By Rory O’Neill
Occupational health adviser, International Trade Union Confederation (ITUC), Belgium
Professor, University of Liverpool School of Law and Social Justice, UK
But one overlooked contributor to this health inequity is the association between low pay and harmful, sometimes deadly, working conditions. Occupational injuries and diseases like diabetes, heart disease and cancer frequently come with less well remunerated jobs.
Poor working conditions are commonly a toxic companion to poor pay. Inequalities at work: Job quality, health and low pay in European workplaces, a 2013 review by Elena Cottini and Claudio Lucifora, concluded “that bad jobs are correlated with adverse health conditions at work”.
Cottini’s 2012 paper, Health at work and low pay: A European perspective, noted “controlling for personal and firm characteristics (adverse) working conditions are associated with poor health status – both physical and mental. Low pay plays a role, mainly for men and when interacted with working conditions, suggesting that stigma and deprivation effects may be correlated with health at work.”
There is compelling evidence for low wages to be recognised as a genuine occupational hazard. In a 2016 editorial in the Journal of Occupational and Environmental Medicine, J Paul Leigh and Roberto De Vogli warned: “Workers earning low wages may be at greater risk for disease and injury than workers earning high wages.”
The authors noted several lines of evidence suggesting that higher wages lead to improvements in health or health behaviours. A study found reduced anxiety and depression among people affected by an increase in the UK minimum wage. In addition to health benefits, higher wages have been shown to improve workplace outcomes such as absenteeism and productivity, they concluded.
The link between low wages and health has important implications for legislation and policies related to minimum wage and living wage rates and trade unions, Leigh and De Vogli asserted, adding: “There is little debate about the effects of hikes in minimum wages on the health of low-income employees.”
A 2017 paper co-authored by Leigh spelled out this positive impact on workers’ health of even relatively small improvements in pay rates. Using two separate statistical analyses of data from the Panel Study of Income Dynamics, a longitudinal survey of 19,000 individuals in 5,000 US families, the study calculated the drop in sickness absence attributable to a US$1 increase in the minimum wage at 19% by one method and 32% by the other. Either way, it was substantial.
Leigh’s analyses revealed that a US$1 raise in the minimum wage resulted in a 2.1% increase in the probability that workers would report themselves to be in good or excellent health. Leigh noted: “Our results support raising minimum wages because it can lead to previously unmeasured reductions in job absences and improvements in worker health.”
There are concerns that changing modes of employment could instead increase pay inequalities and related health impacts, notably the rise of the modern ‘gig economy’. University College London’s Institute of Education reported in 2017 that ‘precarious workers’ are less likely to be in good health, and are at higher risk of poor mental health than workers with stable jobs. It linked the effect to ‘financial stress’ or ‘having a low-status job’.
A 2017 report in Hazards magazine, Make or break, spelled out the way insecurity at work can hurt you. “‘Insecure employment’ covers a lot of sins – fear of losing your ostensibly ‘permanent’ job, inability to find permanent work, scratching a living from multiple jobs or working on short hours or zero-hour contracts, at the whim of someone who claims not to be your employer. They all have one thing in common – they are far more likely to damage your health than secure, permanent work.”
Work-related suicide is one of the emerging ‘diseases of distress’ linked to austerity, economic decline and increased employment insecurity. Substance misuse – prescription or non-prescription drugs and alcohol – is another side-effect. Heart disease is a potentially fatal consequence of working in a bad job too.
Unions are a proven mechanism capable of addressing the pay and other inequalities that cause these increases in morbidity and mortality. As ITUC general secretary Sharan Burrow put it: “It is an indictment of the economic and political process that globalisation has seen a fragmentation of work and a decimation of work rights, causing inevitable harm to the public health.
“But it does put in sharp relief the undeniable benefits of trade unions. It’s not just about wages, or equality or safety. It is about dignity and respect at work. The shame is that without unions this basic decency is in increasingly short supply.”