Flexibility, Health and Disability
Bachelor thesis by Jelle Menges
Student nr: 5673259
February 2015
Source: economist 10.03.2014
Abstract:
One of the ‘structural reforms’ proposed in many European countries to strengthen economies in the long run, is flexibilizing labor markets. While there is much focus in the media on the effects of flexibilization on economic digits, like growth and employment, the effects on workers’ wellbeing and health are underexposed. This thesis discusses literature concerning health effects of precarious labor and/or job insecurity and shows the result of a regression analysis which examines the
relationship between labor market flexibility and labor disability. In the literature evidence is found for a negative impact of flexibility on health. The regression, however with a small sample,
1. Introduction
“Never waste the opportunity offered by a good crisis”. This famous quote of Niccolo Machiavelli and some derivatives of it were used very often in Europe during the last six to seven years. Policy makers, politicians, economists, employers’ organizations and other participants in the public debate were advocating to use the latest financial crisis and Eurocrisis to push through some economic reforms, which are apparently widely believed to strengthen oureconomies in the long run. One of the most intriguing reforms, proposedin both Southern and Northern European countries, is the flexibilization of labor markets. This would lead to all kinds of improvements when it comes to employment, innovation and productivity.
Traditionally many economists believed labor market flexibility would be an effective way to combat unemployment. Especially during the economic stagnation in Europe during the seventies and eighties, this was a popular belief in the field (Brodsky, 1994). When we take a look at more recent (economic) literature however, the consequences of flexible labor markets do not seem to be that unambiguous. The attention for negative consequences of flexible labor markets has increased. Economists do not agree at all about the effects of flexible labor markets on employment (for an overview see for an example: Storm & Naastepad, 2007 or Aguirregabiria & Alonso-Borrego, 2014). Research from Dutch economists suggests flexibility has negative effects on investments in R&D of big, established firms (“routinized innovation”) and no effects on innovation of new firms in a competitive environment (“garage business innovation”)(Kleinknecht, van Schaik & Zhou, 2014). We can find strong support in the literature for a negative link between labor flexibility and labor productivity on individual and/or firm level (storm & naastepad, 2007; Aguirregabiria & Alonso-Borrego, 2014; Auer, 2005; Boeri&Garibaldi , 2007; Giesecke & Gross, 2009; Meer&Ringal, 2009; Quesnel-Vallée, DeHaney & Ciampi, 2010; Scott, 2004; Vergeer & Kleinknecht, 2014). There is empirical evidence for consequences of flexible contracts on decisions about having children (Golsch, 2003) and some theorists even see a connection with racism (Scott, 2004).
In the public debate and also in the publications of economists, there is not much attention for the health effects of flexible labor (markets). Nonetheless it may be, and as we will see in the literature it is, vital to first ask the question what it means to people to have a job with little employment protection. What does an unsecure job really mean to people when they have to provide for
themselves or their families? What does the stress they experience out of it, do to their health? And how serious are these consequences? Can it lead to labor disability? These are the questions
discussed in this thesis. First of all there will be a short introduction about one of the foundations of the need for labor flexibility in economic theory, different types of flexibility and the composition of the population in flexible contracts. Secondly we will take a look on the literature written by social and medical scientists (surprisingly not by economists) concerning the evidence for health-effects of precarious labor, job insecurity and job mobility. After this a regression analysis will be presented concerning the link between labor market flexibility and labor disability. This regression analysis will be followed by a brief discussion of potential implications of the results found in the literature and regression analyses. There will also be attention for ways to dampen or prevent negative health consequences of labor market flexibility.
Economic theory: the NAIRU
As mentioned before, pleads for flexibilizing labor markets are not new. After the economic downturn in western countries in the seventies and eighties of the last century politicians like Margaret Thatcher and Ronald Reagan, both inspired by the Nobel prize-winning economist Milton Friedman, proposed drastic reforms in the economy. Labor market reforms towards more flexibility were an essential part of their policies. Fundamental support in economic theory for labor market flexibility came, not surprisingly, from their favorite economist Milton Friedman. Back in 1968 Friedman introduced the “natural rate of employment”. Every labor market, Friedman argued, will always have a given amount of unemployment due frictional unemployment and labor market rigidities, which prevent wages from adapting into the market clearing level. This concept was the basis for the theory of the NAIRU, which stands for non-accelerated inflation rate of employment. The name descends from the relationship between employment and inflation, as reflected in the Philips curve. Unemployment levels below the natural rate could occur as a result of unexpected inflation. Only a situation of accelerated inflation would lead to an unemployment level which would permanently be under the natural rate (Friedman, 1958; Modigliani & Papademos, 1975).
