of the three household situation indicators in model 2 lowers the odds for most labour market positions, but the differences with the standard job type remain statistically significant for both the unemployed and the precarious job type. The odds ratios observed in model 1 are strongly reduced in the final model (additionally controlled for social support), but remain significant for both the unemployed and respondents holding a job resembling the precarious type. Home ownership, financial situation and social support are significantly related to self-perceived general health. The household context and social support indicators seem to be particularly important for the general health level of respondents in unemployment.

Table 4 presents the results for the relations between the labour market typology and poor self-rated mental health. In model 1, unemployment, the precarious job type and the instrumental job type show significantly higher odds than the standard job type to report poor mental health. The difference is largest for the unemployed, followed by the respondents holding a job that resembles the precarious type and those holding a job resembling the instrumental type. Controlling for the household context (model 2) and social support (model 3) generally lowers the odds of poor mental health for the different labour market positions, but differences remain significant for the three labour market positions. Household composition, financial situation and social support are significantly related to self-rated mental health. The household situation and the presence of social support appear to be very important for the unemployed and to a lesser extent for respondents holding a job resembling the precarious type.

Two labour market positions are consistently related to poor self-perceived general and mental health in Belgium: unemployment and the precarious job type. The instrumental job type is related to poor self-rated mental health only. The introduction of the individual’s household situation and the presence of social support provides us with important insights considering the relation between labour market position and health.

First of all, the reduction in odds ratios following the inclusion of the social context variables in the model is in accordance with previous research indicating that part of the health problems associated with unemployment and low-quality employment are due to the fact that these labour market positions often coincide with a precarious or deprived situation at the household level [25]. Research has illustrated the importance of employment at the household level during recent decades, amongst other things because of changing household structures [30, 31]. Giatti, Barreto & César report a relationship between unemployment and poor self-rated health at the individual level and an additional association between poor self-rated health and living in a household with at least one informal or unemployed worker [32]. However, Scutella & Wooden find no evidence for an additional mental health effect of living in a jobless household among unemployed individuals [33]. Lim, Kimm & Song examine the interaction between employment status and household income [34]. They conclude that the self-perceived health of precarious workers is more strongly affected by household income, due to the instability of their employment status.

The results of our analyses do not only point out that the accumulation of health-damaging societal positions is a worrisome reality for a part of the Belgian population. The rather small gap in poor general and mental health between the unemployed and individuals in precarious employment in the final model suggests that low-quality employment and unemployment have an equally strong link to health. This observation has been largely overlooked in studies merely focussing on the health associations of unemployment and opens up a debate about the importance of job quality in addition to merely promoting employment for the unemployed. Several other authors have also emphasised that any job is not necessarily better for health than no job at all [13, 20, 35, 36].

The use of latent classes based on multiple employment quality indicators to represent different types of waged employment is another innovative aspect of this study. It allows to broaden the mere comparison between employment and unemployment by taking into account the multidimensional nature of the employment situation. Previous research on data from the European Working Conditions Survey has applied the same technique for employees living in the EU27 [8, 23]. The job types that were discovered are strikingly similar, with that difference that two precarious job types (precarious intensive and precarious unsustainable employment) were found instead of one [23]. The fact that more or less the same job types were found in a different dataset and using a different set of variables is a strong validation of our approach to employment quality. The results from this European research also confirm the status of precarious employment as the most detrimental job type for employees’ general and mental health [8].

The results of this study show the importance of high-quality employment for individuals’ general and mental health situation and suggest that not just any job will do. However, further research using a multidimensional approach towards the quality of employment is needed to confirm the health gradient from unemployment over low-quality jobs to high-quality employment. So far, empirical evidence on this topic remains limited for Belgium as well as for other countries. In particular, longitudinal research designs including employment quality could provide plenty of extra information with regard to the health effects of labour market mobility and about the relative strength of both directions of causality. This would also allow to study whether the actual change from unemployment to a low-quality job results in an improvement in health or not.

The results of this study also suggest that the household situation and social support are important factors mediating the relationship between labour market position and health. However, the analyses in this study do not allow a formal test of individuals’ social context as a pathway linking labour market position to health. Further research is needed to clarify the relationship between labour market position, social context and health.

The limitations of this study are mainly related to our use of secondary data and the resulting restrictions with regard to the operationalisation of our main concepts: labour market position, household situation, social support and health. The cross-sectional nature of our data implies that no statements about the causality of the reported associations can be made. This also means that we cannot rule out the existence of a certain bias due to health selection effects. The existence of health selection entails that part of the relation between labour market position and health is shaped by the fact that individuals with lower health are less likely to obtain a (high-quality) job [37]. Finally, the limited number of cases in our dataset made it impossible to include more labour market positions in the typology or to perform gender-specific analyses. Future research is needed to clarify the health associations of those individuals in (early) retirement, housekeepers or students and to examine the role of gender in the relation between labour market position, social situation and health. However, the use of GGS-data in this study is also one of its innovative features, since data from this survey have been used mainly for research on fertility and family formation. The application of this dataset in research focussing on labour market position and health is quite unique and proves the value and the large scope of these data.

This article presents evidence of clear relations between the labour market position and the self-perceived general and mental health of working-aged individuals in Belgium, even when taking into account the fact that an individual’s labour market position is necessarily embedded in a broader social context. The unemployed and those employed in low-quality (precarious) jobs are most likely to face health problems.

This paper makes several contributions to occupational health literature. While previous research has mainly focused on the health consequences of unemployment (often in comparison with the employed in general), this study pays attention to the existing diversity in the employment situations of workers. Not only self-employed are included, but on top of that an innovative approach is used to integrate information with regard to the quality of employment conditions for those in waged employment. Finally, this article acknowledges that precarious labour market positions tend to coincide with precarious living arrangements and a lack of social support, by taking into account the household context and social support when considering the health associations of the individual labour market situation.