RHP&EO is the electronic journal of the International Union for Health Promotion and Education

Health effects of fear of unemployment among employees in the general population

Gianfranco Domenighetti
Faculty of Economics and Political science,
Universities of Lausanne and Geneva and Cantonal Health Office,
6500 Bellinzona Switzerland

Abstract

Several studies have shown that socio-economic status, unemployment, psychosocial work environment and its control by individuals are key and independent factors in explaining differences in risk factors, morbidity and mortality between groups and populations. On the other hand, studies on job insecurity are scarce and this study provides a preliminary picture of the relationship between health and insecurity generated by fear of unemployment among employees in the general population.

Employed persons exhibiting a high level of fear of unemployment have in general worse health indicators compared with those experiencing a low degree of fear. For some indicators (low self-esteem, consumption of tranquillizers, low-back pain) standardized prevalence rates were two or three fold higher under insecurity status. Higher educated people seem to have more difficulties than lesser educated in coping with fear of unemployment. More troubling, the results show that people under high job insecurity avoid visiting physicians and taking care of themselves for fear of missing work.

The analysis shows that the anxiety of fear of unemployment generated by the economic and social model of development, largely dominated, in the nineties, by the new neo-liberal theocracy, deserves medical and political attention.

As a first action, it is suggested to break the wall of silence generally erected by the lay press around studies showing the inverse relationship between socio-economic status of individuals and health, in order to promote and sustain a public and political consciousness in favour of less excluding and more solidary social and economic choices.

Background

Despite the general silence of the lay press, the relationship between welfare, economic and social development and the health of groups and populations has been extensively analysed, particularly on the basis of classical morbidity and mortality indicators [1].

Socio-economic status [2, 3, 4], unemployment [5], psychosocial work environment [6] and its control by individuals [7] have been recognized as key factors in explaining differences in risk factors and in morbidity and mortality between groups and populations.

It is important to point out that the use of this kind of indicators (such as morbidity and mortality rates) does not allow us to appropriately describe how macro- and microeconomic changes and differences in personal social and economic status affect individuals in their everyday life, particularly with respect to nutrition, social contacts and behaviours, sense of belonging and mattering, humiliation, etc. [8].

More troubling evidence suggests that, even in nations that since 1950 have assured equity of access to health care and services for the whole population, the mortality gap between higher and lower social classes has increased dramatically instead of decreasing, as expected consequence of the universal access to care [9].

All these results suggest that (i) improvements in the economic and social environment are independent key factors in improving the health of populations and also that (ii) for several groups of individuals health promotion and services consumption might be regarded as a sort of "survival techniques" for coping with situations of programmed deprivation. This later seems today particularly true for the growing "new poverty" groups in Western countries and for large groups of the populations on way to "democratic transition" in Central and Eastern Europe [10, 11].

All the evidence showing the key role of economic and social environment on health status is, in general, ignored by politicians and top health administrators, because emphasizing these factors could mean that (i) they would have to seriously consider the problem of mastering the current model of economic and social development, (ii) they would have to explicitly and publicly acknowledge that the mere consumption of health goods is not sufficient for maintaining and improving health.

To do so seems to be equivalent to a "political suicide" because politicians well know that in the nineties, since the fall of the Berlin wall, governments have lost a great part of their power and capacity to interfere in the economic model of development, largely dominated by the new neoliberal theocracy which postulates in particular (i) the discredit of every collective structure able to interpose obstacles in the way of the faith in free trade, (ii) the maximum "flexibility" of market labour and (iiii) the downsizing of social security expenses and framework.

This new model is supported by the globalisation of markets, particularly financial, by the privatisation of public sectors, by the progress of the information technologies and by the creation of a manpower reserve army made docile by precariousness and the permanent threat of unemployment [12].

The economic order is founded, in the nineties, on the absolute cult of "freedom" and "winner" and could be synthesized in the principle of "a free fox in a free poultry-house".

Fear of unemployment and health

The new neoliberal model of economic development has greatly contributed to spread even further in the public opinion the arbitrary opposition between the economic logic founded on a competition deemed to lead to effectiveness and efficiency and the social logic making place for the principle of equity [12].

In this perspective, the notions of "winner" and "looser" have been tied to the professional status attained and above all to having or not a remunerated activity. At the same time, the number of unemployed in the OECD European countries has increased from 7% in 1990 to 10,5% in 1997 [13] reaching 17 millions of unemployed in EU area and the proportion of part-time workers has reached 33 % in the Netherlands and about 25 % in Switzerland, Sweden and the U.K. [14]. This last form of activity corresponds essentially to the needs of business [15].

