To examine the relationships between healthcare and social protection policies and changes in health during the pandemic, both preventive and corrective measures were included.
Preventive measures are those implemented before the pandemic, which may have put the country in a better position to cope with the pandemic’s health
implications. Government spending on healthcare and social protection in the year before the pandemic were included in the models tested (Eurostat [gov_10a_exp]), as a better-funded national healthcare system may help avoid overcrowded facilities, while higher social protection spending may create a safety net in cases of radical economic shifts. However, the relationship between these expenditures and health changes were not statistically significant (Table 18 and Table 19 of Annex II), which suggests that the pandemic similarly
affected respondents’ (perceived) health, regardless of their country’s healthcare and welfare systems.
Among the corrective measures implemented as a direct response to the pandemic, the first was blanket financial support given to households to better cope with the changing circumstances of the labour market.
No significant relationships were found between this indicator and physical and mental health (Table 19 of Annex II), suggesting that while such government support helped families navigate financial difficulties during the pandemic (see ‘Income inequality during the pandemic’ in Chapter 2), it may not have had a direct effect on people’s well-being, which may instead be mediated by other factors.
Traditional sickness and disability benefits were also analysed, based on EU-SILC data. The findings suggest that an increase in disability or sickness benefits between 2019 and 2020 was associated with a lower likelihood of worsening health (Table 18 of Annex II).
This could mean that people in already poor health were the main recipients of benefits: for recipients of disability benefits, respondents in good health accounted for only 21% of the total. People in poor health may not have perceived their health to have further worsened, even if their disability benefits increased. Sickness benefits were less dependent on the recipient’s health status; a reason for this might be that respondents may have recovered by the time they were surveyed, even if they had claimed sickness benefits earlier in the year. The same negative effect between disability and sickness benefits and the likelihood of worsening health was found in the years before the pandemic, suggesting that it may be part of a general trend rather than a pandemic-specific corrective measure.
Box 2 presents some examples of national policies aimed at promoting healthcare and increasing access among disadvantaged groups.
In Ireland, outreach policies are a component of the Healthy Ireland strategic action plan for 2021–2025, which features ‘reducing health inequalities’ as one of its six components. Targeted actions that will be part of this area will be guided by research, to tailor these to the needs of the population. Among other measures, policies tackling obesity and smoking will be reviewed to address inequalities, and areas will be targeted in order of deprivation level (Government of Ireland, 2021). Furthermore, one of the actions set out in the Irish Child Guarantee national action plan is to develop a child health workforce with an initial focus on highly populated and disadvantaged areas. A pilot model will be used to inform further measures.
Spain’s recovery and resilience plan includes a law with measures promoting equity, universality and cohesion in
Box 2: National policy examples targeting health inequality
Digital technologies have been used to increase the accessibility of healthcare services in different countries (Eurofound, 2014, 2020a). In Greece, a national e-health program for the prevention and management of overweight and obesity in childhood and adolescence provides guidance to all primary healthcare physicians on personalised management. Its evaluation shows that it is effective at reducing the prevalence of obesity after one year of intervention (Tragomalou et al, 2020).
This chapter looks at inequality in employment, working conditions and working lives more broadly, starting with a literature review of the drivers and factors that were found to be important for inequalities in working lives during the pandemic. This is followed by the presentation of levels of employment inequality in the EU27 before the pandemic, as well as how employment inequality changed between 2010 and 2020. The fourth section focuses on government policies as general drivers of working life inequality, while the final section focuses on the drivers during the pandemic.
Literature review
The initial stages of the COVID-19 pandemic led to restrictions on social and economic activity in European countries, including stay-at-home orders and the closure of non-essential businesses. Lockdowns, introduced in spring 2020 and then again in autumn 2020 and early 2021, resulted in a major economic and employment shock. To mitigate their effects on the financial stress of employees and households,
governments implemented various schemes to support the newly unemployed or furloughed workers. However, evidence suggests that these measures were not always able to prevent the deepening of pre-existing
inequalities in labour markets.
The groups of people most affected by unemployment and related issues were largely the same as those who experienced worse job security and working conditions prior to the pandemic. There is significant interplay between many of these individual-level characteristics in explaining the inferior labour market outcomes.
Various quantitative studies from Europe (Adams-Prassl et al, 2020; Campa et al, 2021) and beyond (Ong et al, 2020; Witteveen, 2020; Gray et al, 2022) showed that the groups most affected included women, young people, people from ethnic minorities, blue-collar workers and people in non-standard working arrangements.
Evidence from past epidemics shows that the epidemics led to a lower employment ratio for workers with lower education levels and pushed people into precarious employment, self-employment and work in the informal sector (Furceri et al, 2020). Studies comparing the impact of the COVID-19-related crisis on labour markets with the impact of the 2008 financial crisis (for example, Perry et al, 2021) found that less educated workers had worse outcomes in both crises, but the difference
between them and more highly educated groups during COVID-19 were higher. In addition, while men were most likely to lose jobs in the financial crisis, in several countries women suffered more during the COVID-19 crisis (Fazzari and Needler, 2021).
These findings are not consistent across the countries covered in the present research, indicating the importance of macro-level and structural factors (Figure 21). Through a simulation analysis of the distributive effects of lockdowns in European countries, Perugini and Vladisavljević (2021) showed that countries with high pre-pandemic levels of inequality, insecure employment regulations and limited social protection measures would experience more severe effects on income inequality and poverty levels due to job losses or reduced working hours. Geography, industrial mix and divergent policy responses also shaped the experiences of the pandemic at meso-level (Herod et al, 2021).
Most of the studies reviewed are based on individual data and concentrate on the following aspects:
£ groups of workers most vulnerable to the effects of the pandemic
£ inequalities in the possibility to work from home
£ occupational inequalities among groups with non-standard types of employment
£ gender inequalities in paid work and unpaid housework and childcare