Introduction
Since 2008 unemployment has risen sharply in many European countries due to the global economic crisis and the prolonged recession. Besides, the political agenda of austerity imposed by European Union to Southern European countries in exchange for financial assistance, contributed to exceptionally high unemployment rates in Spain, Italy, Greece and Portugal (1). Unemployment has multiple striking social effects, including poor physical and mental health, low subjective well-being and life satisfaction (2), and is one of the most important social determinant of health inequalities (3).
During the 1990s, and for economic reasons, many countries introduced Active Labour Market Programmes (ALMPs) in an effort to reduce unemployment (4). ALMPs aim to reintroduce participants into the labour market through vocational training courses, improved job search skills, work experience (internships and subsidized jobs), and behavioural programmes, among others (4,5). In terms of health and wellbeing, ALMPs are thought to ease the negative effects of unemployment through different psychosocial mechanisms (6).
Although the recent economic crisis hit the Southern European countries hardest, few is known regarding the health impact of ALMPs in these countries. A recent review, showed that most of ALMPs evaluated in terms of health are those implemented in Anglo-Saxon and Nordic countries (6). As far as we know, only one ALMP implemented in Spain has evaluated its health effects (7), and no other has been found for Southern European countries (6). In addition, few of these articles discussed the mechanisms involved in this improvement.
“Employment in the Neighbourhoods” (EiN) is an ALMP implemented in Barcelona, Spain, which aims to reduce social inequalities through the labour market insertion of people living in neighbourhoods with the highest unemployment rates in the city, and with the greatest material needs. A pre-post intervention study evaluation through quantitative research methods showed an improvement of mental health among participants, whereas self-perceived health status remained stable or worsened (8). It is the general objective of this paper to describe the effects of EiN ALMP on quality of life and the mechanisms involved, according to the perception of the program’s participants and technical staff by who are assisted. Technical staff members are those professionals who accompany participants through the entire process as personal guidance counsellor.
Unemployment and health: pathways and mechanisms
Unemployment has been shown to cause poor health through material and psychosocial pathways. Material effects are primarily due to poverty resulting from lost income and financial strain. Psychosocial factors include the loss of non-economic resources provided by employment. According to Jahoda’s “latent functions” theory (9), while people primarily engage in paid work to earn their living (the manifest function of employment), they also profit from five latent functions that are unintended by-products of employment, namely time structure, social contact, collective purpose, social identity/status, and activity. Moreover, uncertainty about one’s future work situation is also a stressor that leads to physiological changes, risky health behaviours, and consequently, poorer health (10,11).
ALMPs and health: effects, pathways and mechanisms
ALMPs are thought to ease the negative effects of unemployment on health and wellbeing by promoting participation in work-related activities (12). ALMPs are thought to alter unemployed people’s environment by providing an opportunity to meet, socialize and strengthen social networks, and offer daily activities, routine and structure (12). In terms of status, vocational training courses may provide the perception of involvement in a legitimate alternative status to employment, namely education status (12). Improved job search and related skills, such as writing a CV and learning to respond in a job interview, could increase control over one’s life course, and workplace participation through work experience and training in a regular market could reduce the psychosocial need for employment by providing a more employment-like life situation (12).
Based on the above theoretical knowledge, we can generally expect involvement in an ALMP to have a positive impact on health and wellbeing, if we compare it with open unemployment situations (i.e. being unemployed not being enrolled in any ALMP). A recent scoping review, including 36 studies both quantitative and qualitative from the 1990s to the present day, of the health impact of ALMPs in high-income countries showed mainly positive results. 80.6% of the studies included in the review found a positive impact on health or quality of life, and the rest showed no effects (6). The heterogeneity of programs and contexts where these programs were implemented could justify part of these results. Only to exemplify the heterogeneity of programmes and their diverse effects on health, Strandh (12) showed that in Sweden at the end of the 90's, those unemployed involved in workplace participation as a specific type of ALMP experimented better mental health than those in open unemployment; however, those involved in vocational training did not improve their mental health.
Few of these studies focused on the mechanisms underlying health changes among unemployed produced by ALMPs. The evaluation – through quantitative methodology- of programs that offered job search assistance with a psychological component (e.g. inoculation against setbacks or increasing self-efficacy), reported positive results in terms of Fryer’s theory of gaining mastery and control over one’s life course (13). Sense of mastery and general increase in the labour market engagement could be related to the improvement of mental health (14). These programs have only been implemented in USA (15), Finland (14) and Australia (16). Also, the evaluation –through qualitative methodology- of job search activities offered to young population in Finland (17) referred to psychosocial mechanisms tied to Jahoda’s latent function theoretical model (9), such as giving structure to life. That is, programs can also be useful for transforming unemployment into a meaningful pattern of time use, especially through work-like activities or education. Moreover, in line with the idea of sense of mastery and economic control, participants reported seeing new possibilities in the labour market, and having economic support from the program.
Contextual factors matter
The impact of ALMPs may depend on various social and political factors, such as the model of activation related to the Welfare State, gender roles and family as a social institution, as well as the culture of work.
