Employmentweb_low

employment relations and health inequalities: a conceptual and empirical overvieW
itself be an important determinant of health. Work characteristics
can vary within the same occupation, depending, for example, on the
style of the line manager. Self-report measures also capture this
variation. On the other hand, it has been argued that health status
can influence perceptions of work characteristics (reverse causality)
and that self report can lead to "sole source" bias (Muntaner & O'
Campo, 1993; Macleod et al., 2002; Macleod & Smith, 2003). Thus,
the inclusion of people with negative affectivity characteristics (the
tendency to complain in general) may induce spurious associations
between self-report measures of both work and health.
There is a considerable body of evidence from prospective studies
showing that all three of these models of work stress are associated with
health. In the UK, these associations have been studied in depth in the
Whitehall II longitudinal cohort study of 10,308 london-based civil
servants. Predictors of incident coronary heart disease included low
control at work and high job demands, effort-reward imbalance (see
Figure 13) and relational justice. Working conditions including low job
control, high job demands, low levels of social supports at work, effortreward
imbalance and relational injustice were associated prospectively
with psychiatric morbidity. low decision latitude and low levels of social
supports were associated with increased rates of sickness absence, and
indicators of both effort-reward imbalance and relational justice were
associated with medically-certified spells of sickness absence. Table 9
summarises the evidence from the Whitehall II study for associations
between the different dimensions of psychosocial working conditions
and health.
Figure 13. effort reward imbalance at work and coronary heart disease in 1997-2000.
Likelihood of Coronary Heart disease
1,4
1,3
1,2
1,1
1,0
0,9
Low Effort & High
Reward
High Effort & Low
Reward
adjusted by age, sex and grade
source: Kuper, h., singh-manoux, a., siegrist, J., & marmot, m. (2002). When reciprocity fails: effort-reward imbalance in relation to
coronary heart disease and health functioning within the Whitehall ii study. Occupational and Environmental Medicine, 59(11), 777-784.
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