The considerable increase of non-standard labor contracts, unemployment and inactivity rates raises the question of whether job insecurity and the lack of job opportunities affect physical and mental well-being differently from being employed with an open-ended contract. In this paper we offer evidence on the relationship between Self Reported Health Status (SRHS) and the employment status in Italy using the Survey on Household Income and Wealth; another aim is to investigate whether these potential inequalities have changed with the recent economic downturn (time period 2006-2010). We estimate an ordered logit model with SRHS as response variable based on a fixed-effects approach which has certain advantages with respect to the random-effects formulation and has not been applied before with SRHS data. The fixed-effects nature of the model also allows us to solve the problems of incidental parameters and non-random selection of individuals into different labor market categories. We find that temporary workers, unemployed and inactive individuals are worse off than permanent employees, especially males, young workers, and those living in the center and south of Italy. Health inequalities between unemployed/inactive and permanent workers widen over time for males and young workers, and arise in the north of the country as well.

Employment status and perceived health condition: longitudinal data from Italy

The risk that flexible forms of employment are harmful to the health of workers is a major public health issue for the many countries, including Australia, where such forms of employment are common or have been growing. We ask whether the century-old system of arbitrated protections for workers and the distinctive welfare state in Australia averts any such harm to mental health. If Australian workers are harmed despite these protections, this adds weight to the international concerns about the hazards of flexible employment. Employing nine waves of panel survey data and dynamic random-effects panel data regression models, we examine the mental health consequences of unemployment, and of employment on a casual or fixed-term basis, compared with permanent employment. We control for demographic and socio-economic characteristics, occupation, disabilities status, negative life events, and the level of social support. We find almost no evidence that flexible employment harms mental health. Unemployed men (but not women) have significantly and substantially lower mental health. But among the employed, only men who are on fixed term contracts, most especially graduates, have lower mental health than those who are employed on full-time permanent terms. Women have significantly higher mental health if they are employed full-time on casual terms.

NILS Working paper no 166. Are casual and contract terms of employment hazardous for mental health in Australia

Background The public health response to the SARS-CoV-2 (COVID-19) pandemic has had a detrimental impact on employment and there are concerns the impact may be greatest amongst the most vulnerable. We examined the characteristics of those who experienced changes in employment status during the initial phase of the pandemic. Methods A cross-sectional, nationally representative household survey of the working age population (18-64 years) in Wales in June 2020. A total of 1,382 adults responded (6.9% response rate). Employment outcomes between February and May/June 2020 were (i) no change in employment status, (ii) a change in employment, (iii) unemployment, and (iv) furlough. Chi-squared tests and logistic regression models examined associations between demographics, health status and employment outcomes. Results Of the working age population in paid employment in February 2020, 3.2% were unemployed and 32.0% had been placed on furlough by June 2020. Groups more likely to be placed on furlough included younger (18-39 years) and older (50-64 years) workers, people from more deprived areas, in lower skilled jobs, living with pre-existing health conditions and from households with less financial security. Groups in poorer health (not good general health, low mental wellbeing) and from households containing a child or with less financial security were more likely to experience unemployment. Conclusion A number of vulnerable population groups were observed to experience detrimental employment outcomes during the initial stage of the COVID-19 pandemic. Targeted support is needed to mitigate against both the direct impacts on employment, and indirect impacts on financial insecurity and health.

https://medrxiv.org/content/10.1101/2020.11.03.20225144v1.full.pdf

Characteristics of those most vulnerable to employment changes during the COVID-19 pandemic: a nationally representative cross-sectional study in Wales

Background The public health response to the SARS-CoV-2 (COVID-19) pandemic has had a detrimental impact on employment and there are concerns the impact may be greatest among the most vulnerable. We examined the characteristics of those who experienced changes in employment status during the early months of the pandemic. Methods Data were collected from a cross-sectional, nationally representative household survey of the working age population (18–64 years) in Wales in May/June 2020 (n=1379). We looked at changes in employment and being placed on furlough since February 2020 across demographics, contract type, job skill level, health status and household factors. χ2 or Fisher’s exact test and multinomial logistic regression models examined associations between demographics, subgroups and employment outcomes. Results Of our respondents, 91.0% remained in the same job in May/June 2020 as they were in February 2020, 5.7% were now in a new job and 3.3% experienced unemployment. In addition, 24% of our respondents reported being placed on furlough. Non-permanent contract types, individuals who reported low mental well-being and household financial difficulties were all significant factors in experiencing unemployment. Being placed on ‘furlough’ was more likely in younger (18–29 years) and older (60–64 years) workers, those in lower skilled jobs and from households with less financial security. Conclusion A number of vulnerable population groups were observed to experience detrimental employment outcomes during the initial stage of the COVID-19 pandemic. Targeted support is needed to mitigate against both the direct impacts on employment, and indirect impacts on financial insecurity and health.

https://jech.bmj.com/content/jech/early/2021/06/29/jech-2020-216030.full.pdf

Characteristics of those most vulnerable to employment changes during the COVID-19 pandemic: a nationally representative cross-sectional study in Wales.

