Precarious employment: Adding a health inequalities perspective

This issue features a contribution on precarious employment in Germany, particularly as it affects the working poor. This is an issue with global relevance. The article outlines the scale of the issue in Germany and in Europe more generally, and goes on to propose further research needs as well as possible policy responses. I would reinforce the public health importance of precarious employment, and – to complement Broding and coauthors – wish to add a health inequalities perspective. In particular, the growing convergence of social epidemiology and occupational health perspectives on precarious employment points to policy and practice implications that extend those proposed by Broding et al. Work is a central determinant of both health and health inequalities – both promoting and detracting from health via several pathways. Paid work is beneficial in many ways, most apparently as a source of income – a primary determinant of adult socio-economic position, and thus health. Work can also play a positive role in adult socialization; in the development of identity and self-esteem. Work extends possibilities for social connectedness, participation in social networks outside family and neighbourhood groups. The converse of these healthand well-being-enhancing aspects of work are also of concern with precarious employment. A qualitative Canadian study describes how precarious or ‘intermittent’ work often puts workers in conflict with their own values in terms of what work means to them. These workers have difficulty accepting this contradiction. The Employment Conditions Network (EMCONET) of the WHO Commission on the Social Determinants of Health developed a