Bad jobs are making Canadians sick

We know that social environment plays a large role in shaping people’s health. Determinants like poverty and housing have recently received much deserved attention. The recent report by Canadian Medical Association, What Makes us Sick?, for example, identifies poverty as the leading cause of poor health outcomes and health inequity among Canadians. But poverty, housing insecurity, and food insecurity are symptoms of deeper problems. And yet, these deeper problems or determinants often get ignored. We want to raise attention to one such important determinant: quality of employment.

Risk factors associated with work environment, such as work load and workplace safety, can have direct impact on our health. But there is also a small but growing body of evidence that other attributes about quality of employment – such as job stability, control over work, job effort-reward imbalance, and employee rights – also impact health.

Employment is of particular concern because the quality and conditions of work in Canada is deteriorating. During the last couple of decades, we have seen a systematic erosion of full-time, stable types of employment. This has been replaced by “non-standard” and precarious types of jobs that are temporary, part-time, casual, and on-call with limited or no statutory employee benefits and protections.

In 2012, one in seven Canadian wage workers (about 2 million) held temporary employment compared to one in ten in 1997. In terms of average weekly wage rate, people in temporary employment earn 64% of what people in permanent employment make. In 2012, one in five Canadian wage workers (about 3.3 million) held part-time jobs compared to one in ten in 1976. Of those who held part-time jobs in 2012, 36.6% of working adults aged 25-44 years indicated that this was involuntarily (i.e. they would prefer to work full-time if full-time jobs were available). A recent report by United Way Toronto and McMaster University, It’s more than Poverty, found 40 per cent of Canadian workers in Southern Ontario in precarious types of jobs.

Research also shows that immigrants, racialized people (“visible minorities”), women and youth (15-24 years) tend to be overrepresented in these types of jobs.

The systematic rise in precarious employment is exposing a substantial proportion of Canadians to adverse health risks and health impacts associated with unsafe, unstable and exploitative job conditions.

Studies show that those in precarious jobs face very high risk of workplace injuries and musculoskeletal pains due to overuse. This is because they are more likely to be working in unsafe conditions or tend to be overworked due to limited employee protections. Moreover, there is growing evidence linking long-term exposure to precarious employment conditions (e.g., stress due to job insecurity, high job search effort and juggling multiple jobs, getting overworked and under paid, working odd hours, lack of job satisfaction) to chronic health issues including cardiovascular illnesses, early onset of diabetes, gastro-intestinal ailments, depression and cancers.

While many types of work can be stressful or involve risk of injury, what sets precarious employment apart is that workers in these jobs are not able to access provisions that could help them fully recover and maintain good health such as sick leave, relaxed time to rest and spend with family, getting 8 hours of sleep, and time to exercise. Most do not have extended health coverage from their work. Consequently, research shows that many forgo seeking care for health issues not covered by OHIP. In contrast, people on social assistance (Ontario Works) have access to some level of extended health coverage. Research highlights that health impacts and healthcare access barriers from insecure employment are experienced at the whole household level, including by children.

Many of these health issues and risk factors could be prevented by enabling people get stable, safe and well-paying employment. Preventing chronic illnesses has become a top healthcare policy priority in Canada. We can achieve this only if healthcare sector starts proactively addressing root causes of illnesses, and not just attending to symptoms.

Healthcare policy makers and professionals need to take more seriously employment as determinant of health. Across the healthcare sector (CHCs, hospitals, Family Health teams, and solo practice), let us start collecting client data about employment status to better understand and address health impacts from precarious jobs. Let us build effective cross-sector referral systems with settlement and employment sector to enable clients get safe and stable employment. We need to urgently develop institutional solutions to provide extended health coverage/services for working poor families.

Further, let us become advocates for (i) better awareness and enforcement of the Employment Standards Act and the Occupational Health and Safety Act, specifically in sectors that rely heavily on “temp” jobs; (ii) introduction of fair living wage policy; and (iii) policies that promote economic equity such as employment equity, pay equity, and guaranteed minimum income.

To truly promote the health of Canadians, we need to become champions for good jobs and a healthy Canadian labour market.

All authors work at Access Alliance Multicultural Health and Community Services as follows: Yogendra B. Shakya (Senior Research Scientist), Sideeka Narayan (Registered Nurse), Michael Stephenson (family physician), and Cliff Ledwos (Director of Primary Health Care).

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  1. Yogendra Shakya

    %featured%And we should add that championing for good jobs should begin within our own healthcare institutions. We have evidence of people stuck in temp, part-time, unstable types of jobs in the healthcare sector, and getting sick because of that. %featured%This is particularly true for those doing admin, hospitality, janitorial work. There is also troubling evidence of foreign trained doctors, nurses, psychologists etc getting exploited as unpaid volunteer workers within healthcare institutions for lengthy periods with little or no prospects of integration within the workforce. When working within healthcare institutions make people sick, then we know we have a serious problem. Let us begin the change from within.

    • Lisa Maslove

      I totally agree that health care employers should lead the change by improving the quality of jobs for their workers. Do employers or regions track any relevant indicators such as reliance on casual workers or percentage of their workers who don’t have benefits? Do some sectors or regions perform better than others?

  2. Jennifer Dee

    %featured%It is difficult to know why the term precarious work is now acceptable to Canadian society. Certainly we would not like precarious healthcare. Jobs that are contract or term and may or may not be renewed are the norm for many today. If you have a contract job and want to start a family could it be a contract family; if the contract for your employment is renewed you keep your partner or children for the term of the contract…this is unlikely to be feasible.%featured%

    People who can plan their lives longer than six months into the future and have the luxury of some semblence of stability are more likely to be less stressed…even healthier. We need to think about the choices we make every day and how they impact others. I do not think that Tommy Douglas would be happy to see where we are as a country today nor is it likely he would support the kind of future we are building for our children.

    • Yogendra Shakya

      Well said, Jennifer. Making analogies to family and to other sector we value (eg healthcare) always helps to reveal the gravity of the problem and connect public issues to personal. Thanks. We do need to start pushing for change from within our institutions and around us. Yogendra

  3. TapOff

    This is the case in research and research development, infrastructure and its project management. This phenomenon is even more disturbing because the information, its scientific methodology, project development, including authorship credibility, confidentiality protection and the associated specific and general scientific ethics, that drives turning the research into these and other ‘determinants’ of health originates from often highly trained yet increasingly marginalized and exploited “back office” team members to the ineffectual glory of those who have orchestrated a power structure that all too often ignores the fundamental duty to not play lip-service to pursuing fair and accountable ethics within and across the clinical sector of this ‘industry’. It is in their own back and front yards (institutions). Is politics or social and civic responsibility that will drive a greater effort to do better for human development?

  4. Bill Flask

    Since the biggest determinant of health is social status and income, I guess you could say that no jobs are making them sicker.

  5. paul

    What joke .jobs in ont are bad. I have worked in
    One off the best work place for 19 year.safty was
    There top off the list and health .know I have seen
    Dark side off ont working conditions. Very poor
    Dirty no safety .low pay shame on are leaders

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