The diffusion by the mass media of the new neoliberal ideological paradigms, added to the daily news reporting business closures, worker lay-offs and the increase of unemployment, has created a situation of generalized psychosocial stress among large sections of the population, stress which has further accentuated the basic anxiety level due to the fear of unemployment. Not surprisingly, recent public opinion polls in Switzerland show that unemployment has become the first preoccupation [16], as is the case in most European countries.

While studies on the impact of unemployment on health are numerous and clearly show the negative effect of this social situation on several objective and subjective indicators of health, studies on the effects of fear of unemployment on health are scarce although much clinical research has been done on the health effects of workplace conditions.

Two studies [17, 18] carried out in two firms (one public) assessed the effect of anticipating job change or unemployment on self-reported health status and behaviour before and during the period when employees were facing, respectively, massive layoffs and privatisation. The results show that anticipation of job change or loss affects health even before the change has occurred in employment status.

Two other studies [19, 20] reached the same conclusions. One of these is of particular interest [20] because it analyses the current practice of organizational downsizing (reduction of personnel) as a tactic to ensure "the survival" of the firm in today's "global economic war". The authors concluded that "downsizing is a risk to the health of employees" although that risk varies according to individual and workplace factors.

Rationale of the present study on the general population

As mentioned, several clinical and epidemiological studies carried out on selected groups of individuals and firms have shown that job insecurity, anticipation of job change and downsizing techniques result in worsened health of the individuals exposed to those conditions. However, because the fear of unemployment is to some extent influenced by the personal conditions of the individual or by the actual situation in which one worker finds himself or herself as an employee of a particular firm or organization, those studies do not reflect the general social anxiety in which the whole society is plunged as a consequence of the perceived level of insecurity generated by the general economic and social situation and the basic model of development. This study, which to our knowledge is the first conducted on the general population of a whole nation, purports to investigate the consequences on health of this social distress.

Methodology

To measure the level of fear of unemployment among employees and to test if differences in health indicators exist between groups experiencing subjectively a high or low degree of fear, we carried out two explorative studies of the general population aged 20 and over.

One was aimed at a representative sample (N=2024) of the general Swiss population and the second at the general population of the Canton Ticino (N= 553), a region that experiences the highest official unemployment rate in Switzerland.

The two phone surveys were carried out in May-June 1997 before the announcement of the massive cut of 13,000 workplaces following the merger of the Union Bank of Switzerland with the Swiss Bank Corporation but after the creation of the new firm Novartis following the merger implicating the two multinational pharmaceutical companies Ciba and Sandoz, which resulted in 10,000 job losses. At this time, the official unemployment rates were 5,1 % for Switzerland and 7,1 % for the Canton Ticino.

The question posed in the two exploratory studies to discriminate the perceived level of fear of unemployment among respondents was:

There is lots of talk about the economic crisis. Presently, how do you estimate the probability of losing your job? Can you tell me whether this risk is: (1) very low, (2) low, (3) average, (4) high or (5) very high?

These five levels of fear were recoded in three groups expressing a low (items 1 + 2), middle (item 3) and high (items 4 + 5) perception of job insecurity.

Table 1 shows the employment status of the two representative samples of the general population:

TABLE 1	Switzerland	Canton Ticino
Cases (N)	2024	553
Employed N %	1175 58	287 52
Working full-time N %	862 42,5	224 40,5
Working part-time N %	313 15,5	63 11,5

The analysis of the relationship between fear of unemployment and health was carried out only on the groups having a full- or part-time job at the time of the survey (N=1175 for the Swiss sample, N=287 for Ticino).

In order to show a possible relationship between the perception of job insecurity and health, we calculated the prevalence rate of each health indicator mentioned in Table 2 separately for the group of employed people perceiving their job as secure (low fear group) and for those considering themselves at a high risk of unemployment (high fear group).

The comparative results between the two groups (low and high fear), expressed for each indicator in prevalence rates, were standardized by sex, age, education, having a chronic disease and having a full- or part- time job.

 The health indicators chosen for the comparative analysis are presented in Table 2:

These two surveys were of an exploratory nature, in order to test both the methodology and some questions in view of a more important now ongoing survey of a sample of 15,000 Swiss citizens. This last survey includes a list of about 40 health indicators and will allow us to draw a more detailed picture regarding the issues discussed above. The analyses of the data are planned for Spring 1999.