The PRESSED project aims to explain the links between a multidimensional measure of precarious employment and stress and health. Studies on social epidemiology have found a clear positive association between precarious employment and health, but the pathways and mechanisms to explain such a relationship are not well-understood. This project aims to fill this gap from an interdisciplinary perspective, integrating the social and biomedical standpoints to comprehensively address the complex web of consequences of precarious employment and its effects on workers' stress, health and well-being, including health inequalities. The project objectives are: (1) to analyze the association between multidimensional precarious employment and chronic stress among salaried workers in Barcelona, measured both subjectively and using biological indicators; (2) to improve our understanding of the pathways and mechanisms linking precarious employment with stress, health and well-being; and (3) to analyze health inequalities by gender, social class and place of origin for the first two objectives. The study follows a sequential mixed design. First, secondary data from the 2017 Survey on Workers and the Unemployed of Barcelona is analyzed (N = 1,264), yielding a social map of precarious employment in Barcelona that allows the contextualization of the scope and characteristics of this phenomenon. Drawing on these results, a second survey on a smaller sample (N = 255) on precarious employment, social precariousness and stress is envisaged. This study population is also asked to provide a hair sample to have their levels of cortisol and its related components, biomarkers of chronic stress, analyzed. Third, a sub-sample of the latter survey (n = 25) is selected to perform qualitative semi-structured interviews. This allows going into greater depth into how and why the experience of uncertainty, the precarization of living conditions, and the degradation of working conditions go hand-in-hand with precarious employment and have an impact on stress, as well as to explore the potential role of social support networks in mitigating these effects.

/pdf/precarious-employment-and-stress-the-biomedical-embodiment-4dhtg933og.pdf

Precarious Employment and Stress: The Biomedical Embodiment of Social Factors. PRESSED Project Study Protocol.

Aim:Precarious employment is known to be detrimental to health, and some population subgroups (young individuals, migrant workers, and females) are at higher risk of precarious employment. However,...

https://journals.sagepub.com/doi/pdf/10.1177/1757913920971333

Differences in the impact of precarious employment on health across population subgroups: a scoping review:

The COVID-19 pandemic directly impacted diagnostic services in the UK and globally. This exacerbated the rapid rise in demand for diagnostics that existed before the pandemic, resulting in significant numbers of patients requiring various diagnostic services and increased waiting times for diagnostics and treatment. In 2021, community diagnostic centres were launched in England. As diagnostic services account for over 85% of clinical pathways within the NHS and cost over six billion pounds per year, diagnostic centres across a broader range of diagnostic services may be effective, efficient, and cost-effective in the UK health sector. This rapid review aimed to identify and examine the evidence on the effectiveness of community diagnostic centres. A prior Research Evidence Map was used, along with the stakeholder input, to select a substantive focus for the rapid review. Comparative studies examining community diagnostic centres that accept referrals from primary care as a minimum were included. Prioritised outcomes included those relating to impact on capacity and pressure on secondary care, ensuring equity in uptake or access, and economic outcomes. The review included evidence available up until August 2022. Twenty primary studies were included. Twelve individual diagnostic centres were evaluated across the 20 studies. Most studies evaluated diagnostic centres located within hospital settings. One study evaluated a mobile diagnostic ultrasound service. Most studies were specific to cancer diagnoses. Six studies covered multiple health conditions, which will have also included cancer. Other conditions reported included: severe anaemia, fever of uncertain nature, and multiple sclerosis. A range of outcomes was identified. 11 studies conducted in Spain evaluated the same type of clinic i.e. Quick Diagnostic Unit and seven studies evaluated the same centre at different time intervals. No evidence relating to equity of access was identified. The evidence relating to effectiveness appeared mixed. There is evidence to suggest that diagnostic centres can reduce various waiting times, including time to surgical consultation, time from consultation to treatment, time from cancer suspicion to treatment, time from diagnosis to specialist consultation and time from diagnosis to treatment. Diagnostic centres could help reduce pressure on secondary care by avoiding hospitalisations in stable patients. Cost-effectiveness may depend on whether the diagnostic centre is running at full capacity. Factors that could determine the costs incurred by a centre include the diagnostic and clinical complexity of patients, and the characteristics of the unit including the number of staff and contribution of staff time.

