Initiatives Addressing Precarious Employment and Its Effects on Workers' Health and Well-Being: A Systematic Review

Abstract

The prevalence of precarious employment has increased in recent decades and aspects such as employment insecurity and income inadequacy have intensified during the COVID-19 pandemic. The purpose of this systematic review was to identify, appraise, and synthesise existing evidence pertaining to implemented initiatives addressing precarious employment that have evaluated and reported health and well-being outcomes. We used the PRISMA framework to guide this review and identified 11 relevant initiatives through searches in PubMed, Scopus, Web of Science, and three sources of grey literature. We found very few evaluated interventions addressing precarious employment and its impact on the health and well-being of workers globally. Ten out of 11 initiatives were not purposefully designed to address precarious employment in general, nor specific dimensions of it. Seven out of 11 initiatives evaluated outcomes related to the occupational health and safety of precariously employed workers and six out of 11 evaluated worker health and well-being outcomes. Most initiatives showed the potential to improve the health of workers, although the evaluation component was often described with less detail than the initiative itself. Given the heterogeneity of the 11 initiatives regarding study design, sample size, implementation, evaluation, economic and political contexts, and target population, we found insufficient evidence to compare outcomes across types of initiatives, generalize findings, or make specific recommendations for the adoption of initiatives.

Keywords: employment conditions; evaluation; health equity; implementation; informal employment; intervention; occupational health and safety; population health; precarious employment; worker health and well-being.

Figure 1

The flow diagram of study identification, screening, and inclusion. 1. Editorial, commentary, discussion paper, review; 2. No clear initiative implemented; 3. Initiative designed to (i) Facilitate PE or increase exposure to PE; (ii) Improve workers’ health through individual behavioural change without a focus on PE; (iii) Improve work performance or health, safety, or well-being of workers with disabilities without a focus on PE; (iv) Eliminate or reduce workers’ exposure to unemployment; (v) Eliminate, reduce, or mitigate the effects of unemployment on health and well-being; or (vi) Promote workers’ return to work after illness or injury without addressing PE; 4. (i) Not evaluated formally or assessed using empirical data or (ii) The evaluation does not include a clear focus on the reduction of PE and/or on precarious workers and/or their families. 5. Duplicate. 6. Not in a language mentioned in the protocol. PE—precarious employment.

Figure 2

Global distribution of countries—22 countries across 11 studies.