Results

1. Fear of unemployment

Table 3 shows the distribution of the fear of unemployment among people employed in the general population.

TABLE 3. Distribution of fear of unemployment
Degree of fear of unemployment	% of employees
	Switzerland	Canton Ticino
Low	69,5 (N=817)	52,3 (N=150)
Middle	20,0 (N=235)	27,3 (N=78)
High	10,5 (N=123)	20,4 (N=59)

In Switzerland, in May-June 1997, 1 employee out of 10 (Ticino 2 out of 10) experienced a high degree of fear of unemployment, while 70 % (Ticino about 50 %) has no or a very low perception of job insecurity. The difference between Switzerland and Canton Ticino is due to an objective cause (higher unemployment rate in Ticino) and probably also to a cultural one (Canton Ticino is the only Italian speaking region of Switzerland).

Job insecurity perception varies according to employment in public or private sector as shown in Table 4

TABLE 4. Job insecurity - Private versus Public sector
Degrees of fear of unemployment	Perception by employees (in %)
	Switzerland			Canton Ticino
	Private	Public	P value	Private	Public	P value
Low	64,2	75,2	<0.001	44,0	66,6	<0,001
Middle	22,0	15,2	<0,01	32,5	22,0	<0,1
High	11,3	8,7	NS	23,5	11,4	<0,02

NS = Not Significant

2. Job insecurity and health

Table 5 and Figures 1 and 2 show the standardized prevalence rates (and index) of the health indicators by low and high levels of fear of unemployment, for Switzerland and Canton Ticino among full- and part-time employees. As expected, the great majority of indicators show a deterioration of the state of health for the groups exhibiting a high level of job insecurity as compared to those experiencing a low level.

For some indicators (low self-esteem, consumption of tranquillizers, low-back pain), the standardized prevalence rates are two or three times higher under high insecurity status . The general higher gap between rates in low and high fear groups in the Ticino region seems to indicate that for Italian speaking people cultural background is also an important factor in coping with such stressful life events.

More troubling is the result showing that people under high job insecurity avoid consulting physicians or taking care of themselves for fear of missing work, perhaps in order not to give the impression of having passed from the status of "winner" to one of "looser".

3. Coping with job insecurity

An analysis of the results of this study according to educational level shows that persons with a higher educational level seem to have more difficulties than less educated in coping with job insecurity. Figures 3 and 4 show for some indicators the prevalence rates among lower and higher educated people in the situations of low and high fear of unemployment.

Without insecurity, as expected, higher educated people exhibit in general better health indicators; this is not true anymore when they are exposed to the stress of job insecurity (Figure 3). Even if health indicators for higher educated people are slightly better than those of the lower educated at baseline (that is under low level of fear), their rates sharply increase under exposure to a high fear of unemployment (Figure 4).

These results, deserving further investigation, could find a possible explanation in the fact that investment in the career and in personal expectations is generally higher among higher educated people, a fact which could lead more easily to feel like a "looser" in case of job loss. The same trend between lower and higher educated was observed for the Ticino sample.

Conclusions

Though exploratory, this analysis clearly shows that the condition of psychosocial stress induced in the general population by the new paradigms of economic development previously mentioned, has a negative impact on the health of employees and, probably, on that of their relatives.

These results, added to the studies on the impact of socio-economic status, of unemployment and working conditions on health [1-10] put into question the basic choices in our societies and particularly those required by the present "economic global war". These policies are presented to consumers as "scientific" choices which correspond in fact to the interests of enterprises in the name of the logic requiring that every firm should, year after year, increase its performance measured as an increase in the level of turnover and profit, an objective which is not reasonably possible for everybody and forever. For example, the expansion in the OECD countries from 1950 to 1995 has also expanded the number of unemployed from 10 to 35 million [21] and future perspectives predict that part-time work will increase to over 40% of the active population [14]. The "markets disarmament" [22] is not for tomorrow, although measures such as, for example, the proposition to introduce at world level a tax on financial transactions and currency exchange rates, have been evoked at several international meetings (recently at the G7 summit in Halifax) [23], in order to give back to governments a certain degree of autonomy in macroeconomic policy.

In terms of concrete action, the main recommendation stemming from this study and those previously quoted [1-10, 17-20] is to break the "conspiracy of silence" generally existing around these studies, which question directly the current political action and the new model of social and economic development. The press, because of its dependence on advertising budgets and its increasing concentration, seems largely subservient to the neoliberal paradigms and, with few exceptions, it does not give importance to these results even when they are published in leading medical journals.

The breaking of the wall of silence could help bring about a greater political and social consciousness of the relation between models of economic development and health, promoting in this way public pressures for economic and political choices less excluding and more solidary.

References

1. Levin LS, Mc Mahon L, Ziglio E. Editors. Economic change, social welfare and health in Europe. Who Regional Publications, European Series. No. 54. Copenhagen 1994
2. Markenbach JP, Kunst AE, Cavelaars AE, et al. Socio-economic inequalities in morbidity and mortality in western Europe. The Lancet 1997; 349: 1655-9
3. Kunst AE, Groenhof F, Mackenbach J Pand the EU Working Group on Socio-economic Inequalities in Health. Occupational class and cause specific mortality in middle aged men in 11 European countries: comparison of population based studies. BMJ 1998; 316: 1636-42
4. Mc Kie RM, Hole DJ. Incidence and thickness of primary tumours and survival of patients with cutaneous malignant melanoma in relation to socio-economic status. BMJ 1996, 312: 1125-8
5. Shortt SE. Is unemployment pathogenic? A review of current concepts with lessons for policy planners. Int J of Health Services 1996; 25: 569-89
6. Marmot MG, Bosma H, Hemingway H, et al. Contribution of job control and other risk factors to social variations in coronary hearth disease incidence. The Lancet 1997; 350: 235-9
7. Davey Smith G, Harding S. Is control at work the key to socio-economic gradient in mortality? The Lancet 1997; 350: 1369-70
8. Whitehead M. Counting the human costs: opportunities for and barriers to promoting health. In 1); 59-75
9. Marmot MG. Improvement of social environment to improve health. The Lancet 1998: 351: 57-60
10. Makara P. The effect of social changes on the population’s way of life and health: a Hungarian case study. In 1); 77-94
11. Harrington P, Ritsatakis A, editors, European health policy conference: opportunities for the future, Copenhagen, 5-9 December 1994. Volume 5: Health challenges for countries of central and eastern Europe and the newly independent states. Copenhagen: World Health Organization, Regional Office for Europe, 1995
12. Bordieu P. L’essence du néoliberalisme. Le Monde Diplomatique, mars 1998
13. Perspectives de l’emploi, Organisation de Coopération et Développement Economique (OCDE), Paris 1998
14. Falter JM, Ferro-Luzzi G, Flückiger Y. Travail à temps partiel et indépendants en Suisse: élements d’explication de l’évolution récente. Sécurité Sociale 1998; 3: 122-138
15. Bielenski H. New forms of work and activity: survey of experience at aestablishment level in eight European countries / prepared by Harald Bielenski; in coop. with Mateo Alaluf...[et al.]. Shankill Co. Dublin: European Foundation for the Improvement of Living and Working Conditions; Luxembourg: Office for Official Publications of the European Communities, 1994
16. Huth P, Longchamp C. Wie das Stimmwolk das Gesundheitswesen sieht. Interpharma, GFS Forschungsinstitut, Hergiswill 1998
17. Schnall PL, Landsbergis PA, Pieper CF, et al. The impact of anticipation of job loss on psychological distress and worksite blood pressure. AM J of Industrial Medicine 1992; 21: 417-432
18. Fezzie JE, Shipley MJ, Marmot MG, et al. Health effects of anticipation of job change and non-employment: longitudinal data from the Whitehall II study. BMJ 1995; 311: 1264-9
19. Seifert AM, Messing K, Dumais L. Star wars and strategic defence initiatives: work activity and health symptoms of unionised bank tellers during work reorganisation. Int J of Health Services 1997; 27: 455-477
20. Vahtera J, Kivimàki M, Pentti J. Effect of organisational downsizing on health of employees. The Lancet 1997; 350: 1124-28
21. L’étude de l’OCDE sur l’emploi. Le chômage dans la zone de l’OCDE de 1950 à 1995. OCDE; Paris 1994
22. Ramonet I. Desarmer les marchés. Le Monde Diplomatique, décembre 1997
23. Warde I. Le projet de taxe Tobin, bête noire des spéculateurs, cible des censeurs. Le Monde Diplomatique, février 1997

Acknowledgements

I’m particularly grateful to Dr. Barbara Davanzo (Mario Negri Institute, Milano) and Mrs. Jacqueline Quaglia (Cantonal Health Office, Ticino) for their help in the statistical analysis ant to Prof. Luciano Bozzini (Montréal) for useful comments of the manuscript. The author however assumes the entire responsability for the content.

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