This document outlines a presentation on health inequalities related to gender differences in working time in Europe. It discusses how welfare state regimes influence the gender division of labor, family roles, and working hours. Research presented found that long working hours and family demands were associated with poorer health, especially for women in Continental and Southern European countries. Nordic and Eastern European countries saw fewer associations between working hours/family demands and health outcomes for both men and women. The conceptual framework examines how welfare states, labor markets, family models, and public services influence the gender division of work and health.

1. Health inequalities related to the
gender division of working-time in
Europe
Lucía Artazcoz
Public Health Agency of Barcelona
Barcelona, 3 June 2015

2. Presentation outline
 Conceptual framework based on the sexual division of work
 Work-family balance
 Artazcoz L, Cortès I, Puig-Barrachina V, Benavides, FG, Escribà-Agüir V,
Borrell C. Combining employment and family in Europe: the role of family
policies in health. Eur J Public Health. 2014 Nov 8;24:649–55.
 Part-time work
 Sanchez E, Cortes I, Bartoll, X, Artazcoz L. Part-time employment, health
and gender in Europe: a systematic review. Universitat Pompeu Fabra;
2015.
 Long working hours
 Artazcoz L, Cortès I, Benavides FG, Escribà-Agüir V, Bartoll X, Vargas H,
Borrell C. Long working hours and health status in Europe: The role of
gender and welfare state regimes in a context of economic crisis (under
review).

3. Welfare state regimes
 Gender division of work
 Position in the labour market
 Position in families
 Gender division of family roles
 Responsible for domestic and family
work
 Breadwinner
 Gender division of working time

4. Welfare state regimes and the gender
division of working time and family positions
 Nordic countries
 Double earner/double carer
 Long part-time hours and public services for child care
 Continental countries
 Traditional family model with support for families
 Part-time for WFB
 Southern-European countries
 Traditional family models, with no support for families
 Low participation of women in the labour force
 Post-comunist countries
 Double earner/women carers
 High participation of women in the labour force
 Anglo-Saxon countries
 Market-oriented family models
 Long working hours for men; short part-time hours for women

6. Conceptual framework
Welfare state
models (cultural
aspects)
Family models
Domestic and
Family work
Public services
for child care
Part-time work
Breadwinner
Long working
hours
Voluntary or
involuntary
Poor
employment and
working
conditions and
poor health
Labour market
characteristics
Regulation
Dualization
The importance of economic vulnerability
… and the crisis

8. Objectives
 To analyze the relationship between
health status and paid working
hours and household composition
in the EU-27, and
 To examine whether patterns of
association differ as a function of
family policy typologies and
gender.

9. Methods
 Data from the 2010 European Working Conditions
Survey
 Sample: Workers married or cohabiting (10482 men and
8882 women)
 Employment demands: working hours (< 30, 30-40, 41-50
and >50)
 Household composition
 Number of children
 Living with older than 64
 Partner’s employment status
 Health outcomes
 General health status
 Psychological wellbeing

10. Long working hours and poor
psychological wellbeing among men
1,1 1,14
0,98
2,3
1,39 1,34
1,62
2,22
0,76
0,090
0,5
1
1,5
2
2,5
3
3,5
4
4,5
41-50 51-60 41-50 51-60 41-50 51-60 41-50 51-60 41-50 51-60
aOR(95%CI)
Continental Anglo-Saxon Eastern South Nordic
30-40 hours

11. Long working hours and poor
psychological wellbeing among women
1,81
4,59
1,28 1,06 0,91
1,16 1,25
4,21
1,1
1,98
0
2
4
6
8
10
12
41-50 51-60 41-50 51-60 41-50 51-60 41-50 51-60 41-50 51-60
aOR(95%CI)
Continental Anglo-Saxon Eastern South Nordic
30-40 hours

12. Number of children and poor psychological
wellbeing among men
1,22 1,29
1,63
2,12
1,34
1,13
1,44
1,27 1,28
0,9
0
0,5
1
1,5
2
2,5
3
3,5
1 >=2 1 >=2 1 >=2 1 >=2 1 >=2
aOR(95%CI)
Continental Anglo-Saxon Eastern South
Nordic
No children

13. Number of children and poor psychological
wellbeing among women
1,44
1,69 1,74
1,4
1,06 1
1,32
1,5
0,52
1,34
0
0,5
1
1,5
2
2,5
3
3,5
1 >=2 1 >=2 1 >=2 1 >=2 1 >=2
aOR(95%CI)
Continental Anglo-Saxon Eastern South Nordic
No children

14.  Continental and Southern European countries:
 Long working hours and family demands associated with health status in both sexes, although
these associations are stronger and more consistent among women;
 Men from Southern European countries: Poor health status and psychological wellbeing
among living with older than 64 -> Evictions?
 Anglo-Saxon countries:
 Association between long working hours and family demands and health mainly limited to
men
 Women: The only country where part-time was related to better health status
 Nordic and Eastern European countries:
 Long working hours and family demands largely unassociated with poor health outcomes in
both sexes.

