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Is your job bad for your health? Explaining differences in health at work across gender
Elena Cottini
` Cattolica, Milan, Italy Istituto di Economia dellImpresa e del Lavoro, Universita
Abstract
Purpose The purpose of this paper is to investigate how different measures of working conditions affect the health at work of female and male workers of 15 European countries. Particular attention is paid to the gender dimension of this relationship. Design/methodology/approach Using the European Working Conditions Survey from 2005 the author describes differences in health at work by gender accounting for both psychosocial and physical hazards at work. A Probit OLS estimator is used to obtain the relevant estimates and endogeneity problems have been properly addressed. Findings Results show that controlling for a broad selection of personal and work attributes, working conditions are associated with more work related health problems both physical and mental. Importantly, some evidence is found in support of a different pattern by gender. With respect to mental health at work, males suffer more from high work demands/low job autonomy compared to females. Task segregation may play a role in explaining these differences. A less clear pattern across gender is found with respect to physical health problems at work. When the endogeneity of working conditions is taken into account, results are confirmed and show that the effect of working conditions on health at work is under-estimated when endogeneity is not accounted for. Originality/value The papers findings contribute to shed more light on the controversial analysis between working conditions and health according to gender. Keywords Europe, Working conditions, Employees, Occupational health and safety, Gender, Psychosocial factors, Physical hazards, Health at work, Gender differences Paper type Research paper

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1. Introduction Over the past two decades labour markets have been facing profound changes that had a sizeable impact on the working conditions of workers. For example, the number of standard full time permanent jobs has decreased, while non-standard work arrangements (temporary work, part-time contract, unregulated work, etc.) have ki et al., 2002). In addition the decline of manufacturing become more common (Kivima jobs, the growth of service-oriented work and computerization appear to have made more traditional sources of adverse physical and environmental working conditions less relevant for the analysis of the health of workers and have increased the importance of psychosocial job stressors (Cappelli et al., 1997). As a result of this situation, improving job quality became one of the primary objectives of the European
The author thanks participants at the conference Healthy Human Resources and C. Lucifora for comments on an earlier version of this paper. EWCS data have been provided by the European Foundation for the Improvement of Living and Working Conditions. Financial support from Health@Work FP7 Network is gratefully acknowledged (contract number: HEALTH-F22008-200716). The usual disclaimers apply.
International Journal of Manpower Vol. 33 No. 3, 2012 pp. 301-321 r Emerald Group Publishing Limited 0143-7720 DOI 10.1108/01437721211234174

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Union (EU) and its member states. The turning point in EU health and safety policy was the introduction of the EU directive 89/391/EEC that explicitly encourages improvements in the mental and physical well-being of workers as part of preventive occupational health and safety strategy. More recently, in reaction to the European Council of Nice in 2000, the EU proposed to extend the concept of health and safety in order to address new risks and to take into account the changing labour markets. The impact of health problems at the workplace has also serious consequences for the productivity of the firm. Poor health results in higher absenteeism rates, lower productivity and performance. In addition, an adverse work environment may damage workers health and make more difficult to search for jobs and more physically or mentally costly to work. This paper investigates how different dimensions of working conditions affect the health of female and male workers of 15 European countries. It contributes to the literature in several ways. First paying particular attention to the gender dimension of the relationship between adverse working conditions and health at work. Analysing gender differences, in empirical studies dealing with working conditions and health, has been shown to be very important (see e.g. Bardasi and Francesconi, 2004 or Robone et al., 2011) as both health conditions and working arrangements can vary considerably according to the gender of the worker. Moreover it has been suggested that the increasing participation of women into the labour force over the last decades has positively affected their health, and may in fact enhance their health (Hall, 1992). However, it must be kept in mind that this positive association could be explained by a selection effect, such that women might exit the labour force because of health or family reasons. In addition, even if women have the same job title as men, their specific job tasks are often different (e.g. bank tellers and health care workers). In fact, women are generally engaged in work activities different from those of men, thus they may be subject to different exposures (Stellman, 1994), moreover health responses to exposure may be different for men and women due to biological differences such as the effects of body fat or endocrinological factors. It becomes relevant to clarify differences across gender in terms of quality of working conditions that affect health at work (Vermeulen and Mustard, 2000). Second, we take into consideration the distinct effects of both physical and psychosocial conditions relating to the work environment (Cox et al., 2000) on workers health. In particular, key mental conditions comprise psychosocial strain, work arrangements and work organisational factors, whereas physical hazards typically focus on exposures such as noise and workload (Cox et al., 2000; Stock et al., 2005). In this study we consider the contribution of both these dimensions on the health at work. Finally, given the cross-country evidence we are able to make generalisations of results in a wider context compared to previous literature. Results suggest that controlling for a wide range of personal and job attributes (adverse), working conditions are associated with more work-related health problems both physical and mental. In particular, emerges a different pattern by gender. With respect to mental health at work, male workers suffer more from high work demands/low job autonomy compared to female workers. A less clear pattern across gender is found with respect to physical health problems at work. Results persist also when we control for the endogeneity of working conditions, in fact the instrumental variable estimation offers evidence in support of a causal effect of (demanding) working conditions on individual health at work. The remainder of the paper is organised as follows. Section 2 includes a short literature review; Section 3 presents a description of the data used and some descriptive statistics. Section 4 presents the empirical strategy and results, and Section 5 concludes.

