The rapid growth of precarious employment in the United States, specifically the mushrooming of temporary work arrangements, undermines workers’ health and safety in multiple ways. Temporary workers hired through staffing agencies have higher levels of job insecurity and receive fewer benefits than direct hire workers. Lack of training, protection, and experience can have a particularly deleterious impact among those in hazardous temporary jobs, with disproportionate effects among younger workers and workers of color. Heightened health and safety risks facing temporary workers are shaped in part by the complexities of temporary employment arrangements, which create ambiguous lines of responsibility for complying with health and safety standards, and by a regulatory framework that has not kept pace with changes in labor markets or employment structures. Because temporary workers are largely without union representation and experience high levels of job insecurity, they are reticent to report workplace hazards and on-the-job injuries and illnesses. Temporary workers’ fear of retaliation and termination limit the ability of employers and government agencies to identify and correct hazards and to provide injured workers with access to workers’ compensation. The growth in temporary work also has broad public health implications and effects that include erosion of job security in the broader workforce, an occupational health surveillance system that is based on inadequate or inaccurate data, and cost shifting of injuries and illnesses among temporary workers from the workers’ compensation system to the overtaxed health insurance system. Education, research, and policy initiatives at the state and federal levels are needed to address the public health impact of temporary work arrangements.
Relationship to Existing APHA Policy Statements
As a group, the following APHA policy statements promote the health of all workers by advocating for government policies that prevent work-related injuries and illnesses, compensate those who are injured, support workers’ ability to balance the stress of work and family demands through paid sick and family leave policies, and, finally, provide workers with an avenue to improve working conditions through union representation.
• APHA Policy Statement 20138: Support for Workplace Injury and Illness Prevention Programs
• APHA Policy Statement 20097: Workers’ Compensation Reform
• APHA Policy Statement 20136: Support for Paid Sick Leave and Family Leave Policies
• APHA Policy Statement 20068: Resolution on the Right for Employee Free Choice to Form Unions
• APHA Policy Statement 2005-4: Occupational Health and Safety Protections for Immigrant Workers
In addition, Policy Statement 2005-4 acknowledges the particular socioeconomic and political context of immigrant workers that creates inequities in exposure to hazards and access to health care.
This proposed policy supplements existing APHA policies by explicitly highlighting the lack of viable avenues for temporary workers to exercise the rights afforded to all workers, including the right to report workplace hazards and to access compensation when injured. The recommendations outlined in this policy are designed to ensure that workers hired through temporary staffing agencies are not excluded from the protections and benefits provided to direct hire workers.
Growth and structure of temporary work: Over the course of the last two decades, workers hired through temporary staffing agencies have become a major component of the burgeoning contingent workforce that has penetrated virtually all sectors of the US labor market. Contingent work, which includes temporary workers, is defined by the Bureau of Labor Statistics (BLS) as “any job in which an individual has no explicit or implicit contract for long-term employment.” The BLS has concluded that about one third of the US workforce is employed through some form of contingent work arrangement, recognizing that this workforce is composed of individuals involved in an array of nonstandard, precarious employment relationships (e.g., on-call workers, independent contractors, and day laborers). US Census Bureau data indicate that the contingent workforce occupies a second-class labor market position. For example, less than one fifth of contingent workers (18%) are covered by employer-provided health insurance, as compared with slightly more than half (52%) of workers employed through standard work arrangements.
Contingent workers are, on the whole, slightly younger, more likely to be female, less likely to be White non-Hispanic, and less likely to have a high school diploma (or equivalent) than other workers. Data from the US Census Bureau show that, in 2005:
5.7 million workers were classified as contingent.
- The demographic characteristics of workers in alternative employment arrangements varied depending on the type of arrangement. For example, independent contractors were more likely than workers in standard arrangements to be older, male, and White. Temporary agency workers were more likely to be young, female, and Black or Hispanic/Latino.
- In comparison with noncontingent workers, contingent workers were more likely to have less than a high school diploma and less likely to have at least a bachelor’s degree.
