The contribution of job insecurity to socio-economic inequalities Michael Marmot, Jane Ferrie, Katherine Newman and Stephen Stansfeld Over the past twenty years, socio-economic inequalities in mortality have widened. At the same time, patterns of employment, job security and welfare provision since the Second World War have undergone and continue to undergo major change. Future employment, for many people, is less certain. Job insecurity has started to attract research interest over the past decade. Studies of job insecurity attributed to workplace closure and self- reported job insecurity have demonstrated adverse effects on self-reported physical and mental health. However, well-designed, longitudinal studies remain rare and the contribution of job insecurity to inequalities in health uninvestigated. In this project, data from an ongoing, longitudinal study of civil servants and ex-civil servants were supplemented by new data collected by in-depth interview. These data have been used to examine the effects of self-perceived job insecurity over time, assess its contribution to inequalities in health, and explore the job insecurity-health relationship. Environmental factors, type of work, situational and individual characteristics emerged from the in-depth interviews as determinants of job insecurity. In addition to the threat of job loss, feelings of insecurity were generated by loss of valued features of the job and unwanted additional tasks and responsibilities. Factors which contributed to the job-insecurity-health relationship fell into five categories; personality and attitude, life events, work characteristics, other potentiating or ameliorating factors, and coping mechanisms. The explanatory potential of factors identified by interview were tested in data from all participants in employment. Pessimism, heightened vigilance, difficulty in paying bills, financial security, social support and job satisfaction explained much of the association between job insecurity and self- assessed health. With the addition of job control, the same factors explained most of the association with minor psychiatric morbidity and depression. An exploration of the effects of perceived job insecurity over time showed that, relative to workers who remained in secure employment, self-reported morbidity was raised among workers who lost job security. Workers exposed to chronic job insecurity had the highest self-reported morbidity, indicating that job insecurity acts as a chronic stressor. Among those who regained job security, adverse effects, particularly in the psychological sphere, were not completely reversed by removal of the threat. In our study population there have been slight increases in socio-economic differences in morbidity and cardiovascular risk factors over 11 years follow-up from the late 1980s. There has also been a significant widening of the gap for measures of minor psychiatric morbidity in both sexes and cholesterol in men. However, despite steep gradients in perceived job insecurity, with the exception of depression, adjustment for job insecurity had little effect on inequalities in morbidity and cardiovascular risk factors. Financial insecurity, on the other hand, contributed considerably to health inequalities, particularly in non-employed participants and men in paid employment. Current debate on the flexible labour market concentrates on direct economic returns. However, any deterioration in health has economic and social costs, which end up being borne by society. Policy makers should include these considerations in cost-benefit analyses of structural changes in the labour market. MAY 2001 Research Findings FROM THE HEALTH VARIATIONS PROGRAMME 11 :