Work strains and chronic diseases

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Work evolution and health consequences

Moving work

The face of employment in Europe is changing. Stock-wise and on the extensive margin, employment rates in EU28 reached 70.1% in 2015, nearing the pre-crisis levels of 2008 (Eurostat). These employment rates know important variations between countries (going from 54.9% for Greece to 80.5% in Sweden). When men’s employment rates remained relatively stable between year 2005 and year 2015 (75.9%), women’s knew a sizeable increase (60.0% in 2005, 64.3% in 2015) and even though older workers’ is still rather low (53.3%), it also went up considerably since 2005 (42.2%). Yet, an important education-related gradient still exists, as only 52.6% of the less educated population is employed, when employment rates amount to 82.7% in the more educated. The results for France are slightly below the average of developed countries, as 69.5% of the population aged 20-64 is in employment (73.2% in men, 66% in women), but know a particularly weak level of employment in older workers (48.7%) in 2015. On the intensive margin, weekly working times in Europe have known a slight and steady decreasing trend since 2005, going from 41.9 hours to 41.4 hours in 2015 with rather comparable amounts between countries. France ranks at 40.4 hours a week.
What is also noticeable is that workers’ careers appear to be more and more fragmented. When the proportion of workers employed with temporary contracts globally remained constant over the last decade in Europe (14.1% in total with 13.8% of men and 14.5% of women, 16.0% total in France), resorting to part-time job becomes more and more common. 17.5% of workers worked part-time in 2005, when almost one fifth of them do in 2015 (19.6% and 18.4% in France). The sex differences are very important: in 2015, only 8.9% of men worked part-time, when 32.1% of women did. Almost 4% of EU28 workers resort to a second job (from 0.5% in Bulgaria to 9.0% in Sweden and 4.3% in France). At the same time, unemployment rates also increased in Europe, going from 7% of the active population in 2007 (before the crisis) to 9.4% in 2015, and from 4.6% in Germany to 24.9% in Greece (10.4% in France). Long-term unemployment, intended as individuals actively seeking for a job for at least a year, also drastically increased during this period, going from 3.0% in 2007 to 4.5% in 2015 (1.6% in Sweden, 18.2% in Greece and 4.3% in France).

Intensificating work

On top of these more fragmented career paths, European workers face growing pressures at work. Notably, Greenan et al.(2014) indicate that, between 1995 and 2005, European employees have faced a degradation of their working-life quality. There has been a growing interest in the literature for the health-related consequences of detrimental working conditions and their evolution. In a world where the development of new technologies, management methods, activity controls (quality standards, processes rationalization, etc.) as well as contacts with the public confront employees with different and increased work pressures (Askenazy and Caroli, 2010), the question of working conditions indeed becomes even more acute. When the physical strains of work have been studied for a long time, it has only been the case later on for psychosocial risk factors. Notably, the seminal Job demand – Job control model of Karasek (1979) and its variations (Johnson et al., 1989; Theorell and Karasek, 1996) introduced a theoretical approach for these more subjective strains. Other models later included the notion of reward as a modulator, with the Effort-Reward Imbalance model (Siegrist, 1996). Whatever the retained indicators for strenuous working conditions, their role on health status seems consensual (Barnay, 2016).
These exposures to detrimental working conditions too, beyond possible evolutions in workers’ perceptions of their own conditions at work (Gollac, 1994; Gollac et al., 2014), have known several changes. If exposures to physical strains have slightly declined with the years, psychosocial strains have grown massively within the same time span. Exposures to physical risks as a whole almost remained constant since 1991 (Eurofound, 2012). Some risks declined in magnitude, when some others increased: tiring and painful positions (46% of the workforce) and repetitive hand or arm movements for instance (being the most prevalent risk of all, with 63% of workers exposed). Men are the most exposed to these risks. At the same time, subjective measures for work intensity increased overall for the past 20 years. 62% of workers reported tight deadlines, 59% high speed work, with workers having potentially less opportunities to alter the pace of their work. The level of one’s control on his/her job also seem to evolve in a concerning way: 37% of workers report not being able to choose their method of work; 34% report not being able to change the order of their tasks and 30% not being able to change their speed of work, among other indicators (Eurofound, 2012). The situation in France also appeared to deteriorate between 2006 and 2010, gradually linking high levels of physical strains with low levels of job autonomy: increases in exposures to high work intensity, emotional demands, lack of autonomy, tensions and especially lack of recognition (as measured in the Santé et Itinéraire Professionnel 2006 and 2010 surveys by Fontaine et al., 2016).

Everlasting work

These evolutions are even more alarming that we work longer than we used to, and that we are going to work even longer in the future. Three major factors are in line to explain this situation. First, we live longer. Eurostat projections for the evolution of life expectancy in Europe indicate that, between 2013 and 2060, our life expectancy at age 65 will increase by 4.7 years in men and 4.5 years in women (European Commission, 2014). The regularly increasing life expectancy comes, as a consequence, with an increase in the retirement/work-life imbalance, inducing financing issues.
Second, despite the objective set at the Stockholm European Council to achieve an employment rate of 50% for those aged 55-64 years old by year 2010, the European average was still only 47.4% in 2011 (Barnay, 2016), and only reached 53.3% in 2015 (Eurostat 2016). These particularly low employment rates for senior workers can be explained by a number of factors (economic growth not producing enough new jobs, poor knowledge of existing retirement frameworks, unemployment insurance being too generous, insufficient training at work for older workers, etc.). Notably, even though workers may have the capacity to stay in employment longer (García-Gómez et al., 2016), they can also be explained by the role of strenuous careers and degraded Health Capital (health status seen as a capital stock, producing life-time in good health – Grossman, 1972), increasing risks of job loss or sick leave take-ups (Blanchet and Debrand, 2005). The obvious consequence is that potentially too few older workers contribute to the pension system in comparison to the number of recipients.
Hence, because of these first two points, the third factor is that pay-as-you-go systems are more often than not facing growing deficits. To counter this phenomenon, European governments have progressively raised retirement ages and/or increased the contribution period required to access full pension rights. In France, increases in the contribution period required to obtain full-rate pensions (laws of July 1993 and August 2003) followed by gradual increases of the retirement age of 60 years-old for the generation born before July, 1st 1951 and 62 years-old for those born on or after January 1st 1955 (law of November 2010) have been introduced. The aim of these reforms was to compensate for longer life spans, ensuring an intergenerational balance between working- and retirement-lives, allowing “fair treatment with regard to the duration of retirement and the amount of pensions” (Article L.111-2-1 of the French Social Security Code). As a result of these reforms, the relationship between working lives and retirement has remained relatively constant for generations born between 1943 and 1990 (Aubert and Rabaté, 2014), inducing longer work lives.