When the assumption that the natural rate of employment is caused by labor market rigidities next to frictional unemployment would be true, the solution for the problem of unemployment would be quite straightforward: flexibilize the labor market and allow the invisible hand to do its job. (Vergeer & Kleinknecht, 2014).
Flexibility: three different flavors
The next question is how we should define labor market flexibility. In economic literature we can find three types of flexibility when it comes to labor markets. First of all there is numerical flexibility. Numerical flexibility occurs when organizations are able to change their labor force easily through
hiring and firing employees. Second of all there is wage flexibility. The greater the responsiveness of wages and payment systems to economic circumstances, the greater the wage flexibility. The last category of flexibility distinguished by economic literature is functional flexibility. Functional
flexibility deals with the ability of an organization to implement changes in their internal labor force, without any effects on the external labor market. HR policies to improve productivity or efficiency are also part of the definition of functional flexibility (Beaton, 1994).
This thesis focusses mostly on numerical flexibility, for labor market flexibilization is mostly implemented by allowing employers to change their labor force more easily. For an example by allowing employers to use multiple fixed-term contracts, instead of a permanent contracts or making it easier to hire self-employed employees ( both forms are described in literature as
“precarious employment”). Another way is removing protection for dismissal for employees who are in a permanent contract (“normal employment”). The focus on numerical flexibility is also reflected in the use of the OECD-indicators of employment protection in the OLS-regression later on in this thesis.
The ‘precariat’: not a homogenous group
Before we move to the health effects of a flexible labor market, we should have a look at the population we are talking about. Research suggests we are not talking about a homogeneous group. Qualitative research from Canada suggests there are three different categories of people within the population of precarious workers: a “sustainable group” of people who are in precarious work voluntarily and prefer this kind of employment over permanent contracts (19% of respondents), a “non-sustainable group” of people who are involuntarily trapped in precarious labor and are dealing with all kinds health issues as a consequence (47% of respondents) and last of all a “on a path” group of mostly young people (32%). They would like to have a permanent contract, but are considering precarious labor to be a stepping stone towards permanent labor in the long run and are willing to suffer from short term health consequences (Clarke, Lewchuk, Wolff, & King, 2007). Research from Spain shows similar patterns and heterogeneity among the precarious labor force. According to this study 30% of the workers in these conditions are in precarious contracts voluntarily (Silla, Gracia, & Peiró, 2005). These studies show us that most of the precarious workers are in these circumstances against their will. But it also shows us we should be careful not to see the precariat as a homogenous group.
2. Literature review.
Precarious labor: severe health consequences
The effect of precarious labor on a workers’ health has been studied in many countries. A negative link between precarious labor and perceived (mental) health had been found in: South-Korea (Jung, 2013; Kim, Kim, Park & Kawachi, 2008) Finland (Nurminen, 2008), the US (Quesnel-Vallée, Dehany & Ciampi, 2010) and Spain (Vives et al., 2012). In Canada this link has been found under the “non-sustainable” and “on a path” groups (Clarke, Lewchuk, Wolff, & King, 2007). In the US research shows that two years of precarious labor will increase the chance of having mental health problems by 50%. In Spain 23% of all mental health problems are believed to be linked with precarious labor. In 50% of these cases, so 11,5% in total, there is evidence for a causal relationship between
precarious labor and mental health issues (Vives et al., 2012). In all these cases scientists have corrected for socio-economic status. Evidence has been found that precarious employment has more negative effects on women than on men, for they are more likely to be in precarious labor (Menendez, 2007).
Other indicators of flexibility: Job insecurity & Job mobility
Among the scientists who are interested in health effects of numerical labor flexibility, some have chosen to examine the effects of perceived job insecurity on health, because more numerical flexibility logically means less secure jobs. A negative link between job insecurity and (mental) health has been found in: the US (Burgard, Brand & House, 2009), Taiwan (Cheng &Huang, 2011), Norway (Norlund et al., 2010) and Europe as a whole (Chrirumbolo & Hellgren, 2003; László et al., 2010). In Belgium a relationship between job insecurity and emotional exhaustion has been found (Vander Els et al., 2012). In the US the effect on job insecurity on health might even be worse than the effect of unemployment on health (Burgard, Brand & House, 2009). Also when it comes to job insecurity evidence has been found that the negative health effects are bigger on women than on men (Burgard, Brand & House, 2009; Norlund et al., 2010; Burström, Holland, Diderichsen &Whitehead, 2003).
