UNNATURAL CAUSES is inequality making us sick? HEALTH EQUITY research topics and resources to learn more
Bookmark and Share
Precarious Work



Interview with David Williams, Harvard School of Public Health

Williams talks about the health effects of job loss and about what policies might help protect workers' physical and mental well-being.

Learn more »


See resources related to this case study »

Regardless of the type of work arrangement, companies and employees alike have an economic incentive to improve health. The U.S. loses an estimated $1 trillion annually in work productivity due to chronic illness, and health care costs consumed 16% of our GNP in 2006.

A central issue for improving health is giving workers more power and control over their lives. It goes without saying that we wouldn’t need as much of a safety net if corporate practices and social policies didn’t create inequities in the first place. But as workers find themselves in increasingly vulnerable situations, government policies must be expanded and rewritten to accommodate the new realities of the labor market.

Many European countries protect workers’ health through legislation. For example, EU countries mandate paid sick leave, paid vacation, and severance pay following layoffs. Scandinavian countries have made job strain illegal, and most European countries also provide more substantial unemployment protections, education and retraining, and government or industry-wide pensions. Currently, the U.S. provides no guaranteed paid leave and very little to transition or help workers who lose their jobs.

Many of these countries also provide significant social support for families, including paid parental leave and universal preschool. Although some workers in the U.S. have successfully negotiated with their employer flexible work schedules, job sharing, and provisions for childcare and sometimes eldercare, these accommodations are not available to everyone (particularly non-standard workers), they’re non-transferrable from one job to another, and they are not guaranteed.

Other existing employer-based efforts are also limited. One overlooked but beneficial intervention is to involve workers in changing organizational culture and practice: for example, redesigning stressful jobs with better task variety or rotation; improving co-worker and supervisor support; improving communication, feedback and conflict resolution; and creating a sense of fairness and commitment to workers. Ironically, research has shown these to be very inexpensive and effective measures, even as more companies retreat from a sense of responsibility towards their workers. 

As employer-provided health insurance becomes more of a rarity even among full-time workers, single-payer universal coverage would certainly benefit all workers. At the same time, changing eligibility requirements for government benefits, restructuring unemployment and retirement, providing resources to help cushion workers as they transition in and out of employment, and expanding legal protections for non-standard workers will help the most vulnerable segments of the workforce.