The contingent workforce employed through temporary staffing agencies, the focus of this policy statement, presents a unique array of social and economic problems that are connected to the triangulated structure of temporary work arrangements. The relationship dynamics of this triangulated structure, which includes the worker, a hiring employer of record (the staffing agency), and the host employer (or client firm), differ from those of standard, bilateral work arrangements in which an employer directly hires a worker. That is, the triangulated temporary work structure involves two employer entities: a staffing agency that serves as the employer of record for purposes of hiring, placing, and paying the temporary worker and a client firm that controls the conditions of work and, in most cases, is responsible for day-to-day supervision of the worker. This structure presents an array of challenges to the health and well-being of workers and has severely compromised the enforcement of workplace laws, particularly in the low-wage sector of the temporary staffing industry.
Client firms retain temporary staffing agencies to avoid legal liabilities and to minimize costs. They look to these agencies to assume responsibility for problems that arise in the temporary workforce. However, because staffing agencies often have no role in the day-to-day supervision of temporary workers and limited direct knowledge of the type of work being performed, they are ill suited to evaluate workers’ performance or to correct hazardous work conditions. These problems persist even in temporary staffing arrangements in which the staffing agency supplies on-site supervisors. In these situations, the addition of staffing agency supervisors often contributes to confusion as to who is responsible for worksite health and safety enforcement. Other problems include inadequate training and truncated workforce tenures. The blurred lines of legal responsibility that accompany this employment structure have increased the frequency of wage and hour violations among temporary workers and have led to heightened risks with respect to workers’ health and safety, posing a challenge to government agencies responsible for enforcing compliance with health and labor standards.
The discontent arising from temporary triangulated employment structures is growing for at least two reasons. First, the temporary staffing workforce is expanding more rapidly than the standard workforce. According to the American Staffing Association, 11 million temporary and contract employees are hired by US staffing firms over the course of a given year. In addition, the number of temporary staffing agency workers has jumped by more than 50% since the recession. This indicates that temporary workers hired and deployed by staffing agencies are not used simply to fill in for workers who are on vacation or using sick days. Rather, temporary work has become an established mechanism to perform core business functions in response to the demand for flexible labor and lean production in virtually every sector of the economy. Second, the temporary workforce has a disproportionately large number of vulnerable workers. As noted above, temporary workers, particularly those in the low-wage sector, are more likely to be young, female, and Black or Hispanic/Latino. These temporary workers are not “choosing” contingent work as a matter of lifestyle or choice; studies show that only 32% of temporary workers prefer their current employment arrangement.
Staffing agency temporary workers now constitute more than 2% of the American labor force. But the widespread use of temporary workers to perform core business functions has impacts far in excess of labor market share. The ubiquitous presence of temporary work undermines the hopes of workers who aspire to long-term employment. The temporary staffing industry contributes to the anxiety direct hire workers experience as the ever-expanding use of temporary workers gives them good reason to question the security of their own jobs. And, as explained in greater detail below, temporary work arrangements undermine the enforcement of laws designed to protect worker health and safety and minimum wage standards in workplaces across the United States.
Deleterious effects on workers’ health: The themes emerging from investigative journalism and academic research on the temporary workforce can be divided into two areas: (1) discrepancies related to wages and benefits  and (2) discrepancies related to health outcomes.
First, temporary workers earn less than their permanent counterparts and are less likely to have health benefits. Blue-collar workers in production and transportation and material moving occupations earn 20% to 30% less if they are temporary workers. Those in office and administrative positions also earn lower wages than their permanent counterparts. Differentials are smaller only in the case of some highly skilled professions such as nursing (e.g., temporary nurses’ wages are approximately 10% less than those of direct hire nurses). In addition, BLS data demonstrate limited benefits for contingent workers, including those in temporary work arrangements. For instance, more than half (52%) of direct hire workers are covered by health insurance, as compared with 18% of contingent workers.
Second, temporary work arrangements create factors that contribute to disproportionately negative health outcomes among temporary workers, including greater job stress and associated mental health outcomes, higher rates of exposure to hazardous work environments, inadequate training and experience to help avoid hazards, and, consequently, a higher risk of injuries. For example, temporary workers, including those employed by agencies, are at greater risk than permanent employees of experiencing work-related injuries. Temporary agency workers in the United States have higher rates of workers’ compensation claims and longer claim durations than workers in standard employment arrangements, and those in the construction and manufacturing sectors are twice as likely to incur an injury. Similar outcomes are evident from research on European temporary staffing agency workers. A study involving employees from all 15 member states of the European Union demonstrated that fatigue, backache, and muscular pain were reported more often by full-time temporary workers than by permanent workers. Also, researchers in Spain found more reports of traumatic occupational injuries among temporary workers than among permanent workers. Workers in occupations involving crafting and machine operation or plant assembly were especially at risk. In the Netherlands and Germany, workers employed by temporary agencies account for as many as 13% of occupational accidents, although they fill only 3% of jobs.