Some scientists have examined the relationship between job mobility and health. The more jobs one has in ones live, the greater ones job mobility. Research in Scotland showed that job mobility has a positive effect on unhealthy behavior (smoking, drinking, not exercising etc.), but did not came up
with a significant link between mobility and health. This was a surprise, for researchers expected unhealthy behavior to affect health in a negative way (Metcalfe, 2003).
Labor disability & labor flexibility: not a lot to find in the literature
In the previous sections a lot of evidence has been summed up for a negative relationship between precarious labor and job insecurity on health. Now we turn to the question whether this negative link with health also sorts out in the labor disability rates. In the literature there is not a lot to find about this relationship. In the Netherlands a weak connection has been found between inflow in labor disability benefits and a flexible labor market (APE&Astri, 2014). In the UK, a country with a very flexible labor market, an ever growing group marginalized disabled people are in the workforce (jolly, 2000). The author suggests some kind of link with policies aimed at labor market flexibility but doesn’t show a lot of evidence for it. A comparative study between the deregulated labor market of the UK and the more regulated labor market of Sweden however shows people with a chronic illness, especially women, are relatively worse off in terms of unemployment in the UK than in Sweden (Burström, Holland, Diderichsen &Whitehead, 2003).
3. Methodology
For this thesis an OLS-regression was used to measure the effect of labor market flexibility on labor disability. Three control variables were incorporated to correct for other effects which might affect labor disability. Statistics of 13 OECD-countries were used covering the period 1991-2007. These 13 countries were selected because their statistics regarding labor market flexibility and labor disability were complete over the largest period, resulting the biggest possible sample (221). Because the sample is relatively small, no country-specific dummies were introduced. The following variables were used:
Relative yearly mutations inLabor disability recipiency rate (∆LDRR): It is quite hard to find an
adequate way to measure labor disability. Labor disability is mostly measured in disability benefit recipiency rates as a percentage of GDP or the labor force. This makes these numbers very dependent of institutional differences between countries. Countries with a very comprehensive system of social security (For an example Scandinavian) will always have higher rates than countries with a more sober regime of social security (like the US), in which people with a disability might be in the (un)employment on inactive population rates rather than the labor disability benefit statistics. In order to cut away part of the institutional stuff, relative yearly mutations in the labor disability rates as a percentage of the population between 20 and 64 were used so we can ignore the ‘absolute rates’. The source of the data is the OECD report “Sickness, disability and work” (2010).
Labor market flexibility: To measure labor market flexibility, the indicators of employment
protection from the OECD were used. The OECD uses three different indicators, of which two are used in the regression, for one of the three was not measured yet before 1998. All indicators can vary from 0 to 6, where 6 stands for total rigidity and 0 stands for total flexibility.
-Strictness of regulation of individual dismissals (EPR) (used in the regression) -Strictness of regulation of collective dismissals (EPC) (not used in the regression)
-Strictness of regulation on the use of temporary and fixed term contracts (EPT) (used in the regression).
In order to avoid multicollinearity, the effects of EPR and EPT on labor disability are measured in two different regressions.
Population of 50-64 years old as a percentage of the population between 15 and 64 (Grey) The
percentage of people between 50 and 64 as percentage of the population between 15 and 64 correlates with labor disability (APE & Astri 2014). Therefore this percentage was incorporated as a control variable in the regression.
Economic growth (∆GDP) In recessions the labor disability figures always show a rise in benefit
recipiency rates (APE & Astri 2014). This is the reason why the variable economics growth is included.
GDP per capita (GDP) It might be true that in richer countries people get disabled less easily than in
poor countries because there is more money to pay for decent healthcare. To make sure these effects are taken into account, the variable GDP is used as a control variable.
With all these variables the OLS formula’s look like this: ∆LDRR=β0+ β1*EPR+ β2*∆GDP+ β3*GDP+ β4*grey+ ε
∆LDRR=α0+ α1*EPT+ α2*∆GDP+ α3*GDP+ α4*grey+ ε
4. Results
In table 1 the results of the regression with EPR are shown. In table 2 the results of the regression with EPT are to be found.
