Cross-border mobility in European countries: associations between cross-border worker status and health outcomes

Lucas Nonnenmacher,Louis Chauvel,Philippe Askenazy,Michèle Baumann,Etienne Le Bihan

doi:10.1186/s12889-021-10564-8

Abstract

BackgroundMobility of workers living in one country and working in a different country has increased in the European Union. Exposed to commuting factors, cross-border workers (CBWs) constitute a potential high-risk population. But the relationships between health and commuting abroad are under-documented. Our aims were to: (1) measure the prevalence of the perceived health status and the physical health outcomes (activity limitation, chronic diseases, disability and no leisure activities), (2) analyse their associations with commuting status as well as (3) with income and health index among CBWs.MethodsBased on the ‘Enquête Emploi’, the French cross-sectional survey segment of the European Labour Force Survey (EU LFS), the population was composed of 2,546,802 workers. Inclusion criteria for the samples were aged between 20 and 60 years and living in the French cross-border departments of Germany, Belgium, Switzerland and Luxembourg. The Health Index is an additional measure obtained with five health variables. A logistic model was used to estimate the odds ratios of each group of CBWs, taking non-cross border workers (NCBWs) as the reference group, controlling by demographic background and labour status variables.ResultsA sample of 22,828 observations (2456 CBWs vs. 20,372 NCBWs) was retained. The CBW status is negatively associated with chronic diseases and disability. A marginal improvement of the health index is correlated with a wage premium for both NCBWs and CBWs. Commuters to Luxembourg have the best health outcomes, whereas commuters to Germany the worst.ConclusionCBWs are healthier and have more income. Interpretations suggest (1) a healthy cross-border phenomenon steming from a social selection and a positive association between income and the health index is confirmed; (2) the existence of major health disparities among CBWs; and (3) the rejection of the spillover phenomenon assumption for CBWs. The newly founded European Labour Authority (ELA) should take into account health policies as a promising way to support the cross-border mobility within the European Union.

Highlights

Mobility of workers living in one country and working in a different country has increased in the European Union
Our study aims to: (1) measure the prevalence for the perceived health status and the physical health factors, (2) analyse their associations with commuting status as well as (3) with income and health index among cross-border workers (CBWs)
The sample consisted of 8 groups of workers from 4 countries of destination: for example, CBWs working in Germany (n = 233) and non-cross border workers (NCBWs) working in France but living in the same departments as the CBWs to Germany (n = 6895)

Summary

Introduction

Cross-border workers (CBWs) constitute a potential high-risk population. Since freedom of movement for workers has been defined as the cornerstone of the EU, commuting abroad became a preoccupation of and major challenge for the states such as transport (Bike2Work EU’s project of 2014–2017) (ESPN 2019) and for the European Public Health and Social Policy a major challenge. CBWs represent a potential high-risk population combining several drawbacks which may impact their health. European Social Policy might be soon confronted with a declining health status of workers leading to a rise of health expenditures. In this perspective, an increased understanding of cross-border health issues is a matter of prime importance. Our main research question is: do health disparities between Cross-Border Workers (CBWs) and Non-Cross-Border Workers (NCWBs) exist?

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