15. Review of the evidence:
Sanchez E, Cortes I, Bartoll X, Artazcoz L. Part-time employment, health
and gender in Europe: a systematic review. Universitat Pompeu Fabra;
2015
Part-time work, health, employment
and working conditions

16. Part-time work in the EU-27 by
country and sex in 2013
Eurostat, Labour Force Survey

17. Involuntary part-time work in the
EU-27 by country and sex in 2013
Eurostat, Labour Force Survey

18. Objectives
 To collect the evidence about the
relationship of part-time employment
with employment and working
conditions and health status
 To understand the heterogeneity of
results

19. Methods
 Sistematic review (PRISMA
recommendations): 2000-2013
 Setting: EU 27
 Quality assessment (STROBE)
 Four reviewers, two teams
 31 articles included

20. Results: Employment quality
Countries Gender Other
characteristics
Articles
Favorable outcomes
Better work-family
balance
SE; NL; DE; UK; IR; PT Both sexes; stronger
association in women (NL;
liberal countries)
Short hours part-time
(<20-24h/w) and
permanent contract. Non-
manager position
15-19
Unfavorable outcomes
X Job insecurity EU-15 Both sexes 4
X Lower promotion
prospects
UK (*); ES Both sexes; stronger
association in women
Mothers 5-9
X Lower salaries UK; DE; ES Both sexes; stronger
association in women
7,10-12
X Lower control UK; SE (menos) Both sexes; stronger
association in women
13
X Lower participation UK Both sexes; stronger
association in women
PTE manager position 5
X Occupational
downgrading
UK High qualified women when
changing from FTE to PTE
Mothers 14
* Voluntary PTE

21. Understanding heterogeneous
results
 Country differences:
 PTE as a retention/integration strategy
 PTE as marginalization
 Higher impact among women:
 Feminized occupations
 Really voluntary?: Affordability of
public childcare services
 Gender, willfullness and contract

23. Artazcoz L, Cortès I, Benavides FG, Escribà-Agüir V, Bartoll X, Vargas H, Borrell C.
Long working hours and health status in Europe: The role of gender and welfare
state regimes in a context of economic crisis (under review).
Long working hours and
health status

24. Germany United Kingdom Poland Spain Sweden
Very long working hours (>=50 hours/w) in
some European countries (2013)
Source: OECD better life index

25. Objectives
 To identify employment and family
characteristics associated with moderately
long working hours (41-60 hours a week) in
the EU27;
 To examine the relationship between
moderately long working hours and
health; and
 To analyse whether patterns differ by
gender and welfare state regimes.

26. Methods
 Data from the 2010 European Working Conditions Survey
 Sample: Employees working 30-60 hours a week.
 Working hours (< 30, 30-40, 41-50 and >50)
 Multiple logistic regression models separated by sex and
ajusted for
 Occupational category
 Type of contract
 Type of company (public-private)
 Supervisory role
 Household composition
• Partner/marital status
• Number of children
• Being the main contributor of the household income
 Health outcomes
 General health status
 Psychological wellbeing

27. Long working hours and poor
psychological wellbeing among men
1,15
0,96 0,91
2,8
1,2
0,77
1,4
2,61
1,16
0,24
0
0,5
1
1,5
2
2,5
3
3,5
4
4,5
41-50 51-60 41-50 51-60 41-50 51-60 41-50 51-60 41-50 51-60
aOR(95%CI)
Continental Anglo-Saxon Eastern South Nordic
30-40 hours

28. Long working hours and poor
psychological wellbeing among women
1,62
3,24
1,54
1,1 0,92
1,51 1,27
2,54
1,42
2,73
0
2
4
6
8
10
12
14
41-50 51-60 41-50 51-60 41-50 51-60 41-50 51-60 41-50 51-60
aOR(95%CI)
Continental Anglo-Saxon Eastern South Nordic
30-40 hours

29. Opting out of the 48-hour
week in the UK
 Workers 18 or over who want to work more than 48 hours a
week, can choose to opt out of the 48-hour limit.
 This could be for a certain period or indefinitely. It must be
voluntary and in writing.
 It can’t be contained in an agreement with the whole workforce.
However, employers are allowed to ask individual workers if
they’d be willing to opt out.
 An employer shouldn’t sack or unfairly treat a worker (eg refused
promotion) for refusing to sign an opt-out.
Source: https://www.gov.uk/maximum-weekly-working-hours/weekly-maximum-working-hours-and-opting-out

30.  As the directive stands there is only work and resting—no in
between such as on-call times, when the doctor may not
actually be working. The commission is also concerned about
the use of opt outs, which give individuals the right to opt out
of the weekly limit on working hours. Doctors may opt out
for various reasons, such as the need to earn more
money or to receive more training, or simply due to
pressure exerted by the trust they work for. The more
doctors opt out, the easier it becomes for trusts to comply
with the requirements of the directive.

31. Economic vulnerability
Labour market deregulation
Labour market dualization
Work-family overload
Family models
Understanding gender and country differences
in the relationship between working time and
health status

32. Health inequalities related to the
gender division of working-time in
Europe
Lucía Artazcoz
Public Health Agency of Barcelona
Barcelona, 3 June 2015