Precarious work and the health cost to women

The Women’s Policy Action Tank recently published a special issue of the Good Policy newsletter, exploring three areas of policy with a gender lens: women and the criminal justice system, Indigenous women, and women’s experience of employment. Each topic is explored using a dialectical approach, in which two authors approach a topic from a different angles. We will be publishing the paired articles on our blog over the coming three weeks. This week we publish the last two articles, exploring women and work. This article is a companion piece to Productivity and Pressure: Social Services get an Unhealthy Squeeze, by Fiona MacDonald.

Susan Maury ( @SusanMaury ), Good Shepherd Australia New Zealand

There are multiple gender divides in the work arena, with the gender pay gap being just one of them. The Workplace Gender Equality Agency reports that the ratio of paid to unpaid work is almost exactly inverse for women and men in Australia. While women work on average 56.4 hours per week, over 64 per cent of those hours are in unpaid work (caring work or household chores), with only 36 per cent of work time in paid employment for an average week. Overall work hours are fewer for men at 55.5 hours, reflecting 64 per cent of weekly work time in paid labour, with only 36 per cent spent in unpaid work.[1]

In other words, for women, paid work needs to fit around their ‘full-time’ unpaid commitments. There is a disproportionate burden of both care work and household duties that falls to women, despite changes in employment patterns. It should therefore be no surprise that women are far more likely to be in precarious employment – working part-time, casual or contract work – often below their skill level and sacrificing career advancement.[2]

Nearly 70 per cent of part-time workers in Australia are women.[3] This means women’s experiences of paid employment are very different to men’s, and their outcomes from employment also differ. A stark example is the effects of employment on physical and mental health and well-being. Precarious work contributes to poor physical and mental health outcomes through overwork (when combined with unpaid work into total work hours), conflicting commitments between work and family life, a lack of work-related autonomy, and the stressors that come from the reduced pay of part-time work.

Women have a long history of precarious work in Australia. Match factory workers - primarily young women - Melbourne 1919, courtesy State Library Victoria.

While women, out of necessity, more often seek flexible work arrangements, a significant proportion of flexible positions can also be categorised as precarious – distinguished by lower income, few or no benefits, short-term contracts, and holding little power in the organisational context. Women from low socio-economic backgrounds or who are in the racial or ethnic minority are particularly likely to be employed in precarious, low-status jobs.[4] Precarious employment is now considered a social determinant of (poor) health because of the overwhelming evidence of its detrimental effects. Research consistently demonstrates that job insecurity increases anxiety and depressive symptoms, while temporary employees are at higher risk of exhaustion and use more antidepressants.[5] However, rather than contributing to absenteeism, the nature of precarious work encourages ‘presenteeism’ – that is, being physically present despite poor health.[6] There are also indications that women are more susceptible to the negative health consequences associated with precarious work.[7]

A lack of autonomy in the workplace is another significant contributor to poor mental and physical health. Self-determination – incorporating competence (feeling capable to achieve a task), autonomy (the ability to self-direct energies and focus), and relatedness (contributing to a social network and being meaningfully supported by others) – is so foundational to human thriving that many researchers consider it a psychological need.[8] Research bears this position out. For example, a meta-analysis of nearly 100 studies on work-related factors correlating to ischaemic[9] heart disease found that the strongest contributor was low decision latitude.[10] Another study found that low job control is predictive of high blood pressure and reported stress levels even outside of work hours, and that this effect is stronger for women.[11] Finally, a study found that women experience higher allostatic loading (chronic stress) than men when holding lower-status roles, but that this effect is mitigated by high decision latitude – autonomy.[12] (It is also noteworthy that high allostatic loading is more likely experienced by women generally[13] but particularly women who belong to ethnic or cultural minorities, with severe consequences to health across the lifespan.[14]) The low-status jobs that women are more likely to fill are both psychologically and physically damaging.

Low status, or powerlessness, in the organisational context means women in precarious work often have little or no control over their work schedules, resulting in conflicts with family-related commitments. HILDA[15] data indicates that work-family conflict is a significant contributor to overall poor mental health, for both women and men.[16] This can be mitigated by giving employees control over their schedules[17] – again, reinforcing the importance of autonomy.

Part-time, precarious and contract work is remunerated at a lower hourly rate compared to full-time work; reduced work hours and (most often) no career pathway further undermine both short-term wages and long-term earnings for women. These factors contribute to the feminisation of poverty. Research indicates that women experience depression at nearly twice the rate of men, and this is partially explained by their reduced socio-economic standing.[18] Additionally, their health-related quality of life is significantly lower to men’s, which is mediated in part by their lower socio-economic status.[19] This is alarming.

While the majority of women in paid employment experience precarious work conditions due to the need for flexibility, men are at greater risk for over-work (50+ hours per week),[20] which also has significant negative impacts on health and well-being, including a marked increase in rates of coronary disease[21] and a range of negative psychological and social outcomes.[22] The current method of organising work/life responsibilities is failing everyone.

Policies are reinforcing these unhealthy practices; changing policies to align more closely with current realities and needs will encourage social and cultural changes as well. Recommended policy responses include setting a maximum work-hour week to limit over-work and free up men to be active participants in family life;[23] provide adequate, non-stigmatised welfare support for parents to reduce work hours when needed for family duties – particularly critical for single parents;[24] provide expanded parental leave options;[25] and equalise superannuation contributions.[26] The health implications, particularly for women, of maintaining the status quo is undermining productivity in its truest sense and eroding the well-being of all Australians.

References

[1] Workplace Gender Equality Agency. Unpaid care work and the labour market: Insight Paper.

[2] Ibid.

[3] Ibid.

[4] Menendez, M., Benach, J., Muntaner, C., Amable, M., & O’Campo, P. (2007). Is precarious employment more damaging to women’s health than men’s? Social Science & Medicine, 64, pp. 776 – 781.