2. Literature review In the occupational health literature two theoretical models predict elevated health risks in workers exposed to adverse working conditions: the demand-control model (Karasek, 1990; Karasek and Theorell, 1990) and the effort-reward imbalance model (Siegrist, 1992; Siegrist, 1996). The first model suggests as the worst combination for one individuals health the joint interaction of high job demand and low job control. The idea behind the model is that psychosocial demands create stress, if the worker cannot control this stress because of a low level of control, the accumulation of this unreleased stress has a negative impact on the workers health. Instead, the second model emphasises the non-reciprocity of social exchange at the firm. The effort-reward imbalance model considers the categories of effort, such as the demands of the job and the motivation of workers in challenging situations, and reward at work in terms of salary, esteem, job stability and available career opportunities. It predicts that a negative impact on health occurs when there is an imbalance between these two dimensions. Several empirical studies analysed the effect of adverse working conditions on physical and mental health and have provided evidence in favour of the two models. In particular the Whitehall civil servant study (Marmot and Rose, 1978; Holme et al., 1982 among others) have demonstrated that after controlling for socioeconomic status and traditional risk factor, psychosocial work characteristics still constitute an independent risk for a variety of health outcomes. Some other studies, that focus on indicators of general self-assessed health, show that jobs with high demands, low control and low social support have a negative influence on health of workers (Cheng et al., 2000; Niedhammer et al., 2000; and Datta Gupta and Kristensen, 2007). Using British data evidence that job insecurity and shift work have a negative influence on health is provided by Ferrie et al. (1998). Other studies, however, have in part failed to support the theories outlined above (e.g. Vermeulen and Mustard, 2000) and overall there does not appear to be a clear consensus on the empirical validity of these models. This could result because of differences in exposure to work-related conditions or different responses to such conditions across gender. Some studies have also analysed, empirically, the effect of physical exposure on health outcomes (e.g. Ostry et al., 2006). Mechanisms through which physical working conditions may be linked with employee health include direct physical pathway and a psychological stress-mediated pathway (Cox et al., 2000). Physical and psychosocial working conditions are also interconnected. Subsequently, physical working conditions need to be taken into account even when examining psychosocial working conditions in order to produce a more comprehensive picture (Stock et al., 2005). When studying the relationship between health at work and the work environment it becomes relevant to focus on gender differences, since adverse working conditions may affect men and women in different ways, as already outlined. Some studies, specifically addressing this issue, indicate that employed women experience worse psychosocial work conditions (in terms of lower job control and poor career opportunities) compared to men and that a higher health burden might result from such exposures (Vermeulen and Mustard, 2000; Bildt and Michelsen, 2002). Others proposed that women are more vulnerable to adverse conditions at work than men, given similar levels of exposure (Roxburgh, 1996). Men experience higher job demand, higher effort, higher commitment and lower social support at work, whereas women show lower job control and lower reward (Nelson and Burke, 2002; Siegrist, 2002). It is not clear, however, whether the growing literature describing health consequences of adverse work conditions applies equally to men and women.

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Within health economics literature, to the best of our knowledge the studies that combine the analysis of working conditions and health are: Robone et al. (2011) that examine the impact of working and contractual conditions on self-assessed health and psychological well-being in the British labour market, and Cottini and Lucifora (2010) who focus on the link between employment arrangements, working conditions and mental health in a European context. Using the same dataset Cottini (2011) analyses the adverse effects of working conditions and low pay condition on health. All these studies find evidence that adverse workplace attributes lead to a higher probability of reporting health problems at work, but fail to distinguish the contribution of each factor across gender. 3. Data, variable definition and descriptive statistics The data used in this paper consist in the 2005 wave of the European Working Condition Survey, which is carried out by the European Foundation for the Improvement of Living and Working Conditions every five years for a representative sample of workers in the EU[1]. This dataset is aimed at providing a picture of the working conditions of European workers as they are perceived and reported by them. As such, the survey consists in a set of rich information in terms of demographics, mental and physical work-related health, as well as working conditions and other job attributes. It is based on a standardised questionnaire administered face-to-face to a representative sample of the employed population in the EU. We concentrate our analysis on EU15 countries that are: Greece, Sweden, Italy, Finland, Luxemburg, France, Portugal, Belgium, Spain, Denmark, UK, Germany, the Netherlands, Austria and Ireland. We restrict our sample to full time workers and exclude observations with missing data. This yields a final sample of 17,161 observations (approximately 1,150 for each country). The list of the variables and their definition is discussed henceforth (see Table AI in the Appendix for basic statistics on the whole sample). The dependent variable of our empirical analysis is a measure of self-reported health problems at work, intended both as mental and physical. These indicators are constructed from the following question: Does your work affect your health, or not? If yes, how does it affect your health?: (1) skin problems; (2) respiratory difficulties; (3) stomach-ache; (4) hearth disease; (5) stress; (6) sleeping problems; (7) anxiety and (8) irritability. Out of the above responses we construct a set of dummies that take value 1 if the worker mentions the problem and 0 otherwise. We built a measure of physical health problems summing up dummies from (1) to (4). We replicate the same procedure to measure mental health problems, summing up dummies from (5) to (8). It should be stressed out that our dependent variable is based on self-assessment of a particular health condition referring to the job. However, some authors have questioned whether these indicators are good proxies for individual true health, selfassessed indicators of health have been used in empirical studies and it has been shown that they secure valuable information about the persons health and overall well-being (Idler and Benyamini, 1997). Working conditions variables consist in a set of dummies describing psychosocial factors and physical hazards experienced by the worker at the workplace. To select variables with psychosocial content we focus on the existing occupational health literature, for instance the demand-control-support model developed by Karasek (1990) and Karasek and Theorell (1990) and the effort imbalance model of Siegrist (1992) and Siegrist (1996). Consequently, the following indicators have been constructed. High work intensity takes value 1 if the job includes working at very

high speed and tight deadlines from half of the time to all of the time (0 otherwise). Similarly no autonomy, work that involves complex tasks, working in shifts and low colleague support, all take value 1 if the conditions are reported from half of the time to all of the time (0 otherwise). Long working hours takes value 1 if the employee works more than 40 hours per week (0 otherwise). In the empirical strategy, in order to analyse the impact of all psychosocial factors together, we also use a summary measure of the overall psychosocial factors reported by the worker. This indicator is constructed using principal component analysis. In practise out of this set of dummy variables we create an index for psychosocial job conditions capturing work related conditions at the psychosocial level. Second we are also able to control for a set of variables describing exposure to physical hazards. More specifically we create a set of ten dummy variables that take value 1 if the worker was exposed from half of the time to all of the time to: vibrations from hand tools; or noise so loud that he/she has to raise his/her voice to talk with other people; or high temperature; or coldness (work outdoor or in cold rooms); or skin contact with refrigerants or lubricants; or radiations, or solvent vapour; or passive smoke; or exposure with dangerous materials; repetitive arm movement; otherwise. As before, using principal component analysis, out of these ten dummies describing physical hazards, we extract the index physical hazard capturing workers exposition to physical hazards at the workplace. Additionally, to capture other relational aspects of the job that might have an effect on the workers health, we also include a dummy describing discrimination at work that is 1 whether the worker has experienced any type of discrimination at the workplace (gender, sexual orientation, religious, ethnic and disability). Contractual conditions are taken into account by a dummy variable that is 1 if the worker has a permanent contract, 0 otherwise. Further to the above, we include a set of controls for individual and work characteristics, such as four age group dummies, dummy for married and for the presence of children in the household. Education is created from the ISCED classification, and takes three levels. Finally we control for a set of workplace and firm attributes that include dummies for firms size, industry and occupational dummies. Table I reports the mean distribution of health problems at work, psychosocial and physical risk factors at work by gender. Men report, on average more health problems at work compared to women, this is true both for mental health and for physical health problems. In general, more men than women report being subjected to traditional physical hazards (such as noise and vibration), although there are some exceptions. For example, repetitive movements (that can be classified as ergonomic risks) tend to be more gender neutral. Certain risks, like using dangerous/infectious materials, show a higher prevalence among women compared to men, reflecting the segregation of sexes in specific sectors, such as for example the health and social workers sectors. With reference to psychosocial risks it can be noted that overall incidence is higher for male workers. More men than women report to face complex tasks in their job, and to perceive higher levels of work intensity. No differences across gender are noted with reference to job autonomy and colleague support. Men, more than women, on average work in shift and work overtime. Country differences with respect to health at work are pictured in Figure 1, that shows which kind of work-related problems are mostly reported in each country included in this study. With this respect some differences across countries can be noted.

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Health at work Mental health (0-4) Physical health (0-4) Physical hazards Vibration hand tool Noise High temperature Low temperature Vapour Skin contact Radiation Passive smoke Dangerous material Repetitive arm movements Work hazard indexa Psychosocial job conditions High task complexity Low colleague support No autonomy High task intensity Work in shift Overtime (H440) Psychosocial job conditions indexa Nobs

Female

Male

0.52 0.14 0.173 0.26 0.27 0.21 0.246 0.14 0.037 0.19 0.18 0.51 1.1 0.51 0.52 0.48 0.42 0.12 0.18 1.8 8,035

0.57 0.21 0.228 0.31 0.24 0.24 0.242 0.17 0.045 0.22 0.1 0.49 1.4 0.66 0.51 0.47 0.48 0.15 0.28 2 9,126

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Table I. Health and working conditions across gender

Notes: aScores obtained via principal component; analysis on the entire set of indicators

1.5

Mean of mental health

0.5

Figure 1. Physical vs mental health at work by country

0.4 0.2 Mean of physical health

0.6

Source: EWCS (2005), own elaborations

Greece shows very high levels of physical and mental health problems at work. Also Sweden and Italy show levels above average of both mental health and physical health problems. Finally in Germany and UK respondents report low than average level of mental and physical problems at work. It should be kept in mind that these correlations

are based on unconditional means and they are likely to be affected by several confounding factors that we will take into account in the next sections. 4. Empirical strategy and results The empirical strategy consists in regressing indicators of work-related health on a set of working conditions indicators, a vector of individual characteristics and a vector of firm and job attributes. The econometric specification can be written as follows: HaWij a bDEMOij gPSYCHOij ZPHAZARDij tJAij cj pij 1

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where the left hand side variable HaWij represents health at work as reported by individual i, in country j. The set of health indicators, as previously described, is based on workers responses to questions on whether the characteristics of their job negatively affect their health. DEMOij is a vector of demographic characteristics (such as age, level of education, presence of children in the household and marital status); PSYCHOij is a set of variables describing psychosocial conditions experienced by the worker in the current job, while PHAZARDij describes physical hazards in the current job. JAij is a vector of workplace/job attributes (such as firm size, industry, occupation, type of contract and discrimination at the workplace). Finally, all the regressions include country (cj) dummies. pij is the error term. Given the ordinal nature of the dependent variable, an ordered Probit could be used in this context, nevertheless it has been shown elsewhere that traditional linear estimations can be used once the dependent variable is transformed into a pseudo continuous one (Terza, 1987; Van Praag and Ferre-i-Carbonell, 2004; Van Praag and Ferrer-i-Carbonell, 2006). Following this intuition we estimate Equation (1) using Probit OLS. Using this approach, even if one does not observe the exact value of the latent variable for each worker, it is possible to approximate it with a set of means of the underlying continuous latent variable[2]. Once the dependent variable has been transformed, OLS (or other linear estimators) can be used. Consequently, as extensively shown by Van Praag and Ferrer-i-Carbonell (2006), Probit OLS is particularly useful, in this context, since it allows the use of linear estimators with the transformed dependent variable[3]. In this technical literature it has been shown that Probit OLS estimates (in terms of sign and standard errors) are similar to ordered Probit estimates[4]. In our analysis, we first explain results for physical health at work (Table II) then for mental health at work (Table III) estimated via Probit OLS. All estimations are carried out pooling countries and dividing the sample by gender (columns 1-3 for female and 2-4 for males). Next we analyse the factors lying behind gender differences ` la Oaxaca (Table IV). in health at work performing a decomposition analysis a Probit OLS estimates of Equation (1) can be biased by endogeneity problems. In our case, unobservable factors (such as for example risk aversion or individual preferences) may be correlated with both the health of individuals and working conditions. Sorting of workers across job and firms may govern the allocation of workers with different working conditions, such as for example that more risk-adverse workers may look for jobs characterized by stricter regulations in terms of safety and better work organisation practices which should reduce risks and hazard at work. Firms may also choose safety levels and related expenditures according to workers health attitudes or hidden actions in exerting any preventive effort. As a consequence, if unobserved individual characteristics simultaneously affect health and working conditions, the estimated effect may be biased, since they capture also the effect of other unobservable

