BACKGROUND:The aim of this study is to estimate the prevalence of informal workers and their working conditions and employment precariousness in the EU-27; and to explore the association of different contract arrangements with health outcomes and how they are influenced by working and employment conditions.METHODS:A sample of 27 245 working-age employees from the fifth European Working Condition Survey of 2010 was analysed. Logistic regression models were fitted to estimate the contribution of different contract arrangement (permanent, temporary and informal) and working and employment precariousness variables on health outcomes (psychosocial well-being and self-rated health).RESULTS:Prevalence of informal employees in the EU-27 is 4.1% among men and 5.1% among women. Although informal employees have the poorest working conditions and employment precariousness, they did not seem to reflect poorer health. Precariousness employment variables have a greater impact than working conditions variables in reducing the association between health outcomes and type of contract arrangement, especially in the case of informal employees.CONCLUSIONS:Informal employment in the EU-27 is characterized by worse working conditions and employment precariousness than the conditions for formal employees. There is no evidence at all that being in informal employment implies better health outcomes compared to permanent employees.

Employment precariousness (EP) has expanded over recent years. The aim of this study is to test the existence of a general precarisation of the Spanish labour market and its association with mental health for different types of contract. On the subsample of salaried workers from the second Psychosocial Work Environment Survey and using the revised Employment Precariousness Scale (EPRES-2010), we calculated the prevalence of EP and poor mental health for salaried workers. We created six groups of workers according to their levels of EP and types of contract. We used Poisson regressions, stratified by gender, to examine associations between belonging to the different groups of workers and poor mental health. Although temporary workers had a higher prevalence of EP and poorer mental health than permanent workers, we found that the association with poor mental health was unexpectedly stronger in permanent workers with high precariousness (2.97, IC95% 2.25-3.92 in men and 2.50, 1.70-3.67 in women) than in temporary workers (2.17, IC95% 1.59-2.96 in men and 1.81, 1.17-2.78 in women). A gradient of poor mental health existed by EP score for both men and women and permanent and temporary workers. The Spanish labour market is highly affected by employment precarisation. Using the multidimensional EPRES is more informative and a better tool for mental health research than type of contract alone. Creating a surveillance system to monitor the magnitude and evolution of EP has to be a priority in order to reduce health inequalities and to evaluate the impact of policies and programs. (C) 2017 Elsevier Ltd. All rights reserved.

OBJECTIVE:To measure time trends in major day surgery rates according to hospital ownership and other hospital characteristics among the providers of the public healthcare network of Catalonia, Spain. METHOD:Data from the Statistics of Health Establishments providing Inpatient Care. A generalized linear mixed model with Gaussian response and random intercept and random slopes. RESULTS:The greatest growth in the rate of major day surgery was observed among private for-profit hospitals: 42.9 (SD: 22.5) in 2009 versus 2.7 (SD: 6.7) in 1996. These hospitals exhibited a significant increase in major day surgery compared to public hospitals (coefficient 2; p-value <0.01) CONCLUSIONS: The comparative evaluation of hospital performance is a decisive tool to ensure that public resources are used as rationally and efficiently as possible.

BACKGROUND:Informal employment (IE) is one of the least studied employment conditions in public health research, mainly due to the difficulty of its conceptualization and its measurement, producing a lack of a unique concept and a common method of measurement. OBJECTIVE:The aim of this review is to identify literature on IE in order to improve its definition and methods of measurement, with special attention given to high-income countries, to be able to study the possible impact on health inequalities within and between countries. METHODS:A scoping review of definitions and methods of measurement of IE was conducted reviewing relevant databases and grey literature and analyzing selected articles. RESULTS:We found a wide spectrum of terms for describing IE as well as definitions and methods of measurement. We provide a definition of IE to be used in health inequalities research in high-income countries. Direct methods such as surveys can capture more information about workers and firms in order to estimate IE. CONCLUSIONS:These results can be used in further investigations about the impacts of this IE on health inequalities. Public health research must improve monitoring and analysis of IE in order to know the impacts of this employment condition on health inequalities.