[5] Benach, J., Vives, A., Amable, M., Vanroelen, C., Tarafa, G., & Muntaner, C. (2014). Precarious Employment: Understanding an Emerging Social Determinant of Health. Annual Review of Public Health, 35, pp. 229 – 253.

[6] Sanderson, K., & Andrews, G. (2006). Common Mental Disorders in the Workforce? Recent Findings from Descriptive and Social Epidemiology. The Canadian Journal of Psychiatry, 51, pp. 63 – 75.

[7] Callea, A., Urbini, F., & Bucknor, D. (2012). Temporary employment in Italy and its consequences on gender. Gender in Management: An International Journal, 27:6, pp. 380 – 394.

[8] Ryan, R.M. & Deci, E.L. (2000). Self-Determination Theory and the Facilitation of Intrinsic Motivation, Social Development, and Well-Being. American Psychologist. 55:1, pp. 68 – 78.

[9] Ischaemic heart disease is also known as coronary artery disease, which is damage to or disease of the heart’s major blood vessels.

[10] Theorell, T., Jood, K., Jarvholm, L.S., Vingard, E., Perk, J., Ostergren, P.O., & Hall, C. (2016). A systematic review of studies in the contributions of the work environment to ischaemic heart disease development. The European Journal of Public Health, 26:3, pp. 470-477.

[11] Steptoe, A. & Willemsen, G. (2004). The influence of low job control on ambulatory blood pressure and perceived stress over the working day in men and women from the Whitehall II cohort. Journal of Hypertension, 22, pp. 915-920.

[12] Juster, R.P., Moskowitz, D.S., Lavoie, J., & D’Antono, B. (2013). Sex-specific interaction effects of age, occupational status, and workplace stress on psychiatric symptoms and allostatic load among healthy Montreal workers.

[13] Yang, Y. & Kozloski, M. (2011). Sex Differences in Age Trajectories of Physiological Dysregulation: Inflammation, Metabolic Syndrome, and Allostatic Load. Journal of Gerontology Series A: Biological Sciences and Medical Sciences, 66:5, pp. 493-500.

[14] Upchurch, D.M., Rainisch, B.W., & Chyu, L. (2015). Greater Leisure-Time Physical Activity is Associated with Lower Allostatic Load in White, Black and Mexican-American Midlife Women: Findings from the National Health and Nutrition Examination Survey, 1999 – 2004. Women’s Health Issues, 25:6, pp. 680-687.

[15] The Household, Income and Labour Dynamics in Australia Survey.

[16] Cooklin, A.R., Dinh, H., Strazdins, L., Westrupp, E., Leach, L.S., & Nicholson, J.M. (2016). Change and stability in work-family conflict and mothers’ and fathers’ mental health: Longitudinal evidence from an Australian cohort. Social Science & Medicine, 155, pp. 24 – 34.

[17] Kelly, E.L., Moen, P., & Tranby, E. (2012). Changing workplaces to reduce work-family conflict: schedule control in a white-collar organization. American Sociological Review, 76:2, pp. 265-290.

[18] Van de Velde, S., Bracke, P., & Levecque, K. (2010). Gender differences in depression in 23 European countries. Cross-national variation in the gender gap in depression. Social Science & Medicine, 71, pp. 305 – 313.

[19] Cherepanov, D., Palta, M, Fryback, D.G., & Robert, S.A. (2010). Gender differences in health-related quality-of-life are partly explained by sociodemographic and socioeconomic variation between adult men and women in the US: evidence from four US nationally representative data sets. Quality of Life Research, 19:8, pp. 1115-1124.

[20] Cha, Y. & Weeden, K.A. (2014). Overwork and the slow convergence in the gender gap in wages. American Sociological review, 79:3, pp. 457-484.

[21] Excessive work hours increase the likelihood of coronary disease by 40 per cent. Virtanen, M., Heikkliä, K., Jokela, M., Ferrie, J.E., Batty, D.G., Vahtera, J., & Kivimäli, M. (2012). Long Working Hours and Coronary Heart Disease: A Systematic Review and Meta-Analysis. American Journal of Epidemiology, 176:7, p. 586-596.

[22] “Extreme workers” (those who work 60+ weekly hours) experience increases in depression, anxiety, sleep dysregulation and the break-down of family relationships. Hewlett, S.A. & Luce, C.B. (2006). Extreme Jobs: The Dangerous Allure of the 70-Hour Workweek. Harvard Business Review, December 2013, p. 49 – 59.

[23] Dinh, H., Strazdins, L.., & Welsh, J. (2017). Hour-glass ceilings: Work-hour thresholds, gendered health inequities. Social Science & Medicine, 176, pp. 42 – 51.

[24] Over 55 per cent of people on Newstart (which includes single parents whose youngest child is over 8 year old) and 51.5 per cent of people on the Parenting Payment are living below the poverty line. ACOSS (2016). Poverty in Australia.

[25] This analysis of 21 ‘peer’ countries rates Australia second-lowest in terms of family-friendly leave policies. Ray, R., Gornick, J.C., & Schmitt, J. (2010). Who cares? Assessing generosity and gender equality in parental leave policy designs in 21 countries. However, since that time the (contentious) Paid Parental Leave scheme has come into effect; see http://www.supportingworkingparents.gov.au/employees/employees-and-leave#what-is-the-australian-government-paid-parental-leave-scheme

[26] See the report resulting from the Parliamentary Inquiry, A husband is not a retirement plan: Achieving economic security for women in retirement (2016). Accessed on 20 February 2017 at http://www.aph.gov.au/Parliamentary_Business/Committees/Senate/Economics/Economic_security_for_women_in_retirement/Report