Working poverty is a big problem. Households Below Average Income (HBAI) data published by the UK government on 25 May 2018 revealed 55 per cent of those living in poverty are now in working families.

And it is getting worse. A Landman Economics analysis for the TUC published on 7 May 2018 estimated 3.1 million children with working parents live below the official breadline, compared to 2.1 million at the start of the decade. Kids with at least one working parent account for two-thirds of children living in poverty in 2018. TUC general secretary France O’Grady commented “millions are stuck in jobs with bosses who treat them like disposable labour. We need a new deal for working people so that every worker gets respect, and every job is a good job.”

PAY DOWN, RISKS UP  Whether your work is white or blue collar, the lower you are down the pay scale, the more likely your job will be bad for your health.

But evidence suggests bad, badly paid jobs could be on the increase. A May 2018 analysis by the TUC revealed over 3.8 million people in the UK are in insecure work, such as agency work, zero hours contracts and low-paid self-employment.  Overall, 1-in-9 workers, or 11.9 per cent of the workforce, is in insecure forms of employment. This amounts to 3,820,000 workers.

A report the same month from the Gangmasters and Labour Abuse Authority (GLAA) warned bogus self-employment contracts are regularly used to disguise abuse, with intelligence suggesting this is a ‘growing problem’ in sectors such as cleaning, construction and flower picking. GLAA found pay and working conditions abuses linked to zero hours contracts in agriculture, construction, food packing and security services, despite many workers effectively being permanent staff. Safety concerns were evident in all these sectors [see: Exploitation rife in UK workplaces].

Low pay and income inequality go hand in hand with poor health and low life expectancy.  But one overlooked contributor to this health inequity is the association between low pay and harmful, sometimes deadly, working conditions. Poverty makes you sick. Combine it with hazardous work and you are really in trouble.

Toxic combination

Occupational injuries and diseases like diabetes, heart disease and cancer frequently come with less well remunerated jobs.  Inequalities at work: Job quality, health and low pay in European workplaces,1 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,2 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,3 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 suggest that higher wages lead to improvements in health or health behaviours, including a study that round reduced anxiety and depression among people benefiting from the introduction of the UK minimum wage.4

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 poor 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 2018 paper co-authored by Leigh 5 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 per cent by one method and 32 per cent by the other. Either way, it was substantial.

The paper noted: “These findings are strongest for persons who are not employed year-round and among the lowest wage earners. In additional analysis, we show that these effects are likely not due to changes in labour supply or job-related attributes. Instead, we find a possible mechanism: higher minimum wages improve self-reported health for lower educated workers.” Leigh commented: “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 6 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’.

Low grade killers

Poor working conditions are commonly a toxic companion to poor pay. 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 can take a toll on your health (Hazards 138).

EX[ER]CISED  The day-long exercise you get in a physically demanding, arduous job isn’t good for you – it can kill you, new research has found. The study reveals an apparent “physical activity paradox” where exercise can be harmful at work but beneficial to health when performed in leisure time. more

Work-related suicide is one of the emerging ‘diseases of distress’7 linked to austerity, economic decline and increased employment insecurity. Substance misuse – prescription or non-prescription drugs and alcohol – is another side-effect. Heart disease 8 is a potentially fatal consequence of working in a bad job too.

Higher paid, higher status work, by contrast, is relatively immune to work-related health problems – occupational injuries, cancers, nervous system disorders, suicides, reproductive problems, strain injuries and cardiovascular diseases are concentrated overwhelmingly in less well remunerated work. The lower your grade, the higher your risks.

The low pay effect impacts on white collar workers too. The ongoing Whitehall II study of UK civil servants showed that stress, sickness and heart disease all went up as your grade went down.

Unfairness at work turns out to be a health risk in its own right. Research by the University of East Anglia and Stockholm University, published in the journal BMC Public Health 9 in December 2017, revealed lower levels of justice at work relate both to an increase in shorter, but more frequent sickness absence periods, and to an increased risk of longer sickness absence episodes. Higher levels of job insecurity were also an important predictor of long and frequent sickness absence.

A follow up study published in the Journal of Occupational Health Psychology 10 in 2018 established that how a firm supports people returning to work from sick leave can have a big impact on whether they feel they are treated fairly by their organisation and their return is a positive and healthy experience.

Unions are a proven mechanism capable of addressing the pay and other inequalities that cause these increases in injury, sickness and early death.  There is a clear and positive union effect on pay rates. There is a substantial union safety effect.
Combine the two and union membership offers a return none of us can afford to live without.

Selected references

Exercise is good for you - but hard labour isn’t

Men who work as labourers or in other physically demanding roles have a greater risk of dying early than those with more sedentary jobs, a study has found. The research, from an international team of researchers, reveals an apparent “physical activity paradox” where exercise can be harmful at work but beneficial to health when performed in leisure time.

Pieter Coenen, lead author of the study published in May 2018 in the British Journal of Sports Medicine, sald the disparity may reflect the different types of exercise people get at work compared with those in their free time. “While we know leisure-time physical activity is good for you, we found that occupational physical activity has an 18 per cent increased risk of early mortality for men,” Coenen said. “These men are dying earlier than those who are not physically active in their occupation.” He said the difference was not explained by ‘lifestyle’ factors.

“If you go out for a run for half an hour in your leisure time,” Coenen said, “that increases your heart rate and you feel well afterwards, but when you are physically active at work, it’s a very different type of activity. You are working for eight hours a day and have limited rest periods. You are lifting, doing repetitive movements, and manual handling.”

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Exploitation rife in UK workplaces

A May 2018 report from the Gangmasters and Labour Abuse Authority (GLAA) warned bogus self-employment contracts are regularly used to disguise abuse, with intelligence suggesting this is a growing problem in sectors such as cleaning, construction and flower picking.

Zero hours contracts linked to abuses are highlighted in agriculture, construction, food packing and security services, despite many workers effectively being permanent staff.

GLAA’s investigation found long shifts of 12-15 hours a day, sometimes seven days a week, wages below the legal minimum or not paid at all, and dangerous working and living environments were issues common to several sectors.

In agriculture, ‘serious safety incidents’ were commonplace. Conditions in some car washes were found to be ‘unsafe and dangerous’. In recycling workers were found to be living in shipping containers, in breach of safety law.

In construction, the report says: “Intelligence indicates that serious accidents have befallen exploited workers and in some cases compensation has been offered to stop victims presenting a case to authorities, however this is not always paid.”

In food packaging, the GLAA report says the majority of temporary workers do not understand English, including health and safety instructions.

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Degraded

Are you sick and tired of too much work for too little pay? Well, you are also likely to be sick because of it, warns Hazards editor Rory O’Neill. Workplace risks go up as your employment grade goes down, with a potentially devastating impact on health.