Table 1 LDRR=β0+ β1*EPR + β2*∆GDP+ β3*GDP+ β4*grey+ ε
Table 2 ∆LDRR=α0+ α1*EPT + α2*∆GDP+ α3*GDP+ α4*grey+ ε
As we can see both indicators prove to be significant in this regression. In both cases p-values are approaching zero. A lowering of the epr indicator by 1 is associated with a yearly rise in labor disability recipiency rates by 1.7%. A lowering of the EPT-indicator with 1 is associated with a yearly rise in labor disability recipiency rates by 1%. These strong associations are also reflected in the correlations between epr and labor disability (-0.5247 ) and ept and labor disability(-0.3469). So according to this regression more flexibility has a bigger impact on labor disability for workers with a normal contract, than for workers who are in precarious employment. One explanation might be the differences within the precariat. Like we have seen earlier 20-30% of the workers in precarious labor are happy with the flexible situation they are in (Silla, Gracia, & Peiró, 2005; Clarke, Lewchuk, Wolff, & King, 2007), so more flexibility might not affect their health and might therefore not lead to labor disability. When we look at the control variables, we can see that ∆GDP is close to significance in
_cons .1097284 .0171397 6.40 0.000 .075946 .1435109 grey -.156745 .0803278 -1.95 0.052 -.3150716 .0015817 dgdp -.001455 .0007811 -1.86 0.064 -.0029947 .0000846 gdp -5.35e-07 3.31e-07 -1.61 0.108 -1.19e-06 1.18e-07 epr -.0173363 .0023003 -7.54 0.000 -.0218703 -.0128023 dldrr Coef. Std. Err. t P>|t| [95% Conf. Interval] Total .260148415 220 .001182493 Root MSE = .02854 Adj R-squared = 0.3114 Residual .175880928 216 .000814264 R-squared = 0.3239 Model .084267487 4 .021066872 Prob > F = 0.0000 F( 4, 216) = 25.87 Source SS df MS Number of obs = 221
_cons .1047971 .0184539 5.68 0.000 .0684244 .1411698 grey -.3595758 .0782989 -4.59 0.000 -.5139035 -.2052481 dgdp -.0013072 .0008439 -1.55 0.123 -.0029705 .0003561 gdp 5.16e-07 3.11e-07 1.66 0.099 -9.74e-08 1.13e-06 ept -.010251 .0023282 -4.40 0.000 -.0148399 -.0056621 dldrr Coef. Std. Err. t P>|t| [95% Conf. Interval] Total .260148415 220 .001182493 Root MSE = .03072 Adj R-squared = 0.2020 Residual .20383469 216 .000943679 R-squared = 0.2165 Model .056313725 4 .014078431 Prob > F = 0.0000 F( 4, 216) = 14.92 Source SS df MS Number of obs = 221
both regressions and the coefficient behaves as expected (negative). ‘Grey’ is close to being
significant in the first regression and significant in the second. Also in this case we see the expected association: a negative one. In both cases the absolute value of the coefficient is larger than that of the indicator of employment protection. With GDP something odd is the case. In the first regression we see a negative association with labor disability and in the second regression we see a positive link. In both cases GDP is not significant. This suggests it might be better to exclude this variable as a control variable in future regression analyses about the link between labor market flexibility and labor disability. It might also be the case that these inconsequential effects are caused by the small size of the sample.
5. Discussion
Limitations: a very small sample
After seeing these low p-values and strong correlations, it would be tempting to jump into conclusions right away. The sample size (221) is just not big enough to do so. And even with a big sample, reversed causation is always on the lurk. At most we can consider this regressions to be a confirmation of negative health implications of flexible labor markets we have found in the literature. Further research with a larger dataset is necessary to be able to be more certain about the effects of flexibility on labor disability. The vulnerability of a model with a small sample can be seen when we look at the control variable gdp. In the regression with EPR it is close to being significant with a negative sign. In the regression with EPT however, the sign is positive.