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Demographics Age from 26 to35

Female (1) (2) (3)

Male (4)

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Age from 36 to 45 Age from 46 to 65 Middle level of education High level of education Married Child Discrimination at work Permanent job Psychosocial job conditions High task complexity Low colleague support No autonomy High task intensity Work in shift Overtime (H440) Physical hazards Vibration hand tool Noise High temperature Low temperature Vapour Skin contact Radiation

0.034 (1.36) 0.087** (3.18) 0.143*** (5.51) 0.075*** (3.33) 0.120*** (5.24) 0.062*** (3.72) 0.002 (0.12) 0.395*** (13.11) 0.011 (0.55) 0.085*** (5.06) 0.042* (1.95) 0.049 (1.24) 0.024 (1.50) 0.092*** (3.75) 0.156*** (7.41) 0.025 (1.04) 0.001 (0.06) 0.051*** (2.40) 0.023 (1.08) 0.110*** (5.02) 0.057*** (2.10) 0.052 (1.21) 0.051 (1.89)

0.03 (1.21) 0.092*** (3.38) 0.145*** (5.54) 0.093*** (4.13) 0.153*** (6.76) 0.063*** (3.84) 0.014 (0.82) 0.432*** (14.58) 0.027 (1.37)

0.041 (1.65) 0.076** (2.87) 0.076** (2.88) 0.049** (2.68) 0.014 (0.66) 0.014 (0.67) 0.001 (0.04) 0.057 (1.61) 0.056* (1.91) 0.032* (1.92) 0.02 (1.29) 0.024 (1.66) 0.080*** (5.94) 0.059*** (2.64) 0.042*** (2.37) 0.026 (1.21) 0.039** (2.14) 0.027 (1.30) 0.006 (0.28) 0.041 (1.73) 0.089*** (3.61) 0.038 (0.95) 0.004 (0.20)

0.038 (1.57) 0.081*** (3.12) 0.078** (3.01) 0.054** (2.95) 0.008 (0.38) 0.021 (1.07) 0.003 (0.18) 0.064** (1.92) 0.052** (2.54)

Table II. Probit OLS estimates, physical health

Passive smoke

(continued)

Female (1) Dangerous material Repetitive arm movement Indices of working conditions Physical hazards Psychosocial job conditions Constant R Nobs
2

Male (2) (3) 0.051*** (2.04) 0.014 (0.96) 0.012** (2.63) 0.033*** (4.65) 0.03 (0.354) 0.179 8,035 0.032*** (7.49) 0.041*** (6.13) 0.13 (1.78) 0.045 9,126 (4)

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0.092 (1.07) 0.195 8,035

0.255*** (3.41) 0.048 9,126

Notes: We also control for sector, occupation, firm size and country fixed effects. Cross-national weights are included; T-statistic in parentheses; ***, **, *significant at the 1, 5 and 10 per cent

Table II.

Female (1) Demographics Age from 26 to 35 Age from 36 to 45 Age from 46 to 65 Middle level of education High level of education Married Child Discrimination at work Permanent job Psychosocial job conditions High task complexity Low colleagues support (2) (3)

Male (4)

0.086** (2.76) 0.130*** (3.83) 0.144*** (4.44) 0.052*** (1.96) 0.089*** (2.20) 0.007 (0.36) 0.019 (0.89) 0.146*** (4.11) 0.004 (0.15) 0.026 (1.24) 0.017 (0.87)

0.089** (2.87) 0.145*** (4.31) 0.141*** (4.34) 0.082*** (3.05) 0.100*** (2.67) 0.021 (1.06) 0.021 (0.99) 0.112*** (3.24) 0.01 (0.41)

0.152*** (5.29) 0.150*** (4.88) 0.094** (3.18) 0.036 (1.68) 0.043 (1.71) 0.034 (1.46) 0.064*** (3.10) 0.157*** (3.53) 0.034 (1.53) 0.089*** (4.82) 0.049*** (2.85)

0.160*** (5.62) 0.154*** (5.07) 0.098*** (3.34) 0.038** (1.81) 0.045 (1.62) 0.032 (1.43) 0.065*** (3.13) 0.152*** (3.39) 0.042 (1.73)

(continued)

Table III. Probit OLS estimates, mental health

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No autonomy High task intensity

Female (1) 0.008 (0.42) 0.078** (1.98) 0.190*** (6.04) 0.077** (2.9) 0.049 (1.62) 0.037 (1.51) 0.001 (0.02) 0.113*** (4.23) 0.121 (1.72) 0.047 (1.54) 0.134*** (2.45) 0.004 (0.17) 0.067*** (2.12) 0.037* (1.92) 0.013*** (4.04) 0.07*** (10.84) 0.189 (1.74) 0.072 8,035 (2) (3) 0.056*** (3.22) 0.082*** (4.86) 0.121*** (4.59) 0.083*** (4.01) 0.051*** (2.14) 0.04** (1.94) 0.028 (1.19) 0.01 (0.42) 0.001 (0.01) 0.036 (1.39) 0.122*** (2.74) 0.068** (3.18) 0.063*** (2.26) 0.056*** (3.26)

Male (4)

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Work in shift Overtime (H440) Physical hazards Vibration hand tool Noise High temperature Low temperature Vapour Skin contact Radiation Passive smoke Dangerous material Repetitive arm movement Indices of working conditions Physical hazards Psychosocial job conditions Constant R2 Nobs

0.309*** (2.83) 0.082 8,035

0.59*** (6.81) 0.089 9,126

0.023*** (3.00) 0.097*** (10.34) 0.39*** (4.58) 0.084 9,126

Notes: We also control for sector, occupation, firm size and country fixed effects. Cross-national weights are included. T-statistic in parentheses; ***, **, *significant at the 1, 5 and 10 per cent Table III.

