In recent decades, economic crises and political reforms focused on employment flexibilization have increased the use of non-standard employment (NSE). National political and economic contexts determine how employers interact with labour and how the state interacts with labour markets and manages social welfare policies. These factors influence the prevalence of NSE and the level of employment insecurity it creates, but the extent to which a country's policy context mitigates the health influences of NSE is unclear. This study describes how workers experience insecurities created by NSE, and how this influences their health and well-being, in countries with different welfare states: Belgium, Canada, Chile, Spain, Sweden, and the United States. Interviews with 250 workers in NSE were analysed using a multiple-case study approach. Workers in all countries experienced multiple insecurities (e.g., income and employment insecurity) and relational tension with employers/clients, with negative health and well-being influences, in ways that were shaped by social inequalities (e.g., related to family support or immigration status). Welfare state differences were reflected in the level of workers' exclusion from social protections, the time scale of their insecurity (threatening daily survival or longer-term life planning), and their ability to derive a sense of control from NSE. Workers in Belgium, Sweden, and Spain, countries with more generous welfare states, navigated these insecurities with greater success and with less influence on health and well-being. Findings contribute to our understanding of the health and well-being influences of NSE across different welfare regimes and suggest the need in all six countries for stronger state responses to NSE. Increased investment in universal and more equal rights and benefits in NSE could reduce the widening gap between standard and NSE.

The COVID-19 crisis is a global event that has created and amplified social inequalities, including an already existing and steadily increasing problem of employment and income insecurity and erosion of workplace rights, affecting workers globally. The aim of this exploratory study was to review employment-related determinants of health and health protection during the pandemic, or more specifically, to examine several links between non-standard employment, unemployment, economic, health, and safety outcomes during the COVID-19 pandemic in Sweden, Belgium, Spain, Canada, the United States, and Chile, based on an online survey conducted from November 2020 to June 2021. The study focused on both non-standard workers and unemployed workers and examined worker outcomes in the context of current type and duration of employment arrangements, as well as employment transitions triggered by the COVID-19 crisis. The results suggest that COVID-19-related changes in non-standard worker employment arrangements, or unemployment, are related to changes in work hours, income, and benefits, as well as the self-reported prevalence of suffering from severe to extreme anxiety or depression. The results also suggest a link between worker type, duration of employment arrangements, or unemployment, and the ability to cover regular expenses during the pandemic. Additionally, the findings indicate that the type and duration of employment arrangements are related to the provision of personal protective equipment or other COVID-19 protection measures. This study provides additional evidence that workers in non-standard employment and the unemployed have experienced numerous and complex adverse effects of the pandemic and require additional protection through tailored pandemic responses and recovery strategies.

Precarious employment (PE) has been linked to adverse health effects, possibly mediated through psychosocial hazards. The aim of this cross-sectional study is to explore if higher levels of PE are associated with psychosocial hazards (experiences of violence, sexual harassment, bullying, discrimination, high demands, and low control) and to explore gender differences in these patterns. The study is based on survey- and register data from a sample of 401 non-standard employees in Stockholm County (2016–2017). The level of PE (low/high) was assessed with the Swedish version of the employment precariousness scale (EPRES-Se) and analysed in relation to psychosocial hazards by means of generalized linear models, with the Poisson family and robust variances. After controlling for potential confounders (gender, age, country of birth, and education), the prevalence of suffering bullying (PR 1.07, 95% CI: 1.01–1.13) and discrimination (PR 1.52, 95% CI: 1.00–2.32) was higher among individuals with a high level of PE. Regarding the demand/control variables, a high level of PE was also associated with low control (PR 1.59, 95% CI: 1.30–1.96) and passive work (the combination of low demands and low control) (PR 1.60, 95% CI: 1.23–2.08). Our findings suggest that workers in PE are more likely to experience psychosocial hazards, and these experiences are more prevalent among women compared to men. Future longitudinal studies should look further into these associations and their implications for health and health inequalities.

