One of the important determinants of health inequalities within society is the availability and nature of employment. Employment matters because

  • having a poor quality job, or no job, can be bad for your health
  • paid employment has the potential to protect health and contribute to reduced health inequalities.

Employment is linked to the fundamental causes of health inequality – the unequal distribution of income, wealth and power. Increasing the quality and quantity of work can help reduce health inequalities.

How employment can affect health

Paid work has the potential to improve health and reduce health inequalities by providing higher incomes and by meeting social and psychological needs. Moving from unemployment into work reduces premature mortality rates by 63%, and vice versa. Being unemployed can increase the risk of poor mental health and hospitalisation.

However, being in paid work is not enough to improve health. Jobs can be as bad for health as unemployment if they

  • are of poor quality
  • offer limited autonomy
  • leave workers in poverty.

In Scotland in 2015/16, 610,000 people were in poverty despite living in households where at least one adult was in paid employment. This means that a majority of both children (70%) and working-age adults (64%) in poverty in Scotland, lived in working households.

We have published a report ‘Health outcomes and determinants by occupation and industry in Scotland’. This explores whether differences in health outcomes in adults were independently associated with job type and industry.

Mental health 

We have published a rapid evidence review of the relationships between employee voice and mental wellbeing.

Employment in Scotland

The recession, recovery and ongoing changes to social security have had mixed consequences for working age health. You can read more about this in the report ‘Pulling in different directions?’.

Factors that can add to unemployment or underemployment (short hours) in Scotland include

  • health issues
  • a lack of available work
  • lack of skills or recent work experience
  • the unequal distribution of jobs available
  • caring responsibilities (including childcare)
  • lack of support to change job or progress in work
  • the lack of jobs available in certain parts of Scotland.

These factors can stop people from entering employment, keeping jobs or benefiting from other opportunities when they arise. Some of these issues are explored in a report published in the Scottish Public Health Observatory’s (ScotPHO) report ‘The chance to work in Scotland’ (external website).

Reducing health inequalities through employment

To reduce health inequalities through employment it is important to

  • increase the availability of work
  • promote trade union organisation
  • increase the wages of low-paid workers
  • support people with health and social issues into work
  • increase the quality of available work by increasing worker autonomy and investing in in-work training.

The quality of work is also important if health is to be improved as a result. This includes focusing on

  • job security
  • the physical work environment
  • the demands of the job and job control
  • the design of the job (including shift work)
  • the balance of power between workers and the employer.

In Scotland, 430,000 people remain in poverty despite being in work. That means almost half of all adults in poverty in Scotland are actually in work. More than half of all Scottish children in poverty live in households which have at least one person in work.

Our briefing, 'Good work for all', focuses on the role that good work can play in reducing health inequalities.

The definition of ‘decent work’ by low-paid workers was explored in the University of the West of Scotland and Oxfam’s report ‘What makes for Decent Work?’ (external website).

You might also be interested in learning about the Fair Work Framework at the Fair Work Convention website (external).