Richard Smith: Is flexible working good or bad for health?

richard_smith_2014Australia, like Britain, pushed hard for more flexible working in the labour market in the 80s, and all political parties and trade unions supported it because they assumed  that it would both boost productivity and give workers more control of their lives. More control, it was thought, would improve health. But is more flexible working good for health? Jane Dixon, a professor at the Australian National University and a member of the Work, Time, and Health Team, addressed this question at a C3 Collaborating for Health Breakfast seminar earlier this week.

In both Australia and Britain the standard pattern of working that applied in the 60s or 70s—a man working 9 to 5 and his wife not working or working part time—has almost disappeared. “Non-standard arrangements are now the norm,” with a wide variety of different patterns. In Australia among those in employment a third of people work overnight, 18% work 6-7 days a week, a third work at weekends, and 30% get no paid leave.

There have been many studies of the effect on health of long hours and shift work, but Dixon and her team are interested in how the organisation of time affects health, which is much less studied. They have conducted two studies, one of which is a qualitative study among a purposive study of 55 workers in four different types of work: construction (mostly men); women working for themselves looking after children; insurance (mostly men and mostly managers); and security. The team studied the number of hours and the security, intensity, predictability, sociability, and flexibility of the employment using interviews and a number of instruments like time diaries.

Flexibility is being used in two senses. A flexible labour market is one that allows many different ways of working and relative ease in hiring and firing. Flexible working for individuals means the opportunity to organise their working time within jobs in different ways. The finding in Australia is that flexible working for individuals is “on the books” but doesn’t happen much in reality.

There were common findings across all the types of work: it was intense, hours were long, there was limited use of flexibility, high dedication to work, and little grumbling. “People are,” said Dixon, “living to work.” All the workers with families had “competing dedications” to work and family with work often “bleeding” into family time.

The study looked at the effects of patterns of work on risk factors for disease, and found that for most workers physical activity was regarded as optional, which means workers “couldn’t fit it in.” (Nurses in the audience recognised the patterns and pressures of work described by Dixon and wondered how much they contributed to obesity among nurses.) Workers set high store by “restorative me-time,” which tended to mean watching television and would often happen after 10pm, meaning workers sacrificed sleep.

Workers gave high priority to eating dinner together with their families, but many ate lunch at their desks and breakfasted on the move. The percentage of food eaten away from home, mostly in fast food restaurants, increased in Australia from 22.8% in 1989 to 26.5% in 2010, and there has been an increase in the consumption of “ultra processed food.”

Sleep was important for the workers, and most aimed for a minimum sleep of seven hours. They would, however, put social connections ahead of sleep, and working long hours was associated with both less sleep and poorer quality of sleep. Not working at weekends emerged as important for health as people could catch up on sleep, eat homemade food, socialise, and find time to walk. Rituals were also important, particularly feeding children at 6pm and walking the dog: whatever was happening people would stick to these rituals.

Although the thinking in the 80s was that flexible working would be good for health, one Belgian sociologist, Mark Elchardus, proposed at about the same time that rigid work patterns were better for health. Flexibility, he argued, reduces peoples control of their lives. British sociologists have found that health practices (like exercising, eating well, etc) are supported by working regular hours and predictability of rosters and tenure. The work of Dixon and the other social scientists shows that the organisation of working time is more important than its duration.

Her final conclusion was that increasing flexibility in the way that work is organised is undermining the nation’s health.

Richard Smith was the editor of The BMJ until 2004. 

Competing interest: RS was until last year an unpaid trustee of C3 Collaborating for Health.