Background: World economies increasingly rely on non-standard employment arrangements, which has been linked to ill health. While work and employment conditions are recognized structural determinants of health and health equity, policies aiming to protect workers from negative implications predominantly focus on standard employment arrangements and the needs of workers in non-standard employment may be neglected. The aim of this study is to explore workers’ experiences of gaps in labour regulations and social protections and its influence on their health and well-being across 6 countries with differing policy approaches: Belgium, Canada, Chile, Spain, Sweden, and the United States. Methods: 250 semi-structured interviews with workers in non-standard employment were analyzed thematically using a multiple case-study approach. Results: There are notable differences in workers’ rights to protection across the countries. However, participants across all countries experienced similar challenges including employment instability, income inadequacy and limited rights and protection, due to policy-related gaps and access-barriers. In response, they resorted to individual resources and strategies, struggled to envision supportive policies, and expressed low expectations of changes by employers and policymakers. Conclusions: Policy gaps threaten workers’ health and well-being across all study countries, irrespective of the levels of labour market regulations and social protections. Workers in non-standard employment disproportionately endure economic risks, which may increase social and health inequality. The study highlights the need to improve social protection for this vulnerable population.

Objectives To investigate the effect of precarious employment (PE) on the risk of diagnosed chronic musculoskeletal disorders (MSDs) among Swedish workers in occupations with strenuous working conditions. Methods This nationwide register-based cohort study included workers registered as living in Sweden in 2005, aged 21–60 at the 2010 baseline. Three samples were included: workers with high biomechanical workload (n=680 841), repetitive work (n=659 422) or low job control (n=703 645). PE was evaluated using the SWE-ROPE (2.0) construct, which includes: contractual insecurity, temporariness, multiple jobs, income and collective bargaining agreement from 2010. Three exposure groups were created: PE, substandard and standard employment (SE). MSD data were obtained from outpatient registers (2011–2020). Cox proportional-hazards models estimated crude and adjusted sex-specific HRs with 95% CIs. Various outcomes were investigated for the different samples. Results Among workers with heavy biomechanical workload, results suggest increased risks of back MSDs in PE compared with those in SE. No association was found between PE and tendonitis in repetitive work, but PE was associated with an increased Carpal Tunnel Syndrome risk among men. Among workers with low job control, PE was associated with increased risks of soft tissue disorders among men and fibromyalgia among women. Conclusions PE was associated with an increased risk of MSDs among workers with strenuous working conditions, with variations depending on disorder and sex. The findings suggest a differential exposure to biomechanical workload within occupations. Targeted interventions and strengthened workplace safety regulations are needed to protect the musculoskeletal health of workers in PE.

Research on health in self-employment shows mixed findings, partly due to limited focus on heterogeneity within self-employment, physical health outcomes and reliance on self-reported, cross-sectional data. This study addresses these gaps by identifying self-employment types using the 'precarious employment framework' and examining their association with cardiovascular health conditions in Sweden. Using the Swedish Work, Illness, and Labour Market Participation (SWIP) cohort, we analyzed individuals born between 1948 and 1968, aged 40-60 in 2008, and living in Sweden in 2005. We identified a typology of precarious self-employment in 2008 (N = 281,251), with cardiovascular health conditions tracked between 2009 and 2020. Latent Class Analysis (LCA) was used to categorize self-employment based on six indicators of precarity: business type, prior unemployment, combined employment, number of employees, income, and income volatility. Cox proportional hazards models estimated the association between the self-employment types and cardiovascular health conditions (diagnoses for myocardial infarction and stroke) compared to waged employment, adjusting for covariates. We identified four self-employment types: entrepreneurial employers, precarious solo self-employed, own-account combiners, and small traders. Precarious self-employment among 40-to-60-year-olds was associated with a higher risk of cardiovascular conditions later in life. The 'precarious employment framework' effectively captures the heterogeneity of self-employment and highlights its role as a social determinant of cardiovascular health. Our findings suggest that precarious self-employment is linked to increased cardiovascular risk. This underscores the importance of considering employment quality and heterogeneity in future research and public policies addressing self-employed populations.