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'Between the doctor, antibiotics and the four days off, it was €600 that I will never see again'

While health inequalities affect people of different backgrounds, those who have precarious jobs are in especially difficult situations, writes Sinead Pembroke.

WORK IS OFTEN viewed as a way out of poverty, however this is not the case for precarious workers who work on a temporary, part-time (no guaranteed hours) or self-employed basis.

Often when we talk about work, it’s either in relation to the falling unemployment rate, or the workplace setting. We don’t talk about addressing job quality, which is a hugely important issue.

Our jobs impact on how we experience our lives outside of work. If we have insecure and poorly paid work, then this will have a detrimental effect on our health, our housing situation and our ability to provide for our family. The FEPS-TASC Report Living with uncertainty: the social implications of precarious work, (launched last week) looks at these issues in relation to precarious workers.

Living with uncertainty

The report looks at the effect of insecure work on health and accessing healthcare, but also housing and family formation.

The results are based on 40 interviews with precarious workers, aged 18-40 who live in Ireland and who work or have worked part-time with variable hours (zero-hour/if-and-when contracts), on temporary contracts (fixed term/ rolling contracts) and solo self-employment (such as the gig economy workers).

Precarious work affects people of all ages. The rise of insecure employment has had an impact on new entrants to the labour market and young people. In addition, a “precarity trap” has become increasingly evident in the job market, whereby more and more people remain in insecure employment for longer periods of time.

Precarious work also affects workers in a range of occupations. Whereas insecurity was once only associated with unskilled and low wage work, increasing numbers of highly skilled people are now being locked into insecure employment.

Access to healthcare services

Ireland’s two-tier health system has been scrutinised for more than a decade for failing to address health inequalities, particularly in terms of access to health-care services and much needed reforms.

While health inequalities and limited access to healthcare services affects many people of different backgrounds, those who have precarious jobs are in especially difficult situations.

Mental health

The majority of participants described how their temporary and insecure working conditions caused depression and anxiety because they were unable to plan for the future.

Anxiety was also experienced as a result of their financial deprivation. Many described the anxiety of not being able to afford to pay the bills or buy food. Social isolation that is experienced as a result of insecure and/or low-waged employment also had an effect on participants’ mental health. It was commonly reported that their lack of job and financial security meant they could not socialise.

Linda (pseudonym) revealed: “I had terrible mental health issues, like awful, really, really bad! And it was all work related. Like, very, very bad anxiety. It’s the mental health that does it worst, and depression really hits you.”

Sickness is not an option

Non-standard employment also had a negative impact on physical health. The majority of our participants spoke about coming into work when they were ill, which often prolonged their illness. Many precarious workers do not get paid sick leave and therefore cannot afford to take time off work.

Numerous participants also described occasions where they or others were injured on the job, and continued working or came back the next day. It is not just the loss of wages, but the cost of seeking medical treatment that creates a situation where illness is a major financial burden.

And precarious workers experience a triple financial burden when ill: unpaid sick leave, the GP fee and the cost of medication or further tests. As Elaine (pseudonym) described:
“Between the doctor’s appointment, the antibiotics and the four days off work, it was approaching €600 that I will never see back again.”

Health insurance

For the majority of our participants, there was a financial barrier to accessing GP, dental and other primary care services. While there are means-tested medical cards and GP cards that do give access to a number of primary care services for free, most precarious workers fall outside of the eligibility criteria.

This ineligibility means that they have to pay the GP fee and the cost of any medication or treatment that they need, which can be very costly. Yet, for the majority of precarious workers, health insurance is also out of reach.

Consequently, a sudden bout of ill health can impact their finances. The majority of our participants admitted that they avoided going to the doctor out of financial concern. For those who avoided going to the GP, this often resulted in their health deteriorating further. And when a person on a precarious contract has a recurring or chronic health condition, then accessing healthcare services becomes a long-term financial burden that cannot be avoided.

As Barbara (pseudonym), a lecturer on a fixed term contract revealed: “I remember the feeling of, ‘shit what am I going to do, I don’t have enough money to do me for the next week?!’ It would have had to come down to one or the other: food or inhaler.”

Universal healthcare needed

If we compare a precarious worker in Ireland to a precarious worker in the UK, there is one fundamental difference: people in the UK have access to universal healthcare that is free at the point of entry and paid for by taxes. In Ireland, we do not have that security.

Therefore, Irish precarious workers face double precarity; contractual and health precarity. This has major implications for health inequalities in Ireland because it places precarious workers at a disadvantage. If we want to reduce inequality, we need to introduce universal healthcare that is paid for by our taxes and free at the point of entry.

Dr Sinead Pembroke is a researcher with TASC.

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