Employmentweb_low

eMployMent relations and health inequalities: pathways and MechanisMs
occupational classes—the lower the socioeconomic position, the higher the risk of exposure to adverse and stressful working
conditions (siegrist, 2002).
however, not all dimensions of stressful working conditions are more prevalent in lower ses occupations. higher job demands, as
characterised by the job strain model, tend to be more prevalent in higher ses occupations (bosma et al., 1997). in addition, workers in higher
ses jobs may be exposed to greater work effort, a characteristic of the effort-reward imbalance model (siegrist et al., 2004) on the other
hand, lower job control (bosma et al., 1997) and fewer rewards (siegrist et al., 2004) tend to characterise lower ses occupations.
Furthermore, when the social gradient in the overall measure of stressful working conditions (job strain and effort-reward imbalance) is
analysed, rather than specific components, work stress tends to be reported primarily by those in lower ses occupations (tsutsumi, Kayaba,
tsutsumi, & igarashi, 2001). even when greater effort-reward imbalance is reported by higher ses workers earlier on in their career, lower
ses workers tend to report a greater deterioration in their working conditions over their career lifetime (chandola, siegrist, & Marmot, 2005).
there is some debate about whether stressful working conditions account for some of the social gradient in health. low control,
(bosma et al., 1997), job strain (chandola, brunner, & Marmot, 2006), and effort-reward imbalance (chandola et al., 2005) have been found
to account for some of the social gradient in different measures of health. on the other hand, not all dimensions of adverse psychosocial
working conditions contribute to explaining social inequalities in coronary heart disease (suadicani, hein, & gyntelberg, 1993). if stressful
working conditions mediate the effect of ses on health, we would expect to find strong evidence of the association between low ses and
stress-related biomarkers. there is some conflicting evidence from the scientific literature. some report that lower ses is not associated
with biological markers for stress (dowd & goldman, 2006), while others find that lower ses is associated with higher biological stress
responses in terms of a greater cortisol awakening response (wright & steptoe, 2005).
in summary, adverse working conditions tend to cluster in lower ses occupations. Most of the studies show that some
dimensions of stressful working conditions mediate or moderate the effect of social inequalities in health, although a minority of
studies questions this link.
References
bosma, h., Marmot, M. g., hemingway, h., nicholson, a. c., brunner, e., & stansfeld, s. a. (1997). low job control and risk
of coronary heart disease in whitehall ii (prospective cohort) study. British Medical Journal, 314, 558-565.
chandola, t., brunner, e., & Marmot, M. (2006). chronic stress at work and the metabolic syndrome: prospective study.
British Medical Journal, 332, 521-525.
chandola, t., siegrist, J., & Marmot, M. (2005). do changes in effort-reward imbalance at work contribute to an explanation
of the social gradient in angina Occupational and Environmental Medicine, 62, 223-230.
dowd, J. b., & goldman, n. (2006). do biomarkers of stress mediate the relation between socioeconomic status and health
Journal of Epidemiology and Community Health, 60, 633-639.
siegrist, J. (2002). reducing social inequalities in health: work-related strategies. Scandinavian Journal of Public Health.
Supplement, 59, 49-53.
siegrist, J., starke, d., chandola, t., godin, i., Marmot, M., niedhammer, i., et al. (2004). the measurement of effort-reward
imbalance at work: european comparisons. Social Science and Medicine, 58, 1483-99.
suadicani, p., hein, h. o., & gyntelberg, F. (1993). are social inequalities as associated with the risk of ischaemic heart
disease a result of psychosocial working conditions Atherosclerosis, 101, 165-175.
tsutsumi, a., Kayaba, K., tsutsumi, K., & igarashi, M. (2001). association between job strain and prevalence of hypertension:
a cross sectional analysis in a Japanese working population with a wide range of occupations: the Jichi Medical school
cohort study. Occupational and Environmental Medicine, 58, 367-373.
wright, c. e., & steptoe, a. (2005). subjective socioeconomic position, gender and cortisol responses to waking in an elderly
population. Psychoneuroendocrinology, 30, 582-590.
effect modifiers of the health effects of adverse working
conditions
another pathway assumes that social health inequalities emerge
because of social differences in susceptibility to adverse working
conditions – even with similar types and levels of exposure
(diderichsen, evans, & Whitehead, 2001; emslie, hunt, &
Macintyre, 1999a). This mechanism is functioning at the same time
as, sometimes even cross-cutting, the mechanism of differential
exposure. differences in susceptibility (i.e., effect modification)
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