Is transitioning from unemployment into any job better than no job for health? A systematic review

Background

Unemployment is associated with poorer health compared to paid employment. The influence of job quality on the health effects of re-employment is still unclear, despite its prioritization in European and global labour market policies. We aimed to quantify the health effects of moving from being non-employed to paid employment of differing job quality levels.

Methods

We searched MEDLINE, PsycINFO, WoS (SSCI) and EconLit from inception to the 3rd March 2025 (PROSPERO: CRD420250635911). We included studies assessing associations between transitions from being non-employed (unemployed/out of work disabled/long term sick) to high versus low quality jobs on health among working age populations. We critically appraised studies using the Cochrane risk of bias (RoB) tools and assessed certainty using GRADE. We conducted synthesis without meta-analysis based on effect direction for all papers and random-effects meta-analyses where possible.

Results

7575 studies were double screened, with a final sample of 23 studies from high-income countries. Transitions to high quality jobs were beneficial for health compared to staying unemployed. Mental health showed an improvement of 0.35 (95% CI: 0.23 to 0.47) and life satisfaction of 0.60 SD (95% CI: -0.50 to 1.70). Low quality jobs compared to staying unemployed were associated with null or negative effects for mental health (SMD -0.01, 95% CI: -0.26 to 0.25), life satisfaction (-0.10 SMD, 95% CI: -0.90 to 0.69) and biomarkers. Physical health and self-rated health showed slight health improvements. Critical outcomes had very low certainty of evidence and studies were mostly high or very high risk of bias (91.3 %).

Conclusions

While transitions into high quality jobs showed health improvements, low quality jobs showed no clear effect across health outcomes. The existing evidence base remains uncertain and poor quality. More robust causal study designs are needed to better inform welfare and employment policies.

Key messages

• While paid employment is associated with health improvements compared to unemployment, our findings highlight that transitions into low quality jobs may have little health benefits or no effect.

• Re-employment is a priority in welfare policy in Europe and globally. To achieve the intended health benefits, policymakers should prioritise access to high-quality jobs in labour market policy.