Physical health Unexplained Explained Table IV. Oaxacas decomposition of gender differences Raw gap (male-female) Linear regression 0.047 0.041 (85.90%) 0.007 (14.10%)

Mental health Unexplained Explained 0.038 0.025 (71.50%) 0.013 (29.50%)

confounding factors. We use an IV approach to address this source of bias. The specification used in this section includes the two indices of working conditions constructed using principal component analysis (psychosocial job conditions and the physical hazard) that potentially generate our source of endogeneity in the health equations. In order to take endogeneity into account, thus we need at least two instrumental variables. To this end, we need variables significantly correlated with adverse working conditions but not directly influencing health at work (and consequently that can be excluded from the health at work equations). First instrument we select is an index describing technological constraints and skill requirements at the firm at the sector-industry level (e.g. have you undergone training paid by employees/on the job training? Does your job involve teamwork? Does your main job involve meeting precise quality standards?). We use (average) firm practices aimed at improving job attributes and workers involvement, to proxy for the pressure coming from international competition and from technology on overall working conditions at the workplace. The literature on high performance practices showed that improvements in work processes and products quality can be related to the diffusion of innovations in working conditions arrangements and innovation practices. This index (highperf_index) is likely to be correlated positively with good working conditions at the firm (both physical hazards and psychosocial working conditions) but not with the residuals of the health equations. The second instrument is an index describing the level of regulation in terms of occupational health and safety (H&S regulation) implemented in each country up to 2005[5]. This index can be considered as a proxy for the level of government regulation in promoting health and safety at work and in reducing exposure to dangerous agents. Hence, governments regulations is expected to influence firms decisions in terms of working conditions inducing them to exert the socially optimal level of health and safety precaution henceforth altering working conditions. Identification relies on the fact that more stringent regulations in terms of health and safety improve overall working conditions at the workplace, whereas they are not correlated with the unobservables of the health equations. In Table V we present results for IV Probit OLS, we show firststage coefficients and provide some tests for instrument strength.
Physical health Female Male (1) (2) Physical Hazards Psychosocial job conditions Nobs First stage regressions H&S regulation Highperf_ index F-test (p-value) 1.1*** 0.29* (2.06) (1.92) 0.206 0.25 (0.53) (1.29) 8,035 9,126 Psychosocial job conditions 0.032*** 0.0123*** (8.1) (3.15) 0.0166*** 0.016*** (2.76) (2.66) 28.28 19.29 (p 0.000) (p 0.000) Mental health Female Male (3) (4) 1.2 0.83*** (1.65) (2.19) 0.89*** 1.09** (2.5) (1.93) 8,035 9,126 Physical Hazards 0.0019 0.059*** (0.95) (3.27) 0.0658*** 0.023* (2.12) (1.89) 11.59 3.66 (p 0.000) (p 0.007)

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Notes: All estimates also include demographics, firm size, sector, and country dummies. T-statistic in parenthesis; *po0.05, **po0.01, ***po0.001

Table V. Probit OLS-IV regression

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5. Results Benchmark estimates In Table II results from Probit OLS estimates on physical health at work are reported. In columns 1 and 3 we present estimates including all dummy indicators describing physical hazards and psychosocial job conditions, while in columns 2 and 4 results including the two composite indexes of working conditions instead of the single dummies are shown. Age dummies show a monotonic positive relationship with our indicator of physical health at work, that means younger workers report suffering from less health problems at work compared to older workers. Higher levels of education are significantly associated with less physical health problems, as shown by the negative and statistically significant coefficient on the education dummy variables. This association appears stronger for female compared to male. The married dummy variable is negative and statistically significant suggesting that married workers report themselves in better physical health at work compared to single workers, but this effect is statistically significant only for females. Studies that have focused on marital-status differences in well-being among men and women show that regardless of gender, married people enjoy better health than unmarried (Waite, 1995; Waite and Gallagher, 2000). In our sample this effect seems to be confirmed for female workers. Suffering from discrimination at the workplace, of any type, is associated with a higher number of physical problems at work, no distinction in terms of sign of the association is found across gender whilst the effect is much higher for female[6]. Holding a permanent job has a positive effect on the physical health of male workers only, no statistically significant effect is found with respect to female workers. In general, atypical employment does not seem to be strongly associated with adverse health consequences in the short term (i.e. when health and employment are measured at the same time). With respect to working conditions, we find that eight out of the 16 dummy indicators show a positive and statistically significant sign for female workers, while seven out of 16 for male workers. The coefficients show all the expected sign, above all we notice that working in shift and working overtime (440 hours a week) have the highest impact on physical reported health problems for both male and females workers. Some differences are worth noting across gender: intensity of tasks is highly statistically significant for male workers but not for female, while being subject to high temperatures and vapour solvents to female rather than male. Results do not qualitatively change when we estimate the model including our indices of working conditions derived from principal component analysis: adverse working conditions are shown to have a positive and sizeable association with physical health problems at work. However, in terms of magnitude the effect of adverse working conditions on physical health, with respect to both indicators, seems to be higher for males compared to females. Table III reports the coefficients for the models for mental health problems for female (columns 1 and 3) and male (columns 2 and 4), respectively. Results are in general similar to those found for physical health, although some differences should be outlined. Particularly, with respect to demographics, being married has no effect on mental work-related health, while having kids has a positive effect on the mental health of men. Holding a permanent job does not show any significant effect on mental health, contrary to physical health.

