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eMployMent relations and health inequalities: pathways and MechanisMs<br />

the worsening in working conditions which accompanies the<br />

downsizing process, which includes increased levels of physical<br />

work demands or job insecurity and <strong>low</strong>er job control, skill<br />

discretion or worker participation (Kivimäki et al., 2000; Vahtera, et<br />

al., 2004). long work hours are associated with a wide variety of<br />

health effects, including work accidents and injuries,<br />

musculoskeletal disorