Inequalities in Health Work-related policies and interventions

Reducing Inequalities in Health A European Perspective Edited by J. Mackenbach And M. Bakker

Unequal distribution of occupational hazards Improvements in working and living conditions, especially for manual workers, improved education and higher income contributed substantially to increases in life expectancy and better health status. In industrialised countries the pattern of diseases changed from infectious diseases to chronicle diseases. Differences in health remain between higher and lower positions in the workforce.

Inequality in health is determined by classic occupational hazards. Additionally, differences in health do follow a clear social stratification defined by the occupational status, associated with type and quality of work including the degree of self-direction at work.

Working conditionProffesionalsClerksCraft and related trades workers Elementary occupations Moving heavy loads Not able to choose or change methods of work Job involving monotonous tasks Job involving learning new things Source: 2. European Survey on Working Conditions

Working conditions contribute to socioeconomic inequalities in health Occupational exposure is responsible for about 4 % of all human cancers in industrialized countries, concentrated among manual workers and lower social class a third of the total cancer difference between high and low social classes, and for half of the difference for lung and bladder cancer (England, Wales) % of cases of musculoskeletal disorders for workers highly exposed to risk factors for musculoskeletal problems the proportion is %. In European countries 40 % of the workers are exposed for at least 25 % of their working time to working in painful position, moving heavy loads, repetitive tasks, repetitive movements lack of control at work is associated with an elevated risk of developing myocardial infarction. The risk is 50 % higher in the lowest employment grade (Withehall-study, M. Marmot) effort-reward imbalance, low decision latitude, high psychological demands increase the risk of depressive symptoms (Withehall-study, M. Marmot)

Work environment interventions There is increasing evidence on the direct association between higher work related risk factors to lower social classes and social inequalities in health. Even though, there are very few preventive programs aimed to reduce social class differences. Such interventions must meet two requirements: reduce ill health, benefit the lower classes.

Phycical working conditions A number of studies describe the effect of interventions directed to improve musculoskeletal health. In general, the sustainability of intervention effects seems unproven. Interventions that attempt to involve the entire organisation seems to be more successful.

Psychosocial conditions and stress Intervention studies to improve the adverse health effects of certain psychosocial conditions are rare. Interventions are company specific and individual orientated. In Sweden the Working Life Fund offered substantial financial incentives, but there was no systematically evaluation. Successful interventions include an adequate analysis of the risk factors and risk groups; they are based on a commitment within the organisation.