Implications: possible effects of negative health effects of labor market flexibility
So far we have discovered evidence in the literature of a negative link between precarious labor and health and job insecurity. The negative health effects of flexible labor markets have been confirmed by a, very limited, regression analyses, which examined the link between labor disability and labor flexibility. Now we turn to the implications of this negative association of labor flexibility with health. Possible implications on labor productivity, health expenditure, health inequality and emancipation of women will be discussed briefly. In most cases it will lead to a recommendation for further research.
Labor productivity: 1+1=2?
As mentioned in the introduction many scientists have found a negative link between a flexible labor market and labor productivity. Looking at the literature discussed in this thesis, it might not be very
strange to assume there might be a link between a worsening of health and lower productivity. It is however quite striking that in the articles about labor productivity written by economists which are studied for this thesis, economists have not been looking at all at health effects of flexibility as a potential explanation for the observed lower productivity. So it might be worthwhile for economists to work together with colleagues from faculties next door, in order to be able to explain what they observe in a more thoroughgoing way.
Health care: more costly?
In recent years many developed countries have been confronted with rising health care costs, caused among other things by an aging population. In the public arena lobbyists, politicians,
economists and experts often discuss ways cut in or diminish the rise of health care spending. From what we have seen in the literature and in the regressions, we can conclude that a more flexible labor market might imply higher spending on health care, because of the negative health effects. So if we look at it the other way around: introducing employment protection might be a way to save on health care spending. Further research should indicate whether or not this will be an implication in reality.
Health inequality: getting even bigger?
In many countries there are differences in life expectancy and healthy life expectancy between different groups in society. Research from the Netherlands for example, widely seen as an
egalitarian country, shows a difference in life expectancy between the lowest and highest incomes of 7,9 years. The difference between the expected years people live in a condition which they perceive as healthy is even 19,5 years. When we look at differences between different levels of educational background, we see more or less the same (CBS, 2014). In the literature we can find that the people in insecure/precarious jobs are relatively more often the people from a lower
socioeconomic class ( Clarke, Lewchuk, Wolff, & King, 2007; Silla, Gracia, & Peiró, 2005; Quesnel-Vallée, Dehany & Ciampi, 2010; Vives et al., 2012; Burgard, Brand & House, 2009; Kim, Kim, Park & Kawachi, 2008; Norlund et al., 2010). It is therefore likely to draw the conclusion that flexibilization of labor markets might increase health inequality. And again, if we look at it the other way around we might conclude that employment protection can be a way to reduce health inequality.
Emancipation of women: lower female labor participation?
In section two of this thesis, we have already found that women are relatively more often in precarious and/or insecure labor conditions and therefore suffer more from the negative health consequences than men. This means flexibility with its health damaging effects might obstruct the
labor participation of women and therefore emancipation of women. This has already been confirmed by some research (Menendez, 2007). More research needs to be done to look at this matter more precisely.
What can be done about negative health effects of flexible labor markets?
Some theorists have made suggestions for ways to dampen the effect of precarious labor or job insecurity on health. One of the solutions might be a system of “flexicurity”. In this system a flexible labor market is combined with a comprehensive safety net of social security and active labor market policies. The most prominent example of a country with flexicurity is Denmark. However literature suggests flexicurity in Denmark presents “more risks to workers’ health than benefits” (Afzal et al., 2013). Research based on enquiries on Finnish universities suggested that a high feeling of
“perceived external employability” (PEE) might prevent feeling of job insecurity. PEE is defined as the “capacity to control one’s employment options through the creation, identification and realization of career opportunities” (de Cuyper et al., 2012). Evidence from the UK however indicates that Human Resource policies to improve the performances of workers in precarious jobs, don’t have any effect (Michie &Sheeham, 2005).
6. Concluding remarks
The literature discussed in this thesis and the regression analyses, shows that reality is more complicated than what we read in the articles of economists and in the newspapers. The literature shows that flexible labor markets can cause serious health consequences. In the regression analyses a strong negative link between labor market flexibility and labor disability has been found, although the sample was quite small. These health consequences are not easy to prevent and might also have implications for labor productivity, health care costs, health inequality and the emancipation of women in labor markets. It is quite striking that these health effects are mostly neglected in the analyses of economists, policymakers and politicians, while they tend to be the biggest advocates of these reforms. One may pose the question whether there might be some ideology involved.
The aim of this thesis was not send out the message that any kind of flexibility should be a taboo. The aim of is this thesis is to plead for a careful look on the consequences of labor market policies. For a good crisis should not be wasted, but also never be misapplied.
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