Introduction Informal employment, despite infrequent in the European Union compared with middle and low-income countries, affects an important number of workers. However, little is known about informal employment and its association with health. The aims of this study were to estimate the prevalence of informal employment in the EU-27, a well as their associated working and employment conditions (extent of employment precariousness), and to analyse its relationship with health compared to other employment arrangements. Methods Data from the fifth European Working Condition Survey of 2010 was used. A subsample of 27,076 salaried workers from EU-27 on working age people (15–64 years) was selected. As dependent variables we selected psychological well-being and self-related health. We calculated the prevalence of poor working conditions (i.e. psychosocial risk variables, job satisfaction, place of work,…) and employment precariousness across three classes of employment arrangements: permanent, temporary and informal. Logistic regression models were fitted in order to test the association between psychological well-being and self-related health with contract arrangements. Results The proportion of informal employees in the EU-27 was 4% among men and 5% among women. A gradient of poor working conditions and employment precariousness was present according to type of contract, where the best conditions were observed among permanent employees and the worst among informal employees. In spite of this gradient, temporary and informal employees had similar risks compared with permanent workers regarding both poor psychosocial well-being and self-related health for both sexes. Conclusions Informal employment is also present in high-income countries and is characterised by worse working conditions and higher employment precariousness than formal employment. However, their risk of poor psychosocial well-being and self-related health was similar to that of temporary employees, both being higher than that of permanent employees.

Introduction Employment precariousness has expanded over recent years. It needs to be analysed as part of a continuum of different employment conditions and in a multidimensional way. The aims of this study were to test the existence of a general precarization of the Spanish labour market and its association with mental health for workers in different types of contracts and whether the Employment Precariousness Scale is a better tool for health inequalities research than a unidimensional measure like temporariness. Methods Using the revised Employment Precariousness Scale (EPRES-2010), this study calculated the prevalence of employment precariousness and poor mental health across six groups of workers according to their levels of employment precariousness and types of contract. Associations between the different groups of workers and poor mental health was analysed using Poisson regressions. All analyses were stratified by gender. Results A higher prevalence of employment precariousness and of poor mental health was found among temporary than permanent workers. The association between precarious employment and poor mental health was stronger than that across contract types, and was somewhat stronger among permanent than temporary workers. For both women and men, a gradient of poor mental health existed by employment precariousness score for both permanent and temporary workers. Discussion The Spanish labour market has become highly affected by employment precarization. The use of EPRES was more informative and a better tool for mental health research than type of contract alone. Creating a surveillance system to monitor the magnitude and evolution of employment precariousness as a multidimensional construct has to be a priority in order to reduce health inequalities and to evaluate the impact of policies and programs.

The generalization of flexible labour markets, the declining influence of unions and the degradation of social protection has led to the emergence of new forms of employment at the expense of the Standard Employment Relationship, as well as a considerable amount of research across social and scientific disciplines. Years ago we suggested the urgent need to disentangle the consequences of new types of employment for the health and well-being of workers, contending that the study of precarious employment and health is in its infancy. Today, research challenges include clearer, more precise definitions of the original concepts, a more detailed understanding of the pathways and mechanisms through which precarious employment harms worker health, stronger information systems for monitoring the problem and a complex systems approach to employment conditions and health research. All of these must be guided by the theoretical and policy debates linking precarious employment and health, and be geared towards developing better tools for the design, implementation and evaluation of policies intended to minimize precariousness in the labour market and its effects on public health and health inequalities. Our aim in this paper is to outline an agenda for the next decade of research on precarious employment and health, establishing a compelling programme that expands our understanding of complex causes and links.

Objetivo: Mostrar por vez primera la prevalencia de la precariedad laboral medida en forma multidimensional en Cataluña y su asociación con la salud mental y autopercibida. Método: Estudio transversal con datos de la II Encuesta Catalana de Condiciones de Trabajo (2010) con una submuestra de personas asalariadas con contrato. Se calculó la prevalencia de precariedad laboral usando una escala multidimensional, y su asociación con la salud mediante regresiones log-binomiales multivariadas estratificadas por sexo. Resultados: La prevalencia de la precariedad en Cataluña es alta (42,6%). Encontramos mayor precariedad en las mujeres y en los/las trabajadores/as jóvenes, inmigrantes, manuales y con menor educación. Existe un gradiente positivo en la asociación con la mala salud. Conclusiones: La precariedad laboral se asocia con peor salud en la población trabajadora. Deberían incluirse preguntas sobre precariedad e indicadores de salud en las encuestas de condiciones de trabajo para poder realizar una posterior vigilancia y un análisis de las desigualdades en salud.

Objective: To show the prevalence of precarious employment in Catalonia (Spain) for the first time and its association with mental and self-rated health, measured with a multidimensional scale.Method: A cross-sectional study was conducted using data from the II Catalan Working Conditions Survey (2010) with a subsample of employed workers with a contract. The prevalence of precarious employment using a multidimensional scale and its association with health was calculated using multivariate log-binomial regression stratified by gender.Results: The prevalence of precarious employment in Catalonia was high (42.6%). We found higher precariousness in women, youth, immigrants, and manual and less educated workers. There was a positive gradient in the association between precarious employment and poor health.Conclusions: Precarious employment is associated with poor health in the working population. Working conditions surveys should include questions on precarious employment and health indicators, which would allow monitoring and subsequent analyses of health inequalities. (C) 2015 SESPAS. Published by Elsevier Espana, S.L.U. All rights reserved.

