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EMploYMEnt, work, And hEAlth inEquAlitiEs - a global perspective<br />

1<br />

Work is the means through which most people provide for their daily<br />

sustenance. People work in or out of their homes, with or without<br />

labour contracts, and in either safe or hazardous working conditions.<br />

Factors related to working conditions have received a great deal of<br />

attention and are recognised as a key social determinant of health and<br />

health inequalities, but this has not often been the case for<br />

employment conditions. Some of the reasons for this neglect are found<br />

in the confusion between the concepts of work and employment, and<br />

the lack of clarity and development of indicators and data related with<br />

employment. Yet, labour markets and social policies determine<br />

employment conditions such as precarious or informal jobs, child<br />

labour or slavery, or problems such as having high insecurity, <strong>low</strong> paid<br />

jobs, or working in hazardous conditions, all of which heavily influence<br />

health inequalities. In sum, these types of employment and working<br />

conditions have different implications for the health of populations and<br />

the social inequalities in health among social classes, genders or<br />

ethnic minorities. To reveal the different ways that employment<br />

relations, employment conditions, and working conditions affect the<br />

health of populations we need to define what those concepts mean.<br />

Then, we must use these concepts and meanings to understand both<br />

how society structures labour relations, labour/capital agreements,<br />

labour or employment contracts, and what the social processes of<br />

production are that affect the health of workers.<br />

To begin with, employment relations, employment conditions<br />

and working conditions are different yet interrelated concepts. The<br />

first term, employment relations, constitutes the relations between<br />

buyers (employers who hire workers who perform labour to sell a<br />

profitable good or service) and sellers of labour (employees who<br />

contribute with labour to the enterprise, usually in return for<br />

payment of wages), as well as the practices, outcomes and<br />

institutions that emanate from or affect the employment<br />

relationship. Two important components of employment relations<br />

are the power relations between employers and employees and the<br />

level of social protection that employees can count on. In wealthy<br />

countries, employment relations are often subject to the provisions<br />

of the law or a hiring contract. In these societies, the government is<br />

often the largest single employer although most of the work force is<br />

employed in small and medium businesses in the private sector. In<br />

middle income and poor countries however, most employment<br />

agreements are not explicitly subject to any formal contract, and a<br />

high proportion of total employment is in the informal economy.<br />

Given this vast spectrum across which types of employment<br />

relations can range, both within and between countries, we concern<br />

2

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