Relating to working conditions, we find that six out of the 16 dummy indicators of working conditions show a positive and statistically significant for female, while 12 out of 16 for male workers. Paying attention to the impact of the different working conditions attributes across gender, we notice that all dummies describing psychosocial job conditions are statistically significant for male whilst this does not happen for female (three out of six indicators). In particular, compared to female, men seem to suffer more from a high demand-low autonomy-low support situation in the spirit of Karaseks model. This is in line with the results of Niedhammer et al. (2000). Gender differences in terms of the impact of physical hazards on mental health at work are less clear. With respect to traditional adverse work factors we find that noise, vibration and repetitive arm movements have an effect on the mental health of men but not on the mental health of women. This could be explained by task segregation, in the sense that women and men in the same occupations are possibly performing different tasks, though subject to different risks and this effect is not likely to be captured completely by occupational and sectoral dummies. Womens mental health is also affected by climate work conditions such as low temperatures, the same explanation as above applies in this case. When we consider our composite indicators of working conditions results are confirmed both in terms of the sign of the relationship and statistical significance. As compared to physical health, effects are higher for male workers compared to females. In general we find that men suffer more distress at work, and that psychosocial working conditions might play a major role in explaining these differences. This is in contrast with part of the existing literature on gender differences in distress that finds lower well being for women compared to men, but it may reflect a selection effect due to women that select themselves out of the labour force or into part time employment in response to work stress or other demands (Roxburgh, 1996). Moreover, it should be kept in mind that our dependent variable is different from the measures of distress widely used in the literature to explain gender differences since it explicitly refers to distress generated from work[7]. We replicate our results using as dependent variable an ordered indicator (for the intensity of mental/physical health problems) and, given the nature of the dependent variable, we estimate an ordered Probit model. Results are qualitatively similar to Probit OLS estimates and are reported in Table AII in the Appendix. The outcomes are qualitatively very similar to the results with the linear model, so we are confident that the cardinality/linearity assumption is exercising very little influence on the results of the paper. Finally, without exceptions, these results do not account for the presence of unobserved individual-specific characteristics that are omitted from our regressions or that cannot be observed in our dataset (e.g. work motivation, risk aversion and innate ability). We return to these issues in the two following paragraph. Decomposition analysis and IV Probit OLS It is interesting to understand how much of the differences in health at work across gender can be explained by differences in observable vs unobservable workers characteristics. A common approach to distinguish the contribution to the gap between explained and unexplained components follows the seminal papers of Oaxaca (1973). This has become a standard technique for decomposition of gaps in outcomes (such as for wages) between different populations. In this case the decomposition can be written as: f 0 ^ m X f 0 ^ m 0 lm ^ lX HaW m HaWf X l lf X l 2

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where HaWi refers to the outcome (in our case the health variables) for individual i who may be male HaWm or female HaWf , X is a vector of determinants of our health variable of interest while l is the associated parameter vector. The difference in the health variables arising from the difference in characteristics is known as the explained component while the difference arising from differences in the returns to characteristics may be labeled the unexplained component. The first term on the righthand side of Equaiton (2) is interpreted as the explained component, while the sum of the final two terms as the unexplained component. In practice, we decompose the differences in health at work into changes in the characteristics of the workers (e.g. level of education, age) vs changes in the level of health at work that are associated with those characteristics[8]. Table IV reports the results of the decomposition by gender. The decomposition is based on the estimates of columns 2 and 4 of Tables II and III for physical and mental health, respectively. We find that, for mental health, the gender gap in average mental health is 0.038. The explained gap taking into account of characteristics alone is 0.013 or 29.5 per cent of the actual gap. Thus if female had the same characteristics as male, then their average mental health gap with respect to male would be one-third of what it actually is. The unexplained gap, for mental health, is about 0.025. With respect to physical health, the explained gap is 0.007 or 14 per cent of total actual gap. The unexplained gap for physical health is about 0.041. Across the two measures of health at work, differences in characteristics account between 15 and 30 per cent of the absolute gender gap. Figure 2 shows the kernel densities of the predicted health variables for male and female, and the predicted health of female when they are attributed the characteristics of male. The distribution of health moves rightwards in both cases. By assigning male characteristics to female, the whole distribution moves to the right suggesting that both female with below and above average health problems at work would take advantage from different endowments (especially for mental health at work). These results seem to indicate the importance of unexplained factors in terms of accounting for the raw gap. The results from instrumental variable estimates are reported in Table V, together with F-tests on the strength of the instruments and first stage regression coefficients. As before, we estimate a model for mental and physical health at work by gender (female estimates are reported in columns 1 and 3 while male estimates in columns 2 and 4). Once we take into account the endogeneity of working conditions previous findings are mostly confirmed (except that in few cases we lose statistical significance) while the magnitude of the coefficients is increased. Results show that psychosocial job conditions cause adverse effects on the mental health at work both for women and for men. No effect is found with respect to physical health. Physical hazards have adverse effects on mental health of male and on the physical health of both male and female workers. Some attention should be paid also to the instruments used to correct for the endogeneity of working conditions. The instrumental variables are jointly, as shown in the bottom lines of the table above, statistical significant at 1 per cent in both first-stage regressions for female, with F statistics of 28.8 and 11.25, while statistical significance is at 5 per cent for first-stage regressions for male, with F-statistics of 19.25 and 3.66. To enforce the validity of instruments we also show first stage regression results. The signs of coefficients of the instruments are as expected; in particular a larger value of H&S regulation reduces adverse working condition, on average, while a larger value of the highperf_index

Physical health 4 2.5 2.5

Mental health

2 2 3 1.5 1.5 2 1 1

1 1 0.5

0.5

0 0 0.5 kernel density female kernel density female if male characteristic Kernel = epanechnikov, bandwidth = 0.02 0.5 1 1 0.5 0 1 1 0.5 0