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Affordable work: what are the health consequences?

Unaccounting for the possible exposures to detrimental conditions faced by individuals at work, being in employment has overall favourable effects on health status. Notably being in employment, among various social roles (such as being in a relationship or being a parent) is found to be correlated with lower prevalence of anxiety disorders and depressive episodes (Plaisier et al., 2008), beyond its obvious positive role on wealth and well-being. This link between health (especially mental health) and employment status is confirmed by more econometrically robust analyses, notably by Llena-Nozal et al. in 2004. This relationship appears to be different depending on sex, as it seems stronger in men. This virtuous relationship between health status and employment is corroborated by another part of the literature, focusing on job loss. When being employed seems to protect one’s health capital, being unemployed is associated with more prevalent mental health disorders, especially in men again (Artazcoz et al., 2004). Losing one’s job is logically also associated with poorer levels of well-being (Clark et al., 2008), even more so considering the first consequences may be observed before lay-off actually happens (Caroli and Godard, 2016). In any case massive and potentially recurring unemployment periods are notorious for their adverse effects on health status (Böckerman and Ilmakunnas, 2009; Haan and Myck, 2009; Kalwij and Vermeulen, 2008). Retirement also comes with likely negative health consequences (Coe and Zamarro, 2011).
Nevertheless, and even if health status seems to benefit from employment overall, exposures to detrimental conditions at work are a factor of health capital deterioration. Factually, close to a third of EU27 employees declares that work affects their health status. Among these, 25% declared a detrimental impact when only 7% reported a positive role (Eurofound, 2012). Thus, in a Eurofound (2005) report on health risks in relationship to physically demanding jobs, the results of two studies (one in Austria and the other in Switzerland) were used to identify the deleterious effects of exposures on health status. In Austria, 62% of retirements are explained by work-related disabilities in the construction sector. In Switzerland, significant disparities in mortality rates exist, depending on the activity sector. On French data, Platts et al. (2016) show that workers who have faced physically demanding working conditions have a shorter life expectancy, in the energy industry. In addition, Goh et al. (2015) determine that 10% to 38% of disparities in life expectancy between cohorts can be attributed to exposures to poor working conditions.

Which are the options?

Because careers are more fragmented than they used to (see Section 1.1) with at the same time increasing and more diversified pressures at work (Section 1.2) and because careers tend to be longer (Section 1.3), health consequences are or will be even more sensible (Section 1.4). From the standpoint of policy-makers, all of this comes as new challenges, with the objective being to ensure that employment in general and the work-life in particular remain sustainable (i.e. workers being able to remain in their job throughout their career). A lot of public policies are hence targeting this objective. In Europe, the European Union is competent in dealing with Health and Safety matters, which in turn is one of the main fields of European policies. The Treaty of Functioning of the European Union allows the implementation, by the means of directives, of minimum requirements regarding “improvement of the working environment to protect workers’ health and safety”. Notably, employers are responsible of adapting the workplace to the workers’ needs in terms of equipment and production methods, as explicated in Directive 89/391/EEC (Barnay, 2016).
In France, the legislative approach is mostly based on a curative logic. As far as the consideration of work strains is concerned, a reform in 2003 introduced explicitly the notion of Pénibilité (work drudgery), through Article 12 (Struillou, 2003). This reform failed because of the difficulty to define this concept, and to determine responsibilities. A reform in 2010 followed by creating early retirement schemes related to work drudgery, with financial incentives. 3,500 workers in 2013 benefited from early retirement because of exposures to detrimental working conditions inducing permanent disabilities. Early 2014, a personal account for the prevention of work drudgery is elaborated, allowing workers to accumulate points related to different types of exposures during their career (focusing exclusively on physical strains). Reaching specific thresholds, workers are eligible to trainings in order to change job, to access part-time work paid at full rate or early retirement schemes. According to the Dares (Direction de l’animation de la recherche, des études et des statistiques – French ministry for Labour Affairs), 18.2% of employees could be affected by exposure to these factors (Sumer Survey 2010).

Table of contents :

General introduction
1. Work evolution and health consequences
2. Work-Health influences: the importance of the individual biography
3. Research questions
4. Outline
Chapter I: Mental health and job retention
1. The links between mental health and employment
2. Empirical analysis
3. Results
4. Discussion and conclusion
Chapter II: Work strains and chronic diseases
1. Literature
2. General framework
3. Data
4. Empirical analysis
5. Results
6. Robustness checks
7. Discussion and conclusion
Chapter III: Health status after retirement
1. Background and literature
2. Data
3. Descriptive statistics
4. Empirical strategy
5. Results
6. Discussion
General conclusion
1. Main results
2. Limitations and research perspectives
3. Policy implications

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