This interview is an excerpt from our podcast Science Unscripted. If you want to know more about precarious work — or the study in Sweden (based on register data of all employees there) — listen to this episode of Science Unscripted. Or you can subscribe to the podcast here.
Nuria Matilla Santander is an assistant professor in occupational medicine at the Karolinska Institutet in Stockholm, Sweden. She conducted a study investigating how precarious employment affects the risk of mortality in the Swedish population.
DW: Nuria, what is the primary conclusion from your work?
Nuria Matilla Santander: People who move from precarious employment to standard employment, which is better and higher quality employment — the risk of death decreases by 20% [over six years]. When they remain in secure employment for 12 years, the risk decreases by 30%.
We need to define these terms. What exactly is precarious employment?
We define precarious employment as having a low income. An income that does not allow you to have a normal life, and to not have a stable employment. So being employed through an agency, for example, being temporarily employed, and not having access to your rights as a worker. Also not being able to take a day off, or go to the doctor — or also not being protected by the unions, by collective bargaining agreements.
And what is standard employment, as you call it?
Standard employment is the opposite. Having stable employment income allows you to have a normal life, and to exercise your normal rights as a worker.
If I, for instance, go from precarious employment and change my job to stable or standard employment, am I going to live longer?
Yes, that's what we found in our study in Sweden.
You start looking into data from 2005 to 2016. You looked at the entire Swedish population?
Exactly, aged between 20 to 55 — with a series of criteria. But the most important one was that they had to be in precarious employment.
And when these Swedish workers went from precarious employment to standard employment, they lived longer. How did you do the analysis?
We compare those that change from precarious to standard employment and those that do not change. Then we test the risk, then we follow them up for 12 years and we see who dies first. And then we see, oh yes, the ones that do not change to standard employment, they die faster and earlier than others. So, we can say that the risk of death is higher.
Did you measure how much earlier they die on average or the likelihood that they will die early?
We did not measure the exact ages, for instance, but we measure the probability of dying. With the methods that we are using, we can be sure that it is due to the change of moving from precarious to standard employment. And it is not due to any other kind of variables of probabilities, of things that happened in their lives during those years.
So, you could not conclude why, exactly, people die when they are in precarious employment, is that right?
Exactly. That is the next step. We have three main hypotheses. The first one is material deprivation. The insecurity of your job, the low income makes sure that you cannot have a normal life. You cannot count on going out on weekends or holidays. You cannot manage to buy things for your children. You cannot plan ahead. And stress is something bad for us and increases the probability of having other diseases.
Then there is another hypothesis — that is the work per se, like the work environment. Having a higher probability of being injured because your work is more dangerous.
And then there is another hypothesis that we call ‘the embodiment of precariousness'. Instead of having an illness caused by a bacterium, you have an illness caused by precarity. Being exposed for so many years to these precarious situations starts to mess things. That accelerates the probability of you having poor lifestyle behaviors, like diets, not having time for doing exercise, not having time for sleeping. And all these [lead to a] high probability of having other diseases.
Now that we know that that people who work in precarious situations will die earlier, what would be your tips? If there is someone in a situation you described, should that person get out of that job immediately? Or is there anything they could do?
I think we can never blame the worker. This should start with the employers providing better employment conditions for their workers. So, more than to the employees, I would like to have this message to the employers. Please be careful with those things, because they are damaging the health of the workers. And the unions have an important role. We see that if you move from a situation where you have no protection to a higher protection from a union, then your chances of being hurt by your work are low.
This also depends on the welfare government of the country where the workers are living. Now, we have done this study in Sweden, with a Nordic welfare regime. I cannot imagine how this would be in other countries, with other kinds of welfare regimes that are not so good for the workers.
How far is the world away from creating jobs that will not shorten people's lives? Would it be impossible? Or is it something that is feasible?
No, I do not think it is impossible. The world of work is changing every day. We see it now with the technologies, with digitalization of the workplaces. Many risky tasks could be done by machines. And then other kinds of jobs like freelancers, or the kind of jobs that cannot be in stable employment, they can have other kinds of protections. So, instead of having stable employment, you can provide the workers with a lot of rights, a lot of social security protection, and this will protect them against many kinds of health damage from work. I think it is quite feasible and possible.
This interview was conducted by Gabriel Borrud. It has been edited and condensed for clarity.