0 0.5 1

0 1 0.5 0 0.5 1 kernel density female kernel density female if male characteristic 1.5

0.5

kernel density male kernel density female

kernel density male kernel density female Kernel = epanechnikov, bandwidth = 0.03

Kernel = epanechnikov, bandwidth = 0.02

Kernel = epanechnikov, bandwidth = 0.02

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Figure 2. Kernel density of the predicted health of male and female

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reduces problems in terms of adverse work environment. Our results seem to support the existence of a causal link between adverse working conditions and workers health at the workplace, such effect is underestimated when the endogeneity of working conditions is not appropriately accounted for. 5. Conclusion Our study investigates the effect of multiple dimensions of working conditions on physical and mental health problems at work for a sample of 15 European countries. We pay particular attention to the gender dimension of this relationship and we assess the distinct effects of a number of specific working conditions on physical and mental health at work. Results suggest that controlling for a wide range of personal and job attributes (adverse) working conditions are associated with more work-related health problems both physical and mental. Our evidence highlights significant gender differences the effects of working conditions on health. In particular negative psychosocial characteristics of work have a stronger impact the mental health problems reported by men compared to female. With respect to traditional adverse work factors we find that noise, vibration and repetitive arm movements have an effect on the mental health of men but not on the mental health of women. A less clear pattern across gender is found with respect to physical health problems at work. These may arise from segregation of women in high strain occupations or gender variability in the subjective assessment of work conditions. In fact there could be differences between men and women in psychological attributes, coping mechanisms or affective responses to their job that could determine the perception of health at work, this calls further exploration. Results hold also when we account for the endogeneity of working conditions, in fact the instrumental variable estimation offers evidence in support of a causal effect of working conditions on individuals health at work. In general our results suggest that working conditions are very important determinants influencing the perception of one individuals health at the workplace. Policy makers should then make efforts to evaluate the cost, both at the economic and social level, of health problems deriving from an adverse work environment, focusing on the role played by new risk factors such as psychosocial hazards.
Notes 1. Several tools tried to address several dimension of quality of work In Europe, as for example Eurostat labour force survey, however, compared to EWCS they give little information on working conditions. 2. Whose number equals the number of categories of the observed ordinal variable, and individuals with the same observed response are characterised by the same value of the transformed variable. In principle, this method, can be used to roughly cardinalize our dependent variables and it results in rescaling the variable in order to make the application of linear model more appropriate. 3. With respect to linear estimations with the true latent variable, we have some loss of information due to discretization, implying that the residual variance is underestimated and hence that the corresponding t-statistics are overestimated (Origo and Pagani, 2009). For more details on Probit OLS see Van Praag and Ferrer-i-Carbonell (2006). 4. For comparison purposes we also report results for ordered Probit estimations (Table AII in the Appendix).

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5. The information used to construct the H&S regulation instrument is derived from www.ilo.org/ilolex/english 6. For example Greenlund et al. (1995) suggest that workplace exposures such as discrimination could be an important factor predicting adverse health outcomes in women. 7. Some literature have explored differential exposure perspectives by focusing on how the combination of work and home roles creates unique stressors for women (Simon, 1995; Ulbrich, 1989). This literature supports the idea that employed women in multiple roles are exposed to unique stressors, such as, for example, childcare responsibilities. These conditions have been found to be associated with higher levels of family strain suggesting that women may be exposed to higher stress through the unique stressors associated to their multiple role responsibilities. 8. We perform a Blinder-Oaxaca type decomposition of the mean outcome differential of our health dependent variables reconstructed via Probit OLS. In our application we use the procedure of Newmark (1988) which suggests using the vector of returns obtained from the pooled sample of males and females.

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Stock, S.R., Fernandes, R., Delisle, A. and Vezina, N. (2005), Reproducibility and validity of workers self-reports of physical work demands, Scandinavian Journal of Work, Environment and health, Vol. 31 No. 6, pp. 409-37. Terza, J. (1987), Estimating linear models with ordinal qualitative regressors, Journal of Econometrics, Vol. 34 No. 3, pp. 275-91. Ulbrich, P.M. (1989), The determinants of depression in two-income marriages, Journal of Marriage and the Family, Vol. 50 No. 4, pp. 121-31. Van Praag, B.M.S. and Ferre-i-Carbonell, A. (2004), Happiness Quantified: A Satisfaction Calculus Approach, Oxford University Press, Oxford. Van Praag, B.M.S. and Ferrer-i-Carbonell, A. (2006), An almost integration-free approach to ordered response models, Tinbergen Institute Discussion Paper No. 2006-047/3, Tinbergen Institute, Amsterdam-Rotterdam. Vermeulen, M. and Mustard, C. (2000), Gender differences in job strain, social support at work, and psychological distress, Journal of Occupational Health Psychology, Vol. 5 No. 4, pp. 428-40. Waite, L.J. (1995), Does marriage matter?, Demography, Vol. 32 No. 4, pp. 483-507. Waite, L.J. and Gallagher, M. (2000), The Case for Marriage: Why Married People Are Happier, Healthier and Better Off Financially, Doubleday, New York, NY. Appendix. Additional tables and results
All sample Mental health Physical health Female Age o26 Age 26-35 Age 36-45 Age 46-64 Low level of education Middle level of education High level of education Married Child Discrimination at work Permanent job High task complexity Low colleague support No autonomy High task intensity Work in shift Repetitive arm movement Overtime (H440) Vibration from hand tool Noise High temperature Low temperature Vapour Skin contact Radiation Passive smoke Dangerous material 0.54 0.18 0.47 0.12 0.23 0.29 0.35 0.29 0.33 0.38 0.63 0.47 0.06 0.79 0.598 0.31 0.46 0.46 0.15 0.426 0.271 0.231 0.296 0.221 0.223 0.242 0.152 0.05 0.08 0.04

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(continued)

Table AI. Sample descriptive statistics

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Female size 1-4 Female size 5-9 Female size 10-50 Female size 51-250 Female size over 250 Agriculture Manufacturing Electricity, gas and water Construction Wholesale and retail trade Hotel and restaurants Transport and communication Financial intermediation Real estate Public administer Other services Legislator Professionals Technicians Clerks Service workers Skilled agriculture Craft and related trade Plant and machine operators Elementary occupation

All sample 0.25 0.15 0.32 0.22 0.06 0.03 0.16 0.01 0.08 0.15 0.04 0.07 0.04 0.08 0.07 0.27 0.08 0.11 0.18 0.13 0.13 0.02 0.14 0.07 0.13

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Table AI.