A study of workers in Washington State showed that temporary workers had higher rates of injury from toxic exposures than permanent workers, almost 400% higher in some sectors. A number of reports in the literature discuss cases of temporary workers without sufficient training who have suffered serious injury or death due to chemical exposures.[14–16]
Researchers have also documented the impact of employment structure on health outcomes. Workers in temporary jobs are at increased risk of psychological illness resulting from factors such as job insecurity and lower work-life quality. Roquelaure and colleagues reported almost double the frequency of self-reported job strain among temporary workers, and Audhoe and colleagues reported that temporary workers have an elevated risk of absence from work owing to psychological problems.
Factors contributing to workers’ risk of injury and illness: The expansion of the temporary staffing industry is, in part, due to the adoption of a “liability model of employment” whereby workers are seen by the client firm and the staffing agency as temporary and disposable rather than as assets to employers. This model elevates the risk of workplace exposures, injury, and illness given the limited incentive to train or provide other health and safety protection for workers who may spend only limited time on the job.
The temporary staffing industry has bifurcated employer responsibilities for health and safety standards in a manner that increases temporary workers’ vulnerability to workplace hazards. For example, an inherent characteristic of temporary work is the worker’s lack of experience with the workplace. This is an established contributor to injuries.[12,21] Temporary workers are frequently limited by staffing agency contracts to employment at a particular job for less than 6 months or a year. Consequently, given their lack of familiarity and experience with a particular job or worksite, their risk of injury is greater. As such, temporary workers’ exposure to risk is akin to that of new workers, a group in which higher injury rates have been demonstrated.[22,23] Similarly, temporary workers may be seasonal employees hired at times of increased demand, leading to a faster pace of work, long hours, and production pressure, all known contributors to accidents.
Failure to provide sufficient training or safety equipment is another cause of injuries experienced by temporary workers.[12,25–28] In some cases, staffing agencies and their client firms (or host employers) are unclear about which entity is responsible for providing training or equipment. In other cases, employer practices are consistent with efforts to cut cost. In the petrochemical industry, for instance, shorter training received by temporary workers is associated with an increased risk of injury among these workers.
Temporary workers have limited avenues to effectively communicate about hazards or to have a voice in health and safety programs. They almost universally lack union representation, a factor associated with safety training. Furthermore, in some industries in which large numbers of temporary workers are immigrants with limited English proficiency, language barriers inhibiting communication about hazards and safety precautions are prevalent.
Finally, the structure of temporary employment creates a system with incentives for employers to outsource hazardous jobs to workers employed through staffing agencies. A major reason businesses are said to use temporary staffing agencies is to decrease the cost of workers’ compensation premiums through misclassification to a lower risk group. When workers’ compensation experience ratings are set according to the temporary agency classification rather than that of the client firm, and when premiums are paid by the agency rather than the client (or host) employer, the financial incentive to create a safer workplace is attenuated and control of hazards is compromised.[8,10]
Failure of the current legal/regulatory occupational health and safety framework: The current federal and state legal/regulatory framework intended to protect workers and enforce compliance with labor standards is severely strained by significant shifts in the structure of the employment relationship and labor markets. This strain on workplace regulation and enforcement is largely caused by the fact that most workplace laws were enacted to regulate the standard employment relationship—in which workers are directly hired, paid, and supervised by an employer that controls the organization and conditions of work—rather than the range of contingent employment relationships that have taken root throughout the economy. The rise of nonstandard work relationships has challenged the efficacy of a host of workplace laws, including those involving the right of workers to unionize and bargain collectively with their employer over wages, benefits, and conditions of work such as safety and the responsibility of employers to provide a workplace free of exposure to recognized hazards, to accurately report work-related injuries and illness, and to compensate injured workers.
