A Caucasian, female office worker climbing on a ladder trying to reach for a box on a shelf. She wears a black outfit from top to bottom and has brown hair. She stands on a ladder that is a bit too short and leans forward dangerously trying to retrieve the box. The shelf has several compartments with the same box in each compartment. There is a wall and large glass windows on the left, behind her. There is a white ceiling above her. The floor of the office is out of view.

Much of the current conversation about work in the United States focuses on recent gains in workers’ rights, power, and working conditions. In the past year, workers elected to create unions at several Starbucks location, an Amazon warehouse, and an Apple store, and are working to create unions in other retail spaces such as Trader Joe’s. Workers are also witnessing an increase in wages after decades of wage stagnation. However, the overall landscape of work in the 21st century would not be described as an era of favorable working conditions.

In fact, work is increasingly characterized by a lack of job security, little control over work schedules and work hours, frequent job changes and instability, and limited social benefits from employers. In a recent study, I documented how these aspects of work – often referred to as precarious work – can impact the health of workers. While prior research has found that precarious work can impact the mental well-being and health of workers, I addressed a gap in the research by demonstrating the lasting health consequences of long-term exposure to precarious work.

In the study, I examined the health trajectories of 8,283 adults over age 65 to understand how their exposure to precarious work from age 50 to 65 shaped their health outcomes after age 65. I considered the number of chronic conditions they developed, how many functional limitations impacted their daily lives (e.g., getting up from a chair, climbing a flight of stairs), and their risk of dying after age 65.

What I found is that individuals who were frequently exposed to adverse work experiences such as unemployment, job insecurity, and insufficient work hours experienced more chronic conditions and functional limitations after age 65 compared to individuals who were not frequently exposed to these conditions. These workers also experienced a higher risk of dying after age 65. Thus, long-term exposure to precarious work can take a lasting toll on a person’s health and shorten their life.

Although the specific reasons for the lasting health effects remain unclear, I suspect that the chronic stress from long-term exposure to precarious work can take a toll on workers’ bodies over time. For example, constantly experiencing job insecurity or insufficient work hours can lead to feelings of hopelessness and psychological distress, which can ultimately “get under the skin” to affect chronic conditions and other physical health problems, as evidenced by prior research.

The findings from my study are particularly concerning in light of the persistence of precarious work in the 21st century. Insecurity and instability at work have seeped into all sectors of the economy over the past several decades, with no sign of abating. Given stark linkages between precarious work and health, precarious work should be considered a public health crisis. If work is causing more health problems and a greater risk of premature death, precarious work will have significant consequences for individuals, their families, and society as a whole.

Although recent improvements in wages and union representation have the potential to help workers and (hopefully) to improve their health outcomes, we have a long way to go. In the United States, we lack protections for workers and social safety net policies that have the potential to alleviate some of the health consequences of precarious work. For example, the United States remains the only high-income country lacking paid leave for workers. Moreover, a number of states have enacted policies to limit the scope and power of unions, at the detriment of workers. We will need a seismic shift in the policy arena to improve the lives of workers in the United States, and my study points to this as a necessary endeavor for public health.

Rachel Donnelly is Assistant Professor of Sociology at Vanderbilt University. Her research focuses on health and health disparities across the life course, with an emphasis on how work and family relationships contribute to disparate health outcomes.