Joan Benach (Barcelona, 65 years old), PhD in Public Health from The Johns Hopkins University and Professor of Sociology at Pompeu Fabra University, has coordinated the preparation of the report Job insecurity and mental health. knowledge and policies, commissioned by the Ministry of Labor. This study calculates that a third of mental health problems in the active population are attributable to endless hours, low wages and many other determinants of precariousness. “Changing reality not only requires making problems visible and understanding their causes but, above all, having the necessary political power to act and avoid the toxic pandemic that today represents job and social precariousness,” he said in an interview with this newspaper to via email.
Ask. Spain is a country with salaries below the European average, with a temporary employment rate in the upper range, with a very high unemployment rate and the highest among young people, we work more hours than the OECD average and distributed more expanded throughout the day. Has your study found a causal relationship between these variables and the high prevalence of mental health problems?
Answer. Contrary to what is usually believed, job insecurity is not only related to the type of contract or salary, but is a multidimensional phenomenon. In addition to stability and security, it is essential to take into account the scarcity of rights, the scant bargaining power, or the vulnerability, defenselessness, and discrimination suffered when working. Scientific knowledge clearly shows how job insecurity is a toxic social determinant of health. He bad job It penetrates the bodies and minds of precarious people, generating anxiety, depression, drug and alcohol abuse, and an increased risk of suicide.
Q. What have you learned about the relationship between precariousness and mental health that you did not know before preparing this study? What are the most original aspects?
R. The study, soon to be published more extensively as a book, is original for two main reasons. In the first place, because it is the first time in the world that a government commissions a study on two issues of such social importance as job insecurity and mental health. And second, because, in order to understand such complex issues, we have carried out transdisciplinary work integrating the best knowledge available from sociology, labor law, epidemiology, psychology and public health, among other disciplines. Through a critical vision, we have managed to obtain a new synthesis and propose political proposals that go far beyond the limited and fragmentary vision of each discipline.
Q. One of the most forceful conclusions is that a third of the cases of depression in the active population in 2020 are attributable to precariousness. Did this result surprise you?
R. No. Years ago we showed how the impact on mental health was more than double in precarious workers, the most affected being the working class, migrants, youth and women, but it is essential to better understand the causes and global impact of precariousness on our lives. It is unfortunate that we still do not have an adequate information and research system to comprehensively measure precariousness, with valid and comparable indicators. In today’s society it is not enough to measure unemployment and temporary employment, it is necessary to measure all the dimensions of labor and social precariousness and know all its effects on health and quality of life.
Q. What reaction does the phrase “you don’t need a psychologist, you need a union” generate in you, which has become so popular lately? What is more important for the mental health of Spaniards to improve: a drop in precariousness rates or a reinforcement of psychological and psychiatric care in public health?
R. Trying to eliminate job insecurity while caring for people who suffer from mental health disorders derived from their employment situation should be complementary objectives. You have to prevent and you have to cure and care, both are essential. However, the precarious and excessively medicalized mental health system cannot prevent the suffering of many people who often blame themselves for their ailments. Job insecurity is a social problem caused by having harmful employment and work relationships. Therefore, the solutions on precariousness and the health system must be political. This means that the suffering generated by precariousness must be politicized.
More than increasing the number of professionals, which is also necessary, what we need is to develop community mental health where almost everything remains to be done.
Q. Trying to be more specific, would a reduction of between five and eight hours in the weekly workday, as proposed in your study, do more for the mental health of Spaniards, or that the number of psychologists and psychiatrists in public health triple, up to situate ourselves in the European average?
R. The report proposes numerous recommendations, as well as the need to open social debates as important as guaranteed work, universal basic income, the democratization of companies or working time. Making working hours shorter and reducing precariousness could have a very positive impact. It would make it possible to reduce unemployment, rationalize schedules, study and family life, as well as increase social relations and political participation. At the same time, it would improve rest, health and quality of life. In relation to care, rather than increasing the number of professionals, which is also necessary, what we need is to develop community mental health where almost everything remains to be done. A public system, not precarious and not medicalized whose center of gravity is primary care and social determinants, and that works in close coordination with social protection systems.
Q. Spain is the country with the highest consumption of anxiolytics per inhabitant. To what extent does the Spanish economy or at least its labor market depend on a labor force that is not really in a real condition to work in a healthy way?
R. Medicalizing mental health disorders derived from job insecurity, trying to solve problems by consuming drugs is not an adequate solution. First, because it does not go to the root of the problem, which means that in the best of cases the medication treats symptoms and not causes; second, because the massive use of medicines generates dependency and iatrogenicity, that is, secondary effects that damage health; and third, because it increases the acceptance of an intolerable social reality. This is clear with an insufficiently studied phenomenon such as labor presenteeism, that is, having to go to work even when sick. An economy that needs precarious people drugged with caffeine, anxiolytics and antidepressants in order to work is not a healthy society.
Q. Has it ever crossed your mind that this high prevalence of mental health problems and the use of anxiolytics may not be due to precariousness, but to the fact that workers in Spain are more lazy or more fragile than in other countries?
R. All the national and international scientific evidence shows that job insecurity is a social determinant of health. This entails above all two things: the greater the job insecurity, the worse mental health; and that this produces inequalities between social groups, where the working class, women, migrants and youth are the most affected, as well as forgotten groups such as cultural workers, people with functional diversity, trans people, among others. This indicates that we are not facing an individual problem but rather a social and collective phenomenon that requires political action to be eliminated. An individual vision of the phenomenon does not allow us to understand its structural causes, in addition to blaming people for their suffering and health.
Q. In which sectors do you think workers suffer more mental health problems?
R. The recent pandemic may help illustrate the situation. With covid-19, there was a lot of talk, almost always rhetorically, about the importance of essential workers. Groups that work in sectors such as health, education, care, food, transportation, culture or communication, among others, with nurses, supermarket cashiers, waiters, educators, carriers, cleaners, child or elderly caretakers, social service workers, journalists and artists, among many other jobs. Jobs that are essential, but undervalued and underpaid, and performed by the working class or a proletarianized middle class, dominated by many women and migrants.
Although the studies are still limited, those who work on digital platforms present high levels of stress, emotional discomfort, sleep disorders, anxiety and depression.
Q. What role do you think platforms such as Uber and Glovo, which maintain relationships with their employees for third parties, even though in practice they are work-related, play in this debate?
R. The economy of digital platforms illustrates very well the worrying reality of job insecurity. Those who work are subjected to meager wages, constant but invisible discipline, irregular working hours, long hours and frequent episodes of discrimination. Although the studies are still limited, those who work on digital platforms present high levels of stress, emotional discomfort, sleep disorders, anxiety and depression.
Q. Do you think that the prevalence of mental health problems among Spanish workers will get worse or better in the coming years?
R. Precariousness is not an inexorable destiny or a historical curse. Like any social problem, everything will depend on the policies that are carried out. In the report we point out a large number of interventions based on the best available knowledge, but changing reality requires not only making problems visible and understanding their causes but, above all, having the necessary political power to act and prevent the toxic pandemic that is currently represents labor and social precariousness. We must not accept having to work in order to exist, but claim to be able to work and live with dignity in a livable environment and in good health. As the Filipino journalist and Nobel laureate Maria Ressa points out, the question is: what are we willing to do and sacrifice to achieve it?
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