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 This has been replaced by “non-standard” and precarious types of jobs that are temporary, part-time, casual, and on-call with limited or no statutory employee benefits and protections.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.