Guest blog from Dr Joanna Wilde C. Psychol. C. Sci. FBPsS
Precarious Work and Psychological Trauma: the long-term occupational health implications of changing work structures
The ESRC “what works for wellbeing” team recently published a report that indicates 38% of working people (12 million people) are in jobs of poor enough quality to be a health risk. Poor quality work can manifest through precarious “gig” work arrangements, financial insecurity and low job control.
I have encountered four broad and often overlapping precarious work situations[1]:
- Workers who can only find unpredictable shift work -paid below the minimum wage, often in zero hours contracts- bogus self-employment or “gig” structures where employers have grabbed “flexibility” as their resource at the expense of the worker and their right to health.
- Workers in alternative working arrangements that are paid at or above the minimum wage but who are constantly concerned about their short term future financial and living situation. (This is a growing issue for those working in Higher Education where 28% of academics are in “alternative working arrangements”).
- Those with a health/disability issue (often removed from employment as their health situation was not accommodated by an employer) as the Stevenson and Farmer report illustrated with the figure of 300,000 people capability dismissed for mental health reasons each year.
- Employees who may be in conventional employment contracts, but are on low pay with limited hours and are concerned about the financial viability of their situation whilst unable to access more paid hours.
There is substantial evidence from the past couple of years that points to a high prevalence of precarious work in the UK:
- The Joseph Rowntree Foundation, reported that 13.5 million people in the UK are living in poverty 55% of whom are in working households: that is 7.4 million people in working poor households, comprising 3.8 million workers, 2.6 million children and another 1 million dependents.
- The Citizen’s Advice Bureau in 2016 reported that 4.5 million workers did not have regular hours, predictable shifts or reliable income.
- The TUC have indicated that 3.2 million suffer from precarious employment rights.
- GMB research points to 10 million people impacted by work insecurity (consistent with the figure of 28% academics in this situation).
Such precarious situations activate all the identified HSE psychosocial hazards: https://www.healthandsafetyatwork.com/viewpoint/joanna-wilde-precarious-gigs-perfect-storm and also add financial insecurity and low justice to the mix (which are increasingly recognized as workplace hazards).
Precarious situations make people anxious. Given that one third of the UK working population work in relatively insecure arrangements it is unsurprising that what is described as “chronic stress” is now reaching crisis levels:
This heightened fear response is a normal psychophysiological response to bad environments and is not a sign of individual weakness. While we have understood that PTSD can develop from a single event, we are increasingly recognizing that day to day adverse experiences can have the same traumatic impact, as Jay Watts (2018) outlines “our bodies and minds stay 'worn and torn', without the energy or safety to repair. This has huge effects on our immune, gastrointestinal and sleep systems, as well as how we feel about ourselves and the world, increasing the chances that we will suffer – be that from illnesses such as heart disease, or mental breakdown.”
This shift in perspective to engage with the long term consequences of adverse experiences has been described as becoming trauma informed: https://www.healthandsafetyatwork.com/mental-injury The precarious workplace situations outlined earlier are consistent with the types of adversity implicated in the activation of this traumatic process. A recent study into work has indicated that “because poor quality work results in more adverse levels of biomarkers, those exposed to poor quality work may be on the pathway to manifesting metabolic- and cardiovascular-related diseases without realizing it.” http://www.manchester.ac.uk/discover/news/having-a-bad-job/
There is oft-repeated sentiment that Occupational Health Services should be available for all workers, with particular reference to a gap in provision for SMEs. However, the notion of SME is not aligned with the reality of these new working arrangements, as many precarious gigs are offered through large organisations via what has been described as bogus self-employment. The notion of the SME to cover those unable to access OH excludes such workers.
Indeed there is evidence that precarious working arrangements also inhibit the ability of those impacted even to access general health care. The realities of temporary accommodation, unpredictable shifts and fear of job loss means using GP services is not straightforward. In addition, there has been a drop of 511 GPs working in the most deprived areas since 2008. https://www.theguardian.com/society/2018/may/19/nhs-gp-doctors-health-poverty-inequality-jeremy-hunt-denis-campbell-deprived-areas
Children in “working poor” households are also impacted by these conditions (Kossarova et al 2017 Nuffield). The choice a carer in precarious work has to make is to either attend a GP appointment with their child (if they can get one) so taking the risk of being dismissed without recourse, or forsake a visit to a GP in order to earn enough for their child to eat and stay housed. It is therefore not surprising that children in these households are 55% more likely to experience an unplanned hospital admission than the least deprived.
In my view, we need to push for an integrated regulatory framework. This framework should connect the negative health consequences of poor work, low pay levels, clarity about the health responsibilities of those who provide work through these structures, proper workplace representation, accessible dispute mechanisms and some effective means of enforcing the obligation to provide healthy work environments regardless of employment status.
[1] I do not include those in well-paid professional “gig” arrangements. This sample is often used to point to the benefits of “flexibility” for workers from alternative arrangements, so deflecting attention from the real issues of bad work and financial insecurity.