Employment inequality

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.

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 2016/17, more than half a million people in Scotland (510,000) were living in poverty despite living in a household where someone works. Half of all people in Scotland living in poverty live in a working household. Most of these (360,000) were working-age adults but there were still 140,000 children in working households living below the poverty line.

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 site).

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

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.

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.

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

Our report, 'Working and hurting', highlights that employment rates in Scotland have risen and the number of children living in workless households has fallen since 2012. The change is strongly seen among those targeted by welfare reform, e.g. lone parents and young adults not in full-time education.

Gains in employment have not yet translated into expected improvements in reduced poverty or better mental health. The number and proportion of working-age adults claiming health-related benefits is also higher than anticipated (based on past trends).

The report also shows a higher than expected level of mortality in older working adults aged 50 to 74 and those adults aged 85 to 89 (in the years 2011-2016). Although this conclusion depends on the choice of baseline year, it is a concern.

Together with rises in health inequalities since 2013, this suggests that concerns that austerity and welfare reform pose a risk to health should be taken seriously.

Our report 'Working and hurting' recommends we use our powers more to

• strengthen action against things that are bad for Scotland's health, such as removing benefits sanctions that affect those with ill health or who are lone parents
• do more on measures that improve health, such as reducing poverty (especially child poverty) and promoting good work.

It also asks that the reasons for the mortality level changes are investigated and supports current actions to reduce harm from alcohol and drugs.

This replaces our previous report 'Pulling in different directions'.

Unemployment in Scotland

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 site).