What is the effectiveness of community diagnostic centres: a rapid review

Abstract Surgical waiting times have reached a record high, in particular with elective and non-emergency treatments being suspended or delayed during the COVID-19 pandemic. Prolonged waits for surgery can impact negatively on patients who may experience worse health outcomes, poor mental health, disease progression, or even death. Time spent waiting for surgery may be better utilised in preparing patients for surgery. This rapid review sought to identify innovations to support patients on surgical waiting lists to inform policy and strategy to address the elective surgical backlog in Wales. The review is based on the findings of existing reviews with priority given to robust evidence synthesis using minimum standards (systematic search, study selection, quality assessment, and appropriate synthesis). The search dates for prioritised reviews ranged from 2014-2021. Forty-eight systematic reviews were included. Most available evidence is derived from orthopaedic surgery reviews which may limit generalisability. The findings show benefits of exercise, education, smoking cessation, and psychological interventions for patients awaiting elective surgery. Policymakers, educators, and clinicians should consider recommending such interventions to be covered in curricula for health professionals. Further research is required to understand how various patient subgroups respond to preoperative interventions, including those from underserved and minority ethnic groups, more deprived groups and those with lower educational attainments. Further research is also needed on social prescribing or other community-centred approaches. It is unclear what impact the pandemic (and any associated restrictions) could have on the conduct or effectiveness of these interventions.

A rapid review of the effectiveness of innovations to support patients on elective surgical waiting lists.

The COVID-19 pandemic has resulted in increased demand and delays to diagnostic services. Community diagnostic centres (which are generally referred to as Regional Diagnostic Hubs in Wales) aim to reduce this backlog and the waiting times for patients by providing a broad range of elective diagnostic services in the community, away from acute hospital facilities. As diagnostic services account for over 85% of clinical pathways and cost the National Health Service (NHS) over six billion pounds a year (NHS 2022), community diagnostic centres across a broader range of diagnostic services may be an effective, efficient, and cost-effective introduction to the UK health sector. This Rapid Evidence Map aimed to identify, describe, and map the available evidence on the effectiveness of diagnostic centres. 50 primary studies were identified. Studies were published between 1995 and 2021: A wide range of study designs were used, and studies were conducted in a range of countries including the UK. 30 studies were specific to cancer diagnosis, whilst the remaining 20 studies focused on diagnosis associated with: anaemia, autism, cerebral palsy, intellectual disability, multiple sclerosis, respiratory conditions, shoulder pain, and unexplained fever Eleven studies reported information on multi-condition diagnostic centres, rather than a specific condition. The majority of studies were conducted within hospital settings. Two studies evaluated diagnostic centres within a community setting. The diagnostic centres offered a wide range of diagnostic tests and incorporated different staff and facilities. Participants were mainly referred by GPs, primary care centres and emergency departments. However, referrals were also made from outpatient clinics located within the same hospital as the diagnostic centre. Over 100 different outcomes were reported covering: patient data and referral outcomes, clinical outcomes, performance outcomes, economic outcomes, and patient and physician-reported outcomes. The findings of this rapid evidence map were used to select a substantive focus for a subsequent rapid review on community diagnostic centres that can be accessed by primary care teams.

A rapid evidence map of what evidence is available on the effectiveness of community diagnostic centres

Abstract: In the United Kingdom (UK), the National Health Service (NHS) provides population-based screening programmes for breast, bowel, and cervical cancer. These programmes were temporarily paused in March 2020, due to the COVID-19 pandemic, resulting in large numbers of the eligible population having their invitations delayed. This disruption may have had a disproportionate impact on underserved populations for whom there was a lower uptake prior to the pandemic. Some people may also be less willing to attend screening after the pandemic. Interventions and campaigns designed to encourage people to take part in cancer screening may need to be adapted after the pandemic, in particular those targeting underserved populations. This rapid review aimed to identify the barriers and facilitators to breast, bowel, and cervical screening uptake in underserved populations (e.g. clinically vulnerable, shielding, multi-morbidities, ethnic minorities, social deprivation, gender, age) during and since the onset of the pandemic, using evidence from the UK and other countries with similar cancer screening programmes (such as Australia and Netherlands), and to compare with the pre-pandemic literature. The pre-pandemic literature was identified using a supplementary scoping search for published systematic reviews. Three primary studies (two published and one ongoing trial) conducted during the pandemic were identified. Five systematic reviews of pre-pandemic evidence were also included. Two qualitative studies conducted during the pandemic were appraised as high quality but both included sample populations with limited representation. No primary studies specifically exploring the impact of the pandemic on barriers and facilitators to screening uptake among underserved groups were identified. The findings did not show marked differences in the barriers and facilitators for screening uptake before and during the COVID-19 pandemic in underserved populations. However, it is unclear whether this is because these genuinely remain unchanged or reflects the lack of available evidence. The findings may only be transferable to the population groups studied.

A Hookway

Papers

Differences in the impact of precarious employment on health across population subgroups: a scoping review:

What is the effectiveness of community diagnostic centres: a rapid review

A rapid review of the effectiveness of innovations to support patients on elective surgical waiting lists.

A rapid evidence map of what evidence is available on the effectiveness of community diagnostic centres

A rapid review of barriers and facilitators to cancer screening uptake (breast, cervical and bowel) in underserved populations