Health changes in a market changing labour market

Abstract: The late 20th century saw major changes in working life across the world. In Sweden, the changes on the labour market had a very strong impact in the early years of the 1990s. Not necessarily because they were larger than in other comparative countries, but because they happened quickly and marked a radical departure from the traditionally very stable and secure labour market in the country. In the span of a few years, almost full employment and high job security was replaced by high unemployment rates, decreased job security, and ubiquitous downsizing and re-organisation of companies. Unemployment was mainly countered by a large augmentation of active labour market programmes (ALMPs), offering intermittent activation of the unemployed. The present thesis aims to investigate health consequences of the changing labour market of the 1990s in Sweden. This is done in three different contexts: survivors of organisational changes, participants in active labour market policy programmes, and different kinds of early labour market exit for older workers. Papers I and II focused on an experimental active labour market programme with pronounced empowerment and (public) health goals. The hypothesis was that participation would improve health generally and result in a shift from catabolic to anabolic processes in the body. Some transient improvements were found, especially in well-functioning groups (Paper II), but there were also indications of long-term adaptation to unemployment (Paper I). Overall, the hypothesis was not supported, and the major conclusion was that six months participation was not enough to achieve lasting health effects. Papers III and IV focused on those persons who stay in work after downsizing, re-organisation or rapid personnel expansion. In Paper III, job strain and cardiovascular risk factors were studied in companies which had been qualitatively classified regarding organisational change. The results indicate that several kinds of 'organisational instability', not only downsizing, might have adverse health effects. In Paper IV, sickness absence and hospital admission was studied in relation to personnel downsizing and expansion in a nationally representative sample of 24,036 workers. The results show an excess risk for health problems among employees who had been repeatedly exposed to either moderate downsizing or large expansion, and lower risk for those who had experienced moderate expansion. Together, Papers III and IV confirm earlier findings by other researchers that personnel downsizing predicts negative health outcome, but add that other types of major organisational change, including prolonged and rapid expansion, can have similar adverse effects. Paper V examined the relative effects of different labour market exits (LMEs) on the risk of hospitalisation compared to those who stay in employment using a nationally representative sample of 7,024 older Swedish workers. The results showed an increased risk of hospital admission following LME for the unemployed. There was also a tendency that those who took disability pension had a reduced risk. These findings confirm the commonly found result that unemployment has negative health effects, but in addition they indicate that withdrawal from bad jobs and/or for persons with pre-existent health problems might have a protective effect on health. Taken together, the thesis demonstrates that structural changes in the labour market, as exemplified by the major changes that took place in Sweden in the early 1990s, can have a significant and differentiated impact on public health, and that the negative health effects are not necessarily easy to counteract by labour market programmes. More research is called for, especially regarding effective interventions to protect health during structural changes at workplaces and in working life as a whole.