The challenge of enforcing these laws in triangulated employment structures calls for legal reform and stepped-up enforcement. This is particularly the case in the logistics sector, in which warehousing of retail goods has been extensively subcontracted to firms that premise their business model on the hiring of a large percentage of their workforce through temporary staffing agencies. Egregious violations of health and safety standards have also been documented in the food processing and recycling/refuse industries, wherein temporary staffing agency workers are routinely employed.
The absence of workplace law reform to address the challenges associated with temporary work has led the Organisation for Economic Co-operation and Development (OECD) to rank the United States second to last among 32 OECD member countries with respect to quality of legal protections for temporary workers. Of particular note is the fact that neither federal nor state laws place restrictions on the number of renewals or prolongations of temporary work assignments or on the maximum cumulated duration of temporary assignments.[32–34] US federal laws that provide minimum workplace standards do not require equal treatment of temporary workers and their permanent counterparts. Inequality in wages for temporary workers and direct hire workers performing exactly the same tasks contributes to degradation of work under the staffing industry business model. To complicate matters, the temporary staffing industry is subject to few uniform authorization, licensing, or reporting obligations; each state determines whether special temporary work agency licenses are required and, if so, establishes its own procedures.
Workers’ health is affected by the inadequacy of US federal and state policies in several ways.
First, lacking union representation (with few exceptions), temporary workers have limited avenues to exercise a voice or negotiate over the conditions of work, including wages, benefits, and safe working conditions.[8,35] Second, blurred lines of responsibility for training and protecting workers enable unscrupulous employers to avoid compliance. Low-road temporary staffing agencies and their client firms, particularly those who employ immigrant workers, routinely skirt their responsibility to inform temporary workers about the conditions of work; fail to establish workable mechanisms to report hazards, injuries, and illnesses to the appropriate employer; and lack a workable process to allow temporary workers to obtain workers’ compensation benefits. Also, government agencies are not adequately educated as to the complex employment dynamics of the temporary staffing industry. Occupational Safety and Health Administration (OSHA) and Mine Safety Health Administration compliance officers may lack clarity about enforcement procedures, and employers may exploit the ambiguity as to lines of liability for violations involving temporary workers to avoid their responsibility to abate workplace hazards.
Enforcement efforts are complicated by the legal separation of responsibility for compensating injured workers (generally assumed by the temporary staffing agency) and responsibility for providing safe working conditions (assumed by the on-site host employer or client firm). Effective use of experience rating rules to incentivize employers to control hazards is based on the assumption that the employer bearing the cost of work-related injury and illness also controls the conditions of work. MacEachen and colleagues have shown how experience rating rules instead create a market for outsourcing risky jobs to temporary staffing agencies, which cannot adequately implement injury prevention activities or return-to-work accommodations. They described how staffing agencies in Canada compromise enforcement efforts by absorbing experience rating costs for their clients and avoid financial risk through cost transfers, premium rate groups, legal positioning, influencing accident reporting practices, and shutting down and reopening their businesses.
Impact of lack of accurate data on public health interventions: The transitory nature of workers hired through staffing agencies and the lack of clear responsibility for recording injury and illness statistics in triangulated employment structures pose challenges to accurate data collection and analysis. The precarious nature of temporary employment magnifies the acknowledged problem of workers underreporting occupational injuries and illnesses. Furthermore, the BLS may not distinguish between the different categories of contingent workers described above. Disjointed, incomplete, and inaccurate data impede public health efforts to monitor the impact of temporary employment and design effective interventions.
Evidence-Based Strategies to Address the Problem
Four strategies have been employed to address the problems described above: organization and education of workers to inform them of their rights, research to document the effects of temporary work and to identify approaches to protect workers, legislation and regulation at the state level, and a regulatory emphasis by OSHA at the federal level. Critical to the success of any strategy is a multidisciplinary, collaborative approach that combines public health, labor, and employment relations expertise and integrates affected workers and worker advocates. The effectiveness of such an approach has been demonstrated in research and policy initiatives designed to ameliorate job insecurity and health problems associated with the nonstandard employment structure of the home care workforce in California and with the situation of low-wage temporary workers in the recycling, light manufacturing, and food processing industries in Massachusetts.
The four strategies just mentioned are supported by the National Staffing Workers Alliance in collaboration with occupational health and safety professionals and worker advocacy groups. Outcomes to date include policy initiatives at both the state and federal levels.