Mental health Female (1) Age from 26 to 35 (2) (3) Male (4)

Physical health Female Male (5) (6) (7) (8)

0.463*** 0.470*** 0.184** 0.203*** 0.237** 0.249** 0.206** 0.240*** (6.71) (6.8) (3.05) (3.4) (2.73) (2.88) (2.83) (3.36) Age from 36 to 45 0.436*** 0.453*** 0.285*** 0.333*** 0.303*** 0.314*** 0.367*** 0.440*** (5.98) (6.28) (4.52) (5.43) (3.32) (3.48) (4.84) (5.97) Age from 46 to 65 0.601*** 0.596*** 0.304*** 0.345*** 0.443*** 0.439*** 0.401*** 0.464*** (8.47) (8.45) (4.97) (5.75) (4.98) (4.97) (5.37) (6.36) Middle level of education 0.091 0.169** 0.047 0.06 0.117 0.169* 0.127** 0.137** (1.77) (3.27) (1.22) (1.59) (1.76) (2.56) (2.81) (3.10) High level of education 0.132* 0.192*** 0.167*** 0.174*** 0.001*** 0.026** 0.176 0.179 (2.53) (3.68) (3.57) (3.79) (3.11) (2.38) (1.14) (1.28) Married 0.141*** 0.087* 0.057 0.051 0.125** 0.098* 0.001 0.018 (3.85) (2.36) (1.32) (1.20) (2.57) (2.01) (0.01) (0.36) Child 0.190*** 0.201*** 0.105** 0.073 0.149** 0.162*** 0.002 0.029 (5.09) (5.38) (2.70) (1.91) (3.02) (3.30) (0.042) (0.617) Discrimination at work 0.365*** 0.308*** 0.640*** 0.642*** 0.439*** 0.411*** 0.330*** 0.349*** (6.74) (5.61) (9.60) (9.71) (6.66) (6.33) (4.84) (5.17) Permanent job 0.085* 0.104** 0.088* 0.121** 0.163* 0.150 0.113** 0.097* (2.06) (2.59) (2.08) (2.86) (1.95) (1.74) (2.29) (1.99) High task complexity 0.092 0.266*** 0.284*** 0.163*** (1.45) (7.37) (5.52) (3.69)

Table AII. Ordered Probit estimates

(continued)

Mental health Female (1) Low colleagues support No autonomy High task intensity Work in shift Overtime (H440) Repetitive arm movement Vibration hand tool Noise High temperature Low temperature Vapour Skin contact Radiation Passive smoke Dangerous material Psychosocial job conditions Physical hazard Nobs 8,035 0.055 (1.53) 0.119*** (3.33) 0.495*** (1.25) 0.415*** (8.31) 0.086*** (2.54) 0.087** (1.99) 0.183*** (3.72) 0.079 (1.84) 0.024 (0.53) 0.187*** (4.18) 0.306 (1.44) 0.031 (0.58) 0.077* (1.89) 0.031 (0.71) 0.019** (1.96) 0.019*** (1.92) 0.27*** (17.3) 8,035 (2) (3) 0.062** (1.98) 0.247*** (7.68) 0.391*** (12.38) 0.366*** (8.16) 0.056* (1.78) 0.377*** (10.49) 0.099* (2.22) 0.111** (2.77) 0.057 (1.36) 0.162 (0.96) 0.05 (1.16) 0.203 (1.49) 0.094* (1.94) 0.110** (2.91) 0.05** (1.99) 0.047*** (5.86) 0.267*** (18.2) 9,126 Male (4)

Physical health Female Male (5) (6) (7) (8) 0.045 (0.95) 0.059 (1.28) 0.368*** (7.91) 0.442*** (7.59) 0.180*** (4.02) 0.233*** (3.42) 0.043 (0.66) 0.096 (1.71) 0.056 (0.96) 0.166 (1.86) 0.213*** (3.47) 0.233*** (3.65) 0.031 (0.28) 0.011 (0.19) 0.063 (0.95) 0.048*** (4.07) 0.203*** (12.78) 8,035 0.07** (1.81) 0.142*** (3.71) 0.327*** (8.64) 0.376*** (7.33) 0.092*** (2.40) 0.290 (1.02) 0.023 (0.45) 0.055 (1.17) 0.064 (1.32) 0.082 (1.70) 0.107 (1.18) 0.223** (4.36) 0.005 (0.06) 0.037 (0.82) 0.067 (1.16) 0.085*** (9.3) 0.246*** (11.09) 9,126

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9,126

8,035

9,126

Notes: Estimated coefficients are significant at 1 per cent level if ***, 5 per cent if ** and 10 per cent if *. Z-tests are reported in parentheses

Table AII.

About the author Elena Cottini is a Post-doctoral Research Fellow at the Institute for Industrial Relations and Labour Economics at Catholic University in Milan. Her research interests are in the field of labour economics, health economics and applied micro-econometrics. Recent research has focused on the analysis of the impact of working conditions on health at work. Elena Cottini can be contacted at: elena.cottini@unicatt.it

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