Employment security and health. (Public Health Policy and Practice).

Objective: To study the relation of contractual and perceived employment security to employee health. Design: Cross sectional survey.

Setting: Municipal sector employees in eight Finnish towns.

Participants: 5981 employees with a permanent contract and 2786 employees with a non-permanent contract (2194 fixed term contract, 682 government subsidised contract).

Outcome measures: Poor self rated health, chronic disease, and psychological distress. Results: Compared with permanent employees, fixed term men and women had better self rated health (men odds ratio 0.70; 95% confidence intervals 0.50 to 0.98, women 0.70 (0.60 to 0.82) and less chronic disease (men 0.69; 0.52 to 0.91; women 0.89; 0.79 to 1.02), but women had more psychological distress (1.26; 1.09 to 1.45). The only difference between subsidised employees and permanent employees was the high level of psychological distress in women (1.35; 1.09 to 1.68). Low perceived employment security was associated with poor health across all three indicators. The association of low perceived security with psychological distress was significantly stronger in permanent employees than among fixed term and subsidised employees, indicating that perceived security is more important for mental health among employees with a permanent contract.

Conclusions: Contractual security and perceived security of employment are differently associated with health. It is therefore important to distinguish between these aspects of employment security in studies of labour market status and health. Such studies will also need to control for health selection, which is unlikely to operate in the same way among permanent and non-permanent employees.

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Atypical employment is no longer a transitory phenomenon but has become an integral feature of European labour markets. (2) Employees with various fixed term contracts perceive their employment security to be low more often than permanent employees, but the unpredictable nature of post-industrial working life has also increased perceptions of poor employment security in permanent jobs. According to a survey in 15 European Union countries in 1995-96, 15% of employees work in precarious jobs. (3)

Studies of employment security and health can be divided into those that have examined self perceived security and those in which security has been externally attributed to labour market status. However, the potential health effects of both types of employment security in combination are poorly understood.

Security of employment may be seen as a component of the more global notion of security of work, which has traditionally been studied under the concept of "job insecurity". (4) In addition to the threat to continued employment, job insecurity is assumed to be generated by other factors such as actual or anticipated organisational changes. It has been shown that factory closures, (5) threat of redundancy, (5-7) outsourcing, (8) downsizing, (9 10) and re-engineering " all increase the risk of health problems among employees. In these studies nonpermanent employees are either mixed with permanent employees, or excluded from the analyses.

Only a few cross sectional surveys have explicitly investigated the association between contractual employment security and health. In a Swedish study carried out in a hospital undergoing organisational change, somatic complaints were less frequent among non-permanent than among permanent employees, but no association was found between contractual employment status and mental distress. (12) In a survey of a random sample of employees from 15 European countries, Benavides et al (3) found that non-permanent employees despite their poorer psychosocial and ergonomic working conditions reported less stress and absenteeism than permanent employees. Work related fatigue and musculoskeletal symptoms were more common in non-permanent than permanent employees.

The above studies have a number of limitations, including the use of non-standard and crude health outcomes, (3) failure to take account of potential differences between sexes and socioeconomic groups, as well as the role of perceived security of employment, (3 12) and a small sample size comprising only a few occupations. (12) To overcome some of these limitations, we examined the association between contractual employment security and health in a large sample of Finnish employees using established measures of health and taking into account differences in occupational status and in perceived security of employment.

METHODS

Participants

The "Eight Town Study" was set up in 1997 to explore the relations between psychosocial factors and health in the personnel of eight Finnish municipalities from different parts of the country. As part of the study a postal questionnaire survey was carried out in 1997-1998. Using lists provided by the employers, we constructed samples of permanent and non-permanent employees. A total of 5981 (67%) permanent employees and 2876 (57%) non-permanent (2194 fixed term and 682 subsidised) employees responded to the survey (table 1). The true response rate is probably higher, however, because many non-permanent employees on the lists had moved before the study and were therefore not eligible for inclusion. Respondents' age (mean 45 years for permanent and 36 years for non-permanent employees) did not differ from that of the eligible population (46 and 36 years, respectively), but the proportion of men was slightly lower (24% and 20% among permanent and non-permanent respondents compared with 28% and 25% in the eligibl e population). The gender distribution of the participants corresponds closely to that …