High quality employment in a regulated labour market is beneficial to workers´health and reduces inequality

Employment precariousness is a social determinant that affects the health of workers, families, and communities. Its recent popularity has been spearheaded by three main developments: the surge in "flexible employment" and its associated erosion of workers' employment and working conditions since the mid-1970s; the growing interest in social determinants of health, including employment conditions; and the availability of new data and information systems. This article identifies the historical, economic, and political factors that link precarious employment to health and health equity; reviews concepts, models, instruments, and findings on precarious employment and health inequalities; summarizes the strengths and weaknesses of this literature; and highlights substantive and methodological challenges that need to be addressed. We identify two crucial future aims: to provide a compelling research program that expands our understanding of employment precariousness and to develop and evaluate policy programs that effectively put an end to its health-related impacts.

M Julià, G Tarafa, J Benach EMCONET, Universitat Pompeu Fabra, Barcelona, Spain Transdisciplinary Research Group on Socioecological Transitions (GinTRANS2). Universidad Autónoma Madrid, Madrid, Spain Contact: gemma.tarafa@upf.edu Background Informal employment (IE) is one of the employment conditions less studied in high-income countries such as in the European Union and the relationship between IE and health or health inequalities that, as far as we know, are not studied in these countries. The objectives of this article are: know how we define IE to be used in measures using European surveys; measure the IE in countries of EU-27 for both 2005 and 2010; know the social distribution of poor work-related health; and know the relationship between this outcome and IE. To our knowledge, this is the first study that evaluates these relationships in highincome countries and could be an interesting issue in public health and policies. Methods A subsample of 57.264 employment aged participants (between 15-64 years old) in the EU-27 from the 4th (2005) and 5th (2010) European Working Conditions Survey was analysed. Prevalence of IE and the social distribution of poor workrelated health were calculated. Binomial logistic regression model were fitted in order to test the association between work-related health and IE. Results IE is present in all countries of the EU-27 but prevalences are different, between 5.5% in Sweden and 46.1% in Cyprus in 2005 and 5.3% and 45.7% respectively in these countries in 2010. Our results are contrary to our initial hypothesis. They show an association for IE with poor work-related health in informal self-employers (0.82; 95% CI = 0.71-0.95), informal employers (0.64; 95% CI = 0.51-0.80) and informal employees (0.72; 95% CI = 0.60-0.86) but the association is not significant in family workers (0.85; 95% CI = 0.63-1.13) in 2010. In 2005, only informal employees are significant only informal employees are significant (0.73; 95% CI = 0.62-0.85). These results are still preliminary. Conclusions Our preliminary results suggest that informal workers not have poor work-related health comparing with formal workers mainly in 2010, with a context of economic crisis. These results are contrary to our initial hypothesis therefore, more research is needed in order to understand and to improve the instruments to measure and analyse the impact on health inequalities of IE. These could be especially relevant for the evaluation of the health inequalities impact of new labour market policies. Key messages We can create surveillance for informal employment and their impact on health inequalities in the EU-27. This surveillance could be useful for future public health policies, labour market policies as well as economic policies. 7th European Public Health Conference: Thursday 20 November 2014 16:00-17:00 53

,yalavez ha aumentado tambien significativamente el debate social enEspana en los ultimos a˜ nos. El copago, tambien conocido en ingles˜comopatientcost-sharingoengeneralout-of-pocketspendingbypri-vate households, incluye muchas posibilidades: desde la puesta enpracticadeunpagoporserviciosdeatencionmedica,elincrementode un pago ya existente, o su ampliacion a personas que deberianpagar. Este articulo revisa algunas de sus ventajas y problemas, conun enfasis especial en la equidad. El copago, sin embargo, no esunasunto“tecnico”quepodamosentendersolamenteconlamejorevidenciacientificadisponible,sinoquetambienesimprescindiblevalorar las estrategias y los intereses politicos que lo sustentan.Ventajas y problemas del copagoLasprincipalesventajasaducidasparajustificarlanecesidaddelcopago tienen que ver con factores asociados a la economia y ladisuasion sanitaria. En el primer caso, se senala que si las personas˜enfermas pagan directamente parte de los servicios o productosconsumidos se reducira el uso excesivo e injustificado de estos,y se ahorraran recursos que podran utilizarse mas eficientementepara ayudar a financiar una sanidad publica que, se dice, es (o vaa ser) “insostenible” por resultar demasiado costosa y generosa.Sin embargo, muchos estudios muestran que el copago reduce eluso de servicios sanitarios, sean o no efectivos, en visitas medicas,prescripciones farmaceuticas, admisiones hospitalarias o serviciospreventivos