Welfare states, flexible employment, and health: A critical review

Kim, Il-Ho; Muntaner, Carles; Vahid Shahidi, Faraz; Vives, Alejandra; Vanroelen, Christophe; Benach, Joan

doi:10.1016/j.healthpol.2011.11.002

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Volume 104, Issue 2 , Pages 99-127, February 2012

Welfare states, flexible employment, and health: A critical review

Il-Ho Kim
- Bloomberg School of Nursing, University of Toronto, Toronto, Canada
- Social and Epidemiological Research Centre for Addition and Mental Health, Toronto, Canada
- Corresponding author at: Social and Epidemiological Research Centre for Addition and Mental Health, 33 Russell Street, Suite T-305, Toronto, ON, M5S 2S1, Canada. Tel.: +1 416 535 8501x4394.
Carles Muntaner
- Bloomberg School of Nursing, University of Toronto, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Health Inequalities Research Group, Employment Conditions Knowledge Network (GREDS-EMCONET), Universitat Pompeu Fabra, Barcelona, Catalonia, Spain
Faraz Vahid Shahidi
- Health Studies Program, University College, University of Toronto, Toronto, Canada
- Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom
Alejandra Vives
- Health Inequalities Research Group, Employment Conditions Knowledge Network (GREDS-EMCONET), Universitat Pompeu Fabra, Barcelona, Catalonia, Spain
- Department of Public Health, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
Christophe Vanroelen
- Health Inequalities Research Group, Employment Conditions Knowledge Network (GREDS-EMCONET), Universitat Pompeu Fabra, Barcelona, Catalonia, Spain
- Department of Medical Sociology, Vrije Universiteit, Brussels, Belgium
Joan Benach
- Health Inequalities Research Group, Employment Conditions Knowledge Network (GREDS-EMCONET), Universitat Pompeu Fabra, Barcelona, Catalonia, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Catalonia, Spain

Received 22 March 2011; received in revised form 24 October 2011; accepted 5 November 2011. published online 05 December 2011.

Abstract

Objectives

The aim of this literature review is to identify whether differences between welfare regimes can manifest diverse consequences for the health effects of insecure and precarious employment, as well as to address challenging issues and implications for future research.

Methods

By searching PubMed, PsychINFO, Stork Social Science Citation Index, and Index Lilac, from 1988 to June 2010, a total of 104 original articles were selected (65 on job insecurity; 39 on precarious employment).

Results

After classifying selected empirical studies according to a six-regime welfare state typology (Scandinavian, Bismarckian, Southern European, Anglo-Saxon, Eastern European, and East Asian), this systematic review reveals that welfare regimes may be an important determinant of employment-related health. Precarious workers in Scandinavian welfare states report better or equal health status when compared to their permanent counterparts. By contrast, precarious work in the remaining welfare state regimes is found to be associated with adverse health outcomes, including poor self-rated health, musculoskeletal disorders, injuries, and mental health problems.

Conclusions

Future research should be conducted by employing conceptual models that specify how macro-economic processes, country-level welfare factors, and individual employment histories and environments relate to employment-related health inequalities.

Keywords: Welfare state, Job insecurity, Precarious employment, Health