Eight states, including California, have adopted legislation in this area. A basic component of these states’ legislative strategy is to inform workers about the terms and conditions of their employment. This approach is consistent with APHA policies supporting workers’ right to know about hazards on the job. Legislation in these states also provides for restrictions on charges accrued by workers and a basic employment notice including information about the nature of the job, wages, contact information for the agency, and the need for training, special equipment, or safety gear. In addition, the California legislation advances the concept of dual employer responsibility.
OSHA has initiated an emphasis program to address the challenges posed by temporary work arrangements. Two memorandums[39,40] and a guidance document on injury and illness recordkeeping requirements are designed to clarify the responsibilities of both employers in the dual employer temporary work structure and to guide the enforcement activities of agency compliance staff. Recommendations on improving temporary worker health and safety have been developed by the APHA Occupational Health and Safety Section, the National Staffing Workers Alliance, and the National Council for Occupational Safety and Health, and these recommendations have been discussed with OSHA leaders. The recommendations specify the need to further clarify health and safety responsibilities in dual employer settings; target, track, and collect data on temporary employment, violations of health and safety regulations, and work-related injuries and illnesses; strengthen the internal capacity of OSHA compliance officers; investigate the use of temporary workers and their exposures as part of the workplace inspection process and investigation protocol; and strengthen protection of temporary workers from retaliation in partnership with nonprofit worker advocacy groups.
Finally, effective workers’ compensation systems are critical when injury prevention strategies fail. Systems that are appropriately structured can create financial incentives to provide safe work environments. However, too often workers’ compensation systems allow host employers that are primarily responsible for safe working conditions to shift that responsibility to temporary staffing agencies, which have little or no control over those conditions. The consequences have been documented in Canada and in a recent analysis of workers’ compensation claims in five US states where, over a 5-year period, the incidence of injuries among temporary workers was between 36% and 72% higher than that among nontemporary workers. OSHA urges host employers and temporary staffing agencies to communicate and coordinate responsibilities for reporting injuries and illnesses and for implementing protective measures before other workers are injured. More clarity and oversight are needed to address these inequities and ensure that injured workers are compensated regardless of employment structure.
The temporary staffing industry has vigorously opposed any regulation aimed at addressing problems associated with its business model. The consistent argument advanced by the staffing industry is that regulation will interfere with its ability to provide a flexible workforce to respond to employer demands for seasonal or fluctuating staffing. The staffing industry also contends that it is meeting temporary workers’ desire for flexibility and that temporary employment is a stepping stone to job promotions and permanent employment. In short, the industry argues that any such regulation would lead to job loss among temporary and standard workers.[44,45]
Flexible hiring is not the only factor driving the devolution of employer responsibilities for safe working conditions and workers’ compensation. As explained by Weil, work is increasingly “fissured” as a wide range of companies in all sectors shed employees to lower labor costs by shifting the work and the cost of liabilities to the temporary staffing industry and other third-party intermediaries.
The staffing industry’s contention that it is merely responding to business demands has been addressed by Hatton, who demonstrated that temporary staffing agencies are not passive market participants. She has shown how the staffing industry uses creative marketing strategies to help create the demand for temporary workers by framing workers as a liability and drain on resources, something the staffing industry can ameliorate by assuming responsibilities for an increasingly broad range of business functions. Similarly, data do not show that the staffing industry is responding to a worker-driven quest for flexible work. As noted above, according to the US Census Bureau, only 32% of temporary staffing agency employees prefer their current arrangement. Furthermore, the rapid growth of “permatemps” (those involved in long-term employment in temporary work arrangements) refutes the assertion that temporary work arrangements are designed to meet a specific need. Rather, this trend is indicative of labor market strategies to disinvest in workers and quality jobs.
