Pay, flexibility, advancement matter most to employees

The terms and conditions of your employment -- including your pay, hours, schedule flexibility and job security -- influence your overall health as well as your risk of being injured on the job, according to new research from the University of Washington.

The analysis takes a comprehensive approach to show that the overall pattern of employment conditions is important for health, beyond any single measure of employment, such as wages or contract type.

"This research is part of a growing body of evidence that the work people do -- and the way it is organized and paid for -- is fundamental to producing not only wealth, but health," said senior author Noah Seixas, a UW professor of environmental and occupational health.

The study was published this month in the Russell Sage Foundation Journal of the Social Sciences.

Technology and other forces are changing the nature of work, researchers said. The traditional model of ongoing, full-time employment with regular hours and job security is rapidly giving way to gig-economy jobs, short-term contracts, nonstandard work hours and flexible employer-worker relationships.

Current models for understanding this work are too simplistic, said first author Trevor Peckham, a UW doctoral student in environmental and occupational health sciences. Studies of a single aspect of employment may not capture important elements of jobs that influence health.

"Employment relationships are complex. They determine everything from how much you get paid, how much control you have over your work schedule, your opportunities for advancement and how much protection you have against adverse working conditions, like harassment," said Peckham, also a clinical instructor in UW Health Services.

The researchers used data from the General Social Survey collected between 2002 to 2014 to construct a multidimensional measure of how self-reported health, mental health and occupational injury were associated with employment quality among approximately 6,000 US adults.

"There are many different forms of employment in the modern economy," Peckham said. "Our study suggests that it is the different combinations of employment characteristics, which workers experience together as a package, that is important for their health."

Among their findings:

• * People employed in "dead-end" jobs (for example, manufacturing assembly line workers who are often well-paid and unionized but with little empowerment or opportunity) and "precarious" job holders (for example, janitors or retail workers who work on short-term contracts and struggle to get full-time hours) were more likely to report poor general and mental health as well as occupational injury compared to people with more traditional forms of employment.

  * "Inflexible skilled" workers (such as physicians and military personnel, who have generally high-quality jobs but with long, inflexible hours) and "job-to-job" workers (such as Uber drivers, gig workers or the self-employed doing odd jobs) had worse mental health and increased injury experience compared to those with standard employment.

  * One of the most surprising findings: "Optimistic precarious" job holders (including service-sector workers with high empowerment, such as florists) had similar health to those in standard employment, despite having jobs characterized by insecurity, low pay and irregular hours. They report high control over their schedules, opportunities to develop and involvement in decision-making and may be opting in to these types of jobs.

"Our research has direct implications for policy," said co-author Anjum Hajat, a UW assistant professor of epidemiology. "As we have seen at the local level, Seattle City Council has been actively promoting policy solutions to improve workers' lives."

That includes the secure scheduling ordinance, minimum wage and family leave policies. These approaches show "the interest and appetite for change," Hajat said.

Researchers and policymakers must continue the dialog with employers "to demonstrate the benefits of increased worker security and stability on employee turnover, productivity and, ultimately, their bottom line," she said.

"Using policy and legal levers to influence how people are hired and treated at work can have profound effects on improving the health of workers and their communities," Seixas said.