Regarding the model of activation, in “work-first” or liberal type, ALMPs and social policies take on a limited role, restricted to inciting individuals to seek work, providing quick information and simple matching services, as well as investing in short-term vocational training, adopting measures inciting people to be as active as possible across their life-course, and accepting any job on the market as it is (18). On the other hand, the universalistic type guarantees relatively high standards of living for the assisted, not pushing unemployed for accepting any job in the market, in a context of relatively good quality jobs (18). Anglo-Saxon countries would fit in the liberal model, and Scandinavian better in the universalistic, while most of other countries such as continental and Southern European countries would oscillate between.
For example, in Germany, participation in “One-Euro-Jobs”, a program based on subsidized employment including coercive elements in line with those of the liberal model, programme participation did not improve perceived integration in comparison to those in open unemployment (19). Authors argue that paternalistic programmes that work through directive methods, imposing unilateral obligations can affect individuals’ interpretations of their roles and status in society.
Gender and family also have a fundamental influence on the unemployment experience, some authors suggesting that non-work will be less damaging in societies where there is a stronger emphasis on family life (20,21), such as for example the Southern European countries. In these countries where Welfare State is weaker in terms of universal social policies, additional material and non-material support is provided by the family. Then, we could hypothesise that ALMPs are not considered as important in terms of social support as in other countries, if traditional family plays its role. On the other hand, in these countries were Welfare State is less developed, women are still major responsible for informal care and men still play the breadwinner role, at least in archetypal terms. It has been shown that in countries where gender roles are still traditional and differentiated, unemployment hits male harder, for whom individual/ social identity impaired (3). In that sense if ALMPs are useful in providing this identity, they could play a very important role among unemployed men.
In terms of culture, it has been discussed that the protestant ethic and the moral virtues of work are central to the Nordic work ethic. In this culture, work provides good role models and stimulates good behaviour (20). Work ethics has an important influence on the significance of employment, probably on the unemployment experience, and thus, in the meaning and effects of ALMPs.
In that sense, it is particularly relevant that most of the evaluations of ALMPs were conducted in Anglo-Saxon and Scandinavian countries, and only one study was carried out in Eastern Europe countries (22) and one in Southern (7). Thus, it is, at least, reasonable to question whether health outcomes of ALMPs, as well as the mechanisms operating are transferable to different contexts. There is a lack of empirical and theoretical studies addressing these issues.
ALMPs in Spain
Spain is one of the countries that spend the smallest fraction of GDP on ALMPs. Total public expenditure on ALMPs is thought to be an important determinant of health and wellbeing among unemployed people (23). Spain’s unemployment benefits are less generous than Nordic ones, and unlike the liberal model of activation, unemployment benefits are not compulsorily linked to ALMPs. In terms of gender and family, Spain is characterized by a strong “familialism”, with a family solidarity model based on an asymmetrical gender division of work and a low female participation in the labour market. Spain has residual family policies with lack of support to families, making them rely on unpaid work (24). To our knowledge, ALMPs in Spain have not been evaluated in detail, with the exception of one study (7) that evaluated the effects of the Madrid Government’s minimum income program (IMI) on health and wellbeing.
“Employment in the Neighbourhoods”: an ALMP to reduce social inequalities in Barcelona, Spain
In 12 neighbourhoods of Barcelona (Catalonia, Spain), an innovative tailor-made ALMP called “Employment in the Neighbourhoods” (EiN) (“Treball als Barris” in Catalan) was implemented to get people from deprived, high-unemployment neighbourhoods back to work, and to promote socioeconomic revitalization of these neighbourhoods. This program is part of a broader initiative, “The Neighbourhoods Law”, launched in 2004, to reduce social inequality in Catalonia by improving the quality of life in specific neighbourhoods primarily through urban renewal projects (DPTOP, 2009).
The EiN ALMP is run by Barcelona City Council through its employment promotion agency, “Barcelona Activa” and partly financed by the Catalan Employment Service (Autonomous Government of Catalonia). Enrolment in the program is always voluntary. The requirements to be eligible are to be registered as job seeker and to reside in one of the neighbourhoods where the program is implemented. People at risk of exclusion are prioritized, meaning people over 50 years old long-term unemployed, under 35 years old who leaved the educational system, people with low professional qualifications, women who has suffered gender violence, women who want to re-join labour market and people with physical disabilities.
Every year between 1500 and 2000 people are enrolled in the program. Most of the individuals enrolled have basic or no formal education, being a high percentage foreigners mostly non-EU nationals, and most of them long-term unemployed workers not eligible for contributory unemployment benefits. Unemployed persons who wish to join the program first complete a personal interview with a trained professional to evaluate their occupational status and a tailored job-search plan. The duration of the program depends on each specific job-search plan that can range from a few weeks to a few months, with a maximum of one year.
The program’s methodology is based on customized integration pathways combining several insertion measures. It mostly provides job search guidance and advice and professional skills training to increase employability, and promotes social and professional integration support for people with special difficulties, considering the specific needs and potential of each neighbourhood and working in close coordination with local associations and the main social agents (See Supplementary Data for specific actions).
Thus, we could expect that EiN would ease the negative effects of unemployment on health and wellbeing of participants, by providing an opportunity to meet socialize and strengthen social networks, and for those who participate at least several weeks a routine and structure through daily activities. More specifically, we could expect an increase of control over participants’ life course through job search activities, the perception of involvement in a legitimate status to employment through professional skills training and a reduction of the psychosocial need for employment through the social integration support.