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This article reports a new conceptual approach to measuring the characteristics of precarious employment and their effect on health. Our starting point is the Karasek 'job strain' model. We argue that 'job strain' focuses on the health effects of work once people are employed. It is less effective in capturing the health effects associated with the employment relationship, the process by which workers acquire work, keep work and negotiate its terms and conditions. We develop a new construct, 'employment strain' to measure these aspects of work organisation. Evidence presented indicates employment strain is associated with poorer health outcomes.