The available data on current labor market trends indicate that employers will continue to hire employees for short-term work assignments through workforce structures that allow for high levels of flexibility and mobility. However, labor market flexibility does not have to be synonymous with low wages, substandard health and safety conditions, or job insecurity. The temporary staffing industry’s economic model is not the only means of addressing employers’ quest for flexibility and just-in-time staffing. The unionized construction and longshore industries, for example, have developed flexible staffing schemes through hiring halls and collective bargaining agreements that address industry needs for seasonal work and variable staffing levels while maintaining decent work conditions, enforcing workplace safety standards, and providing employee benefits. Unfortunately, the US temporary staffing industry, the leading proponent of workforce flexibility, has offered no affirmative strategy to bring fairness to flexible work arrangements. Rather, it has opposed any legislative intervention to regulate low-road practices. Indeed, largely as a result of the temporary staffing industry’s lobbying efforts, the United States is unique among developed countries in its failure to enact nationwide laws that effectively regulate the industry.
Many member countries of the European Union (EU) have coupled laws expanding the legitimate use of temporary staffing with regulations that create protective legislation for temporary workers. In 2002, the European Commission proposed a directive that acknowledged discrimination against temporary workers and proposed minimum EU-wide standards. In 2008, the EU adopted a pair of articles as part of the Temporary Agency Work Directive: Article 4, which restricts or limits temporary work, and Article 5, which requires that temporary workers be given the same treatment as their permanent coworkers.
A growing number of EU member states, including France, Luxembourg, Denmark, Spain, and Greece, have also begun to address the growing problem of “permatemping” by setting limits on the type and duration of temporary work that is permitted. Similarly, Israel responded to the growth of temporary work with legislation regulating temporary staffing agencies; as of 2011, the duration of temporary employment was limited to 9 months, and, during that period, workers were required to be provided with benefits.
In the United States, policy change has begun on a state-by-state level, as described above. For example, Illinois and Massachusetts have enacted legal reforms to provide meaningful protections for the low-wage temporary staffing workforce. Referred to as “right to know” laws, these reforms have created a level of transparency and accountability in the hiring and deployment of temporary workers. More needs to be done in this regard.
To further strengthen protections for temporary workers and enhance the effectiveness of the strategies described above, APHA urges:
• Congress to reform labor laws to provide meaningful labor rights to temporary workers, including access to union representation and the ability to negotiate for equal rights with other workers at the same worksite (e.g., with respect to benefits and working conditions).
• The executive and legislative branches of government at the federal, state, and local levels to, respectively, issue executive orders and enact legislation to limit governmental use of temporary staffing services to situations involving seasonal fluctuations in workload, absences for vacation and sick leave, and additional staffing required by short-term exigent needs. Government actions should also set equitable standards for wages and benefits of temporary workers, precluding the use of temporary staffing agencies to undermine federal and state salaries, benefits, and the right to union representation.
• OSHA to implement the list of recommendations created in 2013 by the APHA Occupational Health and Safety Section, the National Council for Occupational Safety and Health, and the National Staffing Workers Alliance.
• The National Institute for Occupational Safety and Health and universities to expand research that documents, through a multidisciplinary, community-based participatory approach, the impact of temporary work on the health of temporary workers and on the workforce overall.
• The BLS to undertake research on differences between injury rates among employees of temporary staffing agencies and rates among standard/permanent workers.
• States that have not already done so to adopt “right to know” legislative reforms for the temporary staffing workforce. Specifically, states should:
o Require employers to provide temporary staffing agency workers with information about each new job they undertake as well as their rights under the federal Occupational Safety and Health Act, state workers’ compensation laws, and other relevant employment and labor laws.
o Require staffing agencies to report data on the types of workplaces to which temporary workers are assigned and certify provision of training and protection for workers (as required by legislation in Illinois).
o Require staffing agencies to provide information to temporary workers—in writing and in a language in which they are fluent—on the nature of their work assignment, the rate of pay, the location and duration of the assignment, and the types of safety equipment, if any, to be provided. Also, workers reporting an injury or making a compensation claim should be given information about anti-discrimination protections.
o Require explicit agreements between the staffing agency and host employer outlining roles and responsibilities related to worker training and protection, processes to identify and report hazards, and compensation in cases of injury with no fear of retaliation.
o Reform existing statutes to require a publicly accessible licensing and registration system for temporary staffing agencies in a manner consistent with many states’ current requirements for licensing of employment agencies.
• States to pursue policies stipulating that temporary staffing agencies and host employers are jointly responsible for compensating injured workers.
• Municipalities to prohibit contractors from using city funds to subcontract through temporary agencies.
• Employers to end the practice of “permatemping” in both the private and public sectors by setting durational limits on the use of temporary workers.
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