Elsevier

Social Science & Medicine

Volume 124, January 2015, Pages 121-131
Social Science & Medicine

Is temporary employment damaging to health? A longitudinal study on Italian workers

https://doi.org/10.1016/j.socscimed.2014.11.033Get rights and content

Highlights

  • Temporary employment leads to poorer self-rated health among Italian workers, net of selection effects.

  • Temporary employment is particularly damaging for health when prolonged over time.

  • Women's health is strongly affected by the negative consequences of temporary employment.

Abstract

Working conditions have changed dramatically over recent decades in all the countries of European Union: permanent full-time employment characterized by job security and a stable salary is replaced more and more by temporary work, apprenticeship contracts, casual jobs and part-time work. The consequences of these changes on the general well-being of workers and their health represent an increasingly important path of inquiry.

We add to the debate by answering the question: are Italian workers on temporary contracts more likely to suffer from poor health than those with permanent jobs? Our analysis is based on a sample of men and women aged 16–64 coming from the Italian longitudinal survey 2007–2010 of the European Union Statistics on Income and Living Conditions. We use the method of inverse-probability-of-treatment weights to estimate the causal effect of temporary work on self-rated health, controlling for selection effects.

Our major findings can be summarized as follows: firstly, we show a negative association between temporary employment and health that results from a statistical causal effect in the work-to-health direction, and does not trivially derive from a selection of healthier individuals in the group of people who find permanent jobs (selection effect). Secondly, we find that temporary employment becomes particularly negative for the individual's health when it is prolonged over time. Thirdly, whereas temporary employment does not entail significant adverse consequences for men, the link between temporary employment and health is strongly harmful for Italian women.

Introduction

Working conditions have changed dramatically over recent decades in all the countries of European Union, and flexible forms of employment have become increasingly more relevant. Permanent full-time employment characterized by job security and a stable salary is replaced more and more by temporary work, apprenticeship contracts, casual jobs and part-time work. The diffusion of new forms of flexible and temporary work contracts has transformed the labor market entry and exit conditions, leading to growing instability in employment relationships (Benach et al., 2000). Between early nineties and the first decade of two thousand the share of temporary employment rose on average from 10% to 16% in the Euro area and perceived job insecurity increased simultaneously (Caroli and Godard, 2013, Eurofound, 2010).

The consequences of these changes on the general well-being of workers and their health represent an increasingly important path of inquiry. Some scholars have suggested that flexible forms of employment may lead to general benefits for workers (e.g., Natti, 1993, Benach and Muntaner, 2007, Guest and Clinton, 2006, Kalleberg et al., 2000, La Valle et al., 2002). When flexible jobs are a voluntary choice rather than an involuntary constraint – e.g., professional consultants or self-employed people – flexible, contingent and non-standardized conditions can enhance job satisfaction and quality of life, particularly for highly skilled workers (Guest and Clinton, 2006). Research from U.S., European Nordic countries and UK have shown that flexible works may entail higher wages (Kalleberg et al., 2000), and may represent a way to sample a variety of occupational experiences or a necessary phase towards a more integrated position in the labor market (Booth et al., 2002, Natti, 1993, Virtanen et al., 2005). Positive effects, in particular for women, may derive from the fact that these forms of flexible work allow to control working time, helping the reconciliation between paid work and family life (La Valle et al., 2002). On the other hand, however, the majority of scholars argue that flexible working arrangements imply negative consequences for both occupational prospects and private life, including health status, mainly due to their greater insecurity and poorer working conditions (e.g., Benavides et al., 2000, Ferrie, 2001, Ferrie et al., 2005, Benach and Muntaner, 2007). This negative relationship is strengthened by the fact that, in contemporary societies, flexible work is increasingly becoming a necessity.

The majority of previous research addressed this relationship by examining associations, where both health and employment were measured at the same time. Cross-sectional studies are not suitable to disentangle selection effects (Benach et al., 2004, Benavides et al., 2000, Virtanen et al., 2003, Benach et al., 2014) and the need to rely on longitudinal data is straightforward. However, even when one adjusts for prior health status and other covariates, standard regression designs might not represent a solution (Oakes and Johnson, 2006). Only a few attempts have been made to assess statistical causality. Kim et al. (2008) and Quesnel-Vallee et al. (2010) applied propensity-score methods respectively to South Korea and U.S. data, while Caroli and Godard, 2013, Cottini and Lucifora, 2010 and Ehlert and Schaffner (2011) analyzed the relationship between work and health for a large group of European countries using fixed effects and bivariate probit models. All these authors proved the existence of a health gap in favor of permanent employees.

Our objective is to evaluate whether having a temporary contract in Italy, with respect to have a permanent employment, leads to a different assessment of one's own health, taking into account potential selection effects. This issue has never been studied for the Italian case because, even if some of the previously cited studies included Italy, none of them displayed separate analysis for this country. We use data coming from the European Union Statistics on Income and Living Conditions (EU-SILC), and we propose using the method of inverse-probability-of-treatment weights to estimate the causal effect of temporary employment on self-rated health. This method allows us to check for the potential selectivity of healthier individuals in the group of people who find permanent jobs. Another element to take into account in this research context (Benach et al., 2014) – and the proposed method enables to do this – is that having a temporary contract may in turn increase the risk to have another temporary contract the year after, in a sort of vicious circle.

This paper adds new and relevant contributions to literature. Firstly, to the best of our knowledge, this study represents one of the few analyses addressing the existence of a statistical causal effect of temporary work on health status instead of a simple association. Secondly, it is the first analysis for Italy, and thirdly, it explicitly looks at gender differences.

Section snippets

Previous findings

In recent years the term precarious employment has been used quite broadly to indicate a continuum of atypical employment conditions that, with different pace, have been introduced in several European countries beside the standard full-time permanent jobs (Benach and Muntaner, 2007). The term precarious employment implies a multidimensional concept embodying (dis)continuity in time, job (in)security, lack of rights and social protection, low levels of wages and earnings (Benach and Muntaner,

Diffusion of temporary contracts in Italy and Europe

The spreading of various forms of flexible and temporary employment has been observed in almost all European countries over recent years. While some countries registered relevant quotas of temporary workers as early as the '80s, the increase became substantial almost everywhere at the beginning of the '90s, albeit at a different growth rate. United Kingdom (Fig. 1) is the European country with the lowest level of temporary contracts (less than 10%); similar values are registered for other

General methodological framework

We rely on Marginal Structural Models (MSM) (Robins et al., 2000), a propensity-score based approach which uses inverse-probability-of-treatment weights (IPTW) estimators. MSM are a relatively new class of causal models used in medical studies (e.g., Hernan et al., 2000, Robins et al., 2000) or, more rarely, in economic applications (Lechner, 2009, Mariani et al., 2013). They enable to properly consider situations where time-dependent covariates for the event of interest also predict subsequent

Results

Table 1 shows the effects of temporary employment on self-rated health estimated through both a standard approach (logistic regression model) and a marginal structural model. The response variable is self-rated health (0 = good; 1 = less than good), and odds ratios (OR) indicate the increased odd of temporary employment compared to permanent employment. It is worth noting that in 2010 about 16% of the Italian men in the EU-SILC sample evaluated their health less than good, while self-rated

Overall findings

The key strength of this study lies in the marginal structural model framework adopted. We used longitudinal data in a counterfactual approach to estimate the causal effect of temporary employment on self-rated health, for the first time in Italy.

Our major findings can be summarized as follows: firstly, in contemporary Italy temporary employment is not simply associated with worse health compared to permanent employment, but the negative link results from a statistical causality from employment

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