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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. 197
EmpLoymEnT, work, And HEALTH inEquALiTiES - a global perspective Table 9. Working conditions and health: summary of Whitehall ii study findings to date.* low decision latitude High job demands WOrK CHaraCTErISTIC: - Obesity - alcohol dependence - Poor mental health - Poor health functioning - Back pain - Sickness absence - Coronary heart disease - Obesity - Poor mental health - Poor health functioning - Coronary heart disease aSSOCIaTED WITH: - Obesity - Poor mental health low social support at work - Poor health functioning - Sickness absence - alcohol dependence - Poor mental health - Poor health functioning Combination of high effort and low rewards - Poor self rated health - Sickness absence - Diabetes - Coronary heart disease - Poor self rated health - Poor mental health low relational justice - Sickness absence - Coronary heart disease - Weight gain and weight loss High job strain (low control and high demands) - Coronary heart disease Isostrain (low control, high demands, lack of support) - Metabolic syndrome - Poor mental health - Poor self-rated health - Increased general symptoms Organisational change - Increased incidence of longstanding illness - adverse sleep patterns - Increase in blood pressure - Poor mental health - Poor self-rated health - Increased general symptoms and minor health problems Job insecurity - Increased use of health services - Sickness absence - Sickness presenteeism - Increase in blood pressure * a comprehensive list of publications is available at http://www.ucl.ac.uk/whitehallii/ Other studies, mostly carried out in wealthy countries, have also demonstrated associations between psychosocial working conditions and both mental and physical health. a systematic review and metaanalysis of prospective studies reported that job strain, effort-reward imbalance and organisational injustice were all associated with the incidence of coronary heart disease, although the magnitude of effects varied between studies (Kivimäki et al., 2006). a meta-analysis 198
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EmploymEnt, Work and HEaltH InEqual
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CORE GROUP* Carlos H. Alvarado, Fra
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EMplOyMENt, wOrk, aNd hEalth iNEQua
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the adobe house construction has be
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Policies and Interventions 9 "The k
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policies and interventions to reduc
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policies and interventions case stu
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policies and interventions for expo
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policies and interventions 9.3. eMp
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policies and interventions Figure 2
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policies and interventions free pro
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policies and interventions employme
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policies and interventions Pública
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policies and interventions conditio
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policies and interventions factors
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policies and interventions informat
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policies and interventions referenc
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policies and interventions Table 14
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Epilogue: the economic crisis 10
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epilogue: the econoMic crisis this
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Conclusions & recommendations 11 "I
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conclusions and recommendations sho
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Appendix
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AppeNdIx recommendation no. 190 and
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AppeNdIx employment conditions. emp
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AppeNdIx Forced labour. Although th
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AppeNdIx Job discrimination. this t
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AppeNdIx in: muntaner, c., Benach,
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AppeNdIx in: Bartley, m., & Ferrie,
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AppeNdIx work intensification. work
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AppeNdIx Bank's Atlas method (adjus
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AppeNdIx table a2. descriptive stat
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AppeNdIx table a3. labour market fa
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AppeNdIx CorE sEmi-pEriphEry pEriph
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AppeNdIx Country clusters table A5
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AppeNdIx semi-peripheral countries
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AppeNdIx Figure a6. Health indicato
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RefeRences RefeRences 1. IntroductI
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arrangements and precariousness in
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International Labour Organization.
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Benach (Eds.), Desigualtats en salu
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Instituto Nacional de Estadística
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desde América Latina y el Caribe.
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Woldehanna, T., Guta, F., & Ferede,
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unemployment Chan, W. S., Yip, P. S
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International Labour Organization.
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Clarke, S., Sloane, D., & Aiken, L.
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among residents in the Trent region
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Sales, E. C., & Santana, V. S. (200
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Parent-Thirion, A., Fernandez, M. E
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Unemployment and mental health: Und
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Tytherleigh, M. Y., Jacobs, P. A.,
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Chilcoat, E. (2008). Pinkie promise
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Africa. Perspective of Global Devel
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freight transport and distribution
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Índex LIST OF FIGURES 2. Fair empl
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Table A5. Country clusters by labou
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Case study 43. Sexual orientation,
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acronyms and abrevIatures AIDS - Ac
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autHors and contrIbutors CORE GROUP
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Maria da Graça Luderitz Hoefel. Ho
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Maria da Graça Luderitz Hoefel. Ho
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INSTITUTIONS AND ASSOCIATIONS THAT
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