Principle 5

Secure and adaptable employment

"Regardless of the type and duration of the employment relationship, workers have the right to fair and equal treatment regarding working conditions, access to social protection and training. The transition towards open-ended forms of employment (and) Innovative forms of work that ensure quality working conditions shall be fostered. Entrepreneurship and self-employment shall be encouraged. Occupational mobility shall be facilitated. (...) Employment relationships that lead to precarious working conditions shall be prevented, including by prohibiting abuse of atypical contracts."

- Principle 5 of the European Pillar of Social Rights

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Secure and adaptable employment as a determinant of health

Large parts of our lives are spent at work. While the negative impacts of poor working conditions or unemployment on health are relatively well understood, public health still largely overlooks the role of job security and flexibility in promoting and maintaining wellbeing.

Stable and adaptable workplaces and working arrangements can serve as health-enabling settings, improving both physical and mental health, beyond preventing occupational injury, disability or distress. By considering employees’ needs and capacities, work can foster both their wellbeing and productivity through supportive ‘work-life balance’ policies, social protections, predictable work schedules and contracts, and fair remuneration.

Conversely, job and employment insecurity, and unpredictable pay harm health and put one at risk of (in-work) poverty and social exclusion. This is particularly true for certain groups who already face vulnerabilities and disadvantages in the job market, with little control over their earnings, contract stability, or employment conditions.

Work that balances professional and private life, supports career growth, and builds skills strengthens population health, workforce resilience, and an inclusive wellbeing economy.

The Untapped potential of secure work

Although related, job security and employment security impact health in different ways.

Job security − the stability of a job within a company and the confidence of keeping it − reduces an individual’s stress, anxiety, and financial strain. It depends on employer stability, contract type, and workplace protections.

Employment security, on the other hand, affects long-term wellbeing by ensuring a worker’s ability to stay employable, even after job loss. Access to training, in-demand skills, or social protection shields workers from chronic uncertainty, which leads to long-term stress, health and socioeconomic disadvantage.

Predictable schedules, fair wages, and stable employment contribute to healthier individuals, families, and communities by restoring and maintaining a sense of control over and purpose of work. Precarious employment brings on average 15% less income than more stable forms of employment. In 2021, a quarter of EU employees struggled to make ends meet, and financial worries are linked to increased emotional distress.

Evidence consistently shows that job insecurity drives declines in physical and mental health over time, raising the risk of poor health by 39%. Precarious employment is linked to such negative health outcomes like mental and physical illnesses, reduced wellbeing, occupational injuries, harmful lifestyle behaviours, and disparities in healthcare access [44].

Studies also highlight PE’s role in widening health inequities at the population level [9,32-37].contributing to higher rates of non-communicable diseases (e.g., obesity, cardiovascular diseases) and workplace accidents.

Conversely, workplaces that prioritise job stability and adaptability experience less presenteeism (working while unwell, leading to reduced productivity, mistakes, and possible spread of disease), reduced use of mental health services, and higher productivity - lowering the odds of serious psychological distress and anxiety by 26% and 25%, respectively.

A high degree of job control, participation in decision-making, and job security enhance wellbeing, job satisfaction, and motivation, and broader social outcomes, thereby fostering a sense of belonging, cohesion, connection, and purpose.

The untapped potential of secure work

Who is exposed?

For vulnerable and disadvantaged groups, such as women, young people, migrants, low-skilled and seasonal workers, and those in remote or rural areas, secure and adaptable jobs and employment are especially critical. These populations are often more exposed to job insecurity, unstable working conditions, and economic inequality, as they start with a weaker position in the labour market in general, with less protection against redundancies and a higher risk of experiencing financial worries.

In particular, temporary employment is associated with higher job insecurity when it does not serve as a stepping stone to more permanent contracts. In 2023, 12.3% of the EU workforce were in temporary work arrangements, with more than half of temporary workers involuntarily on such contracts in the EU.

