• Occupational Health
• Public Health Surveillance

Do employees with a precarious attachment to the employer have higher risk of occupational injuries (OIs) than non-precarious workers? Kreshpaj et al 1 have cleverly analysed Swedish OI registry data and show that the risk of OIs varies between different employment relationships. The results are interesting and somewhat puzzling. On the one hand, precarious workers, as measured by a summative index, have a decreased risk of OIs. However, when the researchers investigate the risk associated with each dimension of precariousness, they find that male agency workers, multiple jobholders of both genders and female workers earning less than 80% of the median have a higher risk of OIs than their non-precarious counterparts. Contrary, female agency workers, workers in unstable employment, female workers with earnings above 120% of the median and workers at workplaces with low Collective Bargaining Agreement coverage have a lower risk of OIs.

These results leave us with some unanswered questions. Why is precariousness associated with a lower risk of OIs? Why should agency work be riskier for male than female workers? Or low income be a risk to only female workers? Do the registry data tell the whole story?

Precarious employment is characterised by insecurity, low income and limited social rights. Although not opposites, the standard employment relationship, full-time, permanent employment in a contractual relationship with one employer, is often upheld as the ideal to which others are compared.2 Earlier research assumes that precarious workers have a higher risk of OIs because they are more exposed to harmful working conditions and lack knowledge about occupational health and safety (OHS), workplace risks and protective gear.3 Conversely, studies show that unionised workers have a higher risk of OIs than non-unionised workers.4 5 Unionised workers are assumed to be among the least precarious. One possible explanation for this conundrum is that the willingness of an insecure worker with limited social rights to report injuries is lower than that of a secure, permanent employee. Moreover, industries with at high risk of OIs more often have high union coverage. Unionisation could reduce the risk of OIs by increasing OHS awareness, reporting and measures. Adjusting for under-reporting of injuries does not change Kreshpaj et al’s1 results.

Another explanation for why the risk of OIs is higher for unionised workers, is that the risk of OIs vary between occupations and industries. When Berdahl and McQuillan4 adjust estimates for individual characteristics among workers including industry, they find no higher risk of injuries for unionised workers. The varying risk of OIs between occupations and industries are not accounted for in Kreshpaj et al’s1 analyses, and might explain some of the findings. Detailed knowledge about how precarious employment is distributed across the working life could help to explain the findings from the register data. Agency workers are not registered in the industry to which they are hired, but in the industry ‘Employment placement agencies, temporary employment agencies etcetera’.6 Differences in which industries female and male agency workers are hired might explain why only male agency workers have a higher risk of OIs compared with non-agency workers. Industry differences might also account for the gendered differences in risk associated with low income: males with a relatively low income might work in industries that have a low risk of OIs compared with males with median incomes, and the opposite for females.

The Nordic register data are a unique source encompassing near the whole population and a host of variables. However, the registers were often designed for accounting purposes, not research, and have limitations. One of these are under-reporting of injuries by both employees and employers. Another limitation is the invisibility of truly precarious workers in the registers and Kreshpaj et al’s1 study. Self-employed workers, those with absences of employment during the year and workers who are not in the registers for consecutive years were excluded from the study for estimation purposes. Although valid methodological reasons warrant restricting the sample, these restrictions have consequences for the generalisability of the results. Migrant workers who are in the country for short periods or informal workers are not included in the registers at all. These categories of workers are among those most exposed to precarious working conditions.7 The lack of these workers in the registers and the study represent a limitation to the generalisation of the findings.

The same limitations concern the finding that workers with unstable employment have a lower risk of OIs than those with stable employment. ‘Unstable employment’ is defined as having the same employer for less than 3 years. Due to restrictions in the data, the category does not include those with genuinely unstable employment, for instance, absences of employment during the year. The finding that having multiple employers across multiple sectors increased the risk of OI might just as well be interpreted as a risk involved with unstable employment.

More research on the mechanisms that lie behind the results is needed to understand how precarious work affects OHS. One place to start is to investigate how the risk of OIs and under-reporting of OIs within industries differ between workers who are in precarious and non-precarious working arrangements. Also, future research should investigate what happens to OHS and the risk of OIs in industries or occupations where the dominating forms of employment relations change from standard to non-standard employment.

Finally, the consequence of non-standard work for the worker is likely to be affected by the overall welfare and labour market policy. The high degree of unionisation, universal welfare services and active labour market policies in the Nordic countries might contribute to weaken the association between precarious work and OIs. Cross-national studies are needed to assess the contribution of the welfare state context on the association between precariousness and OIs.