Health effects of job insecurity among employees in the Swiss general population.

Objectives. To investigate at national level the association between health and the social distress in which the whole employed population is plunged as a consequence of job insecurity. Design. Cross-sectional study. Setting. Switzerland. Subjects. Individuals working full or part time as employees drawn from a random sample (N=2024) of the Swiss general population interviewed by phone. Main outcome measures. Prevalence rates of ten self reported health and health related behaviour indicators according to three levels of perceived job insecurity (low, middle, high). Odds ratios estimated with logistic regression adjusted for relevant respondents characteristics (sex, age, education, having a chronic disease, working full or part-time and in public or private field). Results. One employee out of 10 experienced a high level of job insecurity, out of five a middle level while about 2/3 have no or a very low perception of job insecurity. The results clearly show that psychosocial stress induced in general employed population by fear of unemployment has a negative impact on the individual health and related health behaviour. A positive "dose-response" gradient was found between rise in job insecurity level's and the indicators investigated, suggesting a linear deterioration of health. In particular, employees in high insecurity group, compared to those in low one, have significantly higher odds ratios for seven indicators out of ten [not being in good health OR 1.6 (CI 1.0-2.7); high level of subjective stress OR 1.6 (CI 1.1-2.3); low self-esteem OR 2.9 (CI 1.5-5.7); daily or weekly consumption of tranquillisers OR 2.1 (CI 1.0-4.3); regular low-back pain OR 2.0 (CI 1.3-3.2); regular smoking OR 1.6 (CI 1.0-2.4); avoiding medical consultation or caring for themselves for fear of missing work OR 3.4 (CI 1.9-5.9)]. Employees with higher educational status seem to have more difficulties than less educated in coping with job insecurity. Conclusions. There is a positive association between health status and health related behaviour and social distress due to perception of job insecurity. Fear of unemployment seems to have stronger unfavourable effect in high educated employees than in less educated, probably because investment in career and in personal expectations are, in that group, generally higher. Although this cross-sectional study carried out at national level do not reach the "gold standard" represented by longitudinal ones, the results are fully consistent with those of few analysis on job insecurity carried out prospectively at firm level. Recommendations. In terms of concrete actions the main recommendations stemming from this study could be [i] to break the wall of silence generally erected around studies showing the positive relationship between job insecurity and deterioration of health, in order to promote a public and political consciousness in favour of less excluding and more solidary social and economic choices and [ii] to promote a systematic measure of health impact of policies and legislations with particular emphasis on those affecting labour market and work environment.