  • Women: Women, especially in low-wage, health, and caregiving sectors, are disproportionately affected by precarious employment, with low job security and unpredictable hours. 4% of women aged 20-64 in the labour market work involuntarily under temporary contracts (vs. 6.2% of men), facing higher stress, worsened mental and physical health, and limited career and financial stability.
  • Young people: Youth entering the workforce often face temporary or gig work, job insecurity, and unstable income, which increases mental health risks and hinders long-term career development. Early job instability and low adaptability during this formative period can have lasting effects on employability and financial security in later life. While job quality is improving – with fewer involuntary and temporary contracts for young people, better work–life balance, and greater sense of security - 8% of young workers (16-24) still experience job insecurity.
  • Migrants: due to a range of factors, migrants may experience exploitative working conditions and lack legal protection, exposing them to job insecurity and low-quality and ‘dead-end’ jobs. This leads to higher stress and anxiety levels, poor health outcomes, including occupational injuries and disability. This can vary by origin (EU vs. non-EU, which constitute about 5% of the EU population), although, generally speaking, migration is considered a significant determinant of health in its own right.
  • Low-skilled, temporary, and seasonal workers: Those in low-skilled jobs, on-call, day hire, zero-hours casual jobs or jobs in organisations undergoing restructuring (privatisation, outsourcing, downsizing) often have less job security and fewer benefits. This not only impacts their health but also perpetuates cycles of poverty and inequality. This instability can affect their physical and mental wellbeing over time. 3% of workers (20-64) were on temporary contracts in 2023 in the EU, and precarious paid employment (fixed-term contracts and temporary work) accounts for 15% of paid employment in the EU. The working conditions of precarious workers are worse than those of permanent workers: 57% work in painful or tiring positions, 38% are exposed to intense noise, 66% perform repetitive movements, 46% perform short repetitive tasks.
  • Rural communities: People in remote or rural areas often rely on a limited range of employment options (especially women and young people), making them more vulnerable to job insecurity. Additionally, these communities may have fewer healthcare resources, amplifying the adverse health effects of unstable work.
Who is exposed?

Positive return on investment

Investing in job security and workforce adaptability generates significant economic and social returns. The European Investment Bank (EIB) estimates that investments in more secure jobs and employment arrangements would contribute an additional 1.10% of EU GDP by 2028.

Conversely, evidence suggests that a rise in self-employment and insecure work results in shortfalls in tax revenues, mainly due to lower earnings among workers on insecure contracts. For example, in the UK, this resulted in a £5.3 billion shortfall in tax revenues in 2017. Stable employment improves health, boosts productivity, and reduces costs to health and social systems.

Policies that support secure and predictable contracts, protection against fluctuations in the demand-supply job market, and reskilling enhance workforce resilience and long-term growth. Proactive and timely measures can help workers in crisis-hit sectors transition into expanding new areas like green and digital industries, as well as ‘essential services industry’ like health, (long-term) care, education, and social innovation.

Evolving skill demands, driven by green and digital transitions, require greater investment in lifelong learning, upskilling, and reskilling. These investments boost employability, address skill gaps, and help workers stay active in the labour market for longer.

Investing in the skills of young unemployed people (aged 15-24) can tackle high youth unemployment rates – an investment of just 0.1 pp more in skill-enhancing training can increase youth employability by 1.4% with overall gains of 0.25% across the life-course, and a long-term GDP growth of 0.18%. This investment can also reduce unemployment disparities and support social convergence, benefiting not just young workers but the broader labour market.

Positive return on investment
About principle 5

What does the EPSR Action Plan say?

The EPSR Action Plan sets out several overarching goals for EU Member States for Principle 5:

  • Increase employment: By 2030, at least 78% of those aged 20-64 should be employed, focusing on young, female and low-skilled workers vulnerable to labour market shifts and economic shocks.

      • At least half the gender employment gap compared to 2019 in order to progress on gender equality and achieve the employment target for the entire working age population.

      • Decrease the rate of young people neither in employment, nor in education or training (NEETs) aged 15-29 from 12.6% (2019) to 9%, namely by improving their employment prospects.

  • Reduce poverty and social exclusion: By 2030, lift at least 15 million people (including 5 million children) out of poverty or exclusion through an integrated, life-course approach tackling its root causes.

  • Enhance digital skills: By 2030, at least 80% of those aged 16-74 should have basic digital skills, and at least 60% of all adults should participate in training every year to ensure inclusion and participation in the labour market and digital society.

  • Ensuring the full participation of underrepresented groups, including older individuals, low-skilled workers, people with disabilities, and marginalised communities, in the labour market will foster more inclusive employment growth.

Where are we now?
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Where are we now?

The Social Scoreboard measures progress on the Principles of the EPSR. Linked to the Principle on secure and adaptable employment, the Scoreboard outlines that in the EU:

  • Unemployment rate was 5.9% among the total EU population, with 9% of all unemployed long-term, while young people aged 15-29 not in employment, education or training (NEETs) at 11%.

  • EU female employment rate was 70.2% (against 80.4% for men), translating to a gender employment gap of 10%.

  • The gender pay gap was 12.7%.

  • Disability employment gap of 21.5%.

  • Basic or above basic digital skills among the EU population aged 16-74 stood at 6%.

  • 8.3% of employed individuals were in-work poor, meaning they were earning an income that is below the poverty threshold, despite having a job.

  • Transition from temporary to permanent contracts 36.3%.

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What are public health actors doing?
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What are public health actors doing?

The following actions taken by public health actors at (sub)national level can support the implementation of EPSR principle 5.

Wales – Healthy Working Wales

Fair work is essential for health and wellbeing, just as good health supports work and the economy. However, not all jobs benefit health — what matters is whether a job is fair and supports pathways into good employment. Fair work ensures workers are fairly rewarded, heard, secure, able to progress, and work in a healthy, inclusive environment where their rights are respected.

Businesses and employers play a vital role in expanding access to fair work, contributing to a more equal, prosperous, and sustainable Wales. Public Health Wales has created and hosts a Healthy Working Wales portal, offering guidance and support on fair work and workplace wellbeing at local and regional agency levels. In addition, the Healthy Working Wales team joined forces in creating a new service with Employee Health and Disability team to help employers and managers provide better support to disabled people and those with health conditions in the workplace.

Wales – Healthy Working Wales

Austria – Health promotion, digital work, and transition management

The Austrian Health Promotion Fund promotes fairness and health in workplaces amid the changing world of work, particularly amid digital transition trends. Its ‘Workplace Health Promotion’ Platform offers practical examples for preparing employees and companies for the challenges of new forms and conditions of work and their impacts on health and wellbeing. It addresses various interest groups (companies, managers, evaluators, employees) from a sustainable and operational perspective.

Austria – Health promotion, digital work, and transition management

Norway – placement and support for people experiencing mental illness

Individual Placement and Support (IPS) is a proven vocational rehabilitation model designed to help people with mental illness gain and maintain competitive employment. It integrates employment support within mental health services, following key principles: rapid job search, personalised and needs-responsive counselling, and ongoing, comprehensive and individualised support. Unlike traditional methods, IPS shifts from ‘train and place’ to ‘place and train’, ensuring individuals secure jobs first and receive tailored stigma-free support thereafter.

The IPS ‘wrap-around’ team consists of an employment specialist, a benefit advisor and a health professional, all integrated within the clinical team providing mental health treatment for service users.

Norway’s Directorates of Health and Labour and Welfare collaborate to implement IPS nationally, addressing relatively high rates of sickness absence and disability benefits. By promoting workforce inclusion and reducing stigma, IPS enhances both mental wellbeing and economic participation, fostering a healthier, more inclusive society.

Norway – placement and support for people experiencing mental illness

Finland – Work Ability Programme

The Finnish Work Ability Programme aims to increase employment by supporting unemployed individuals to regain ability to work. Instead of focusing on incapacity, it strengthens people’s ‘readiness to work’, functional capacity, and employability by:

  • Helping unemployed individuals with partial work ability and long-term unemployed find and retain jobs.
  • Preventing long-term unemployment and physical and psychosocial incapacity for work.
  • Improving labour market participation for vulnerable groups.

From a public health perspective, via the involvement of health professionals such as the Finnish Institute of Occupational Health (FIOH) and the Finnish Institute for Health and Welfare (THL) the programme trains professionals to enhance client employability by focusing on building their health resilience. Training focuses on:

  • Integrating work ability support into social and health centres.
  • Expanding subsidised employment for those facing the greatest challenges.
  • Strengthening professional skills.
  • Evaluating project impact and service coordination.

The Ministry of Economic Affairs and Employment leads the programme in collaboration with the Ministry of Social Affairs and Health, THL, and FIOH. By 2023, €17 million in grants have been awarded to 22 regional projects integrating work ability services into social and healthcare centres.

Finland – Work Ability Programme

Wales - Mass unemployment events: a public health informed response and support

Mass Unemployment Events (MUEs) occur when large-scale job losses destabilise local economies, often due to automation, globalisation, or industrial shifts. These events have severe and lasting effects on health, social structures, and financial security, comparable to those of other major public health emergencies, such as natural disasters.

While responses typically focus on re-employment and vocational training of replaced or redundant workers, the broader health and social consequences – including effects on families and communities – are often overlooked. MUEs increase risks of mental and physical illness, housing, income and food insecurity, and social inequities, requiring a proactive, public health-informed approach. Public Health Wales took such an approach when developing ‘The Public Health Informed Response to MUEs’, a eight step-wise guidance framework. The tool focuses on:

  • Identifying at-risk communities and assessing potential impacts.
  • Developing an early warning system for potential MUEs.
  • Mobilising a multi-sector response with health and community perspectives included.
  • Implementing tripartite support through re-employment, financial stability, health and wellbeing.
  • Addressing specific needs, including older and unskilled workers.
  • Extending support to affected family members.
  • Supporting the wider community and leveraging local assets.
  • Evaluating the responses’ impacts and refining strategies.

This framework ensures MUE responses are place-based, recognising local labour markets, infrastructure, and cultural identities while fostering health and social resilience in affected communities.

Wales - Mass unemployment events: a public health informed response and support

Netherlands – Return to work

Trimbos Institute in the Netherlands developed guidelines to design sustainable policies and practices to support working-age people with mental ill-health or occupational psychosocial conditions to (re-)gain resilience, recover, and return to work (Return@Work programme), and to support their individual job placement arrangements. In 2024, Trimbos Institute gained the status of a WHO/Europe Collaborating Centre on Well-being in the Workplace.

Netherlands – Return to work
What EU tools are out there?

EU tools that help implement Principle 5

There are EU policies and instruments that can help relevant actors in the field, including public health, to work together to achieve EPSR Principle 5 on Secure and adaptable employment.

More information about the EU institutions and programmes is available on EuroHealthNet's Health Inequalities Portal.

Read about EU funding and contact points
Youth Employment Support initiative A fair transition towards climate neutrality EU Joint Employment Reports Improving working conditions in platform work EU Social Economy Action Plan Active support to employment
Youth Employment Support initiative

In 2020, to mitigate the negative impact of the COVID-19 pandemic for young people, the Commission adopted the Youth Employment Support framework. The framework is built around four strands that together provide a bridge to jobs for the next generation:

A fair transition towards climate neutrality
EU Joint Employment Reports
Improving working conditions in platform work
EU Social Economy Action Plan
Active support to employment

Available resources

For more supportive policy instruments on the topic, consult our other flashcards:

More information about the EU institutions and programmes is available on EuroHealthNet’s Health Inequalities Portal.

Available EU funding

Available EU funding

Contact points for further assistance

Contact points for further assistance

Technical resources

Technical resources
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Have your say

Would you like to share promising policies or practices carried out by your public health institute, which support the implementation of this EPSR principle?

Feel free to reach out to our EuroHealthNet colleague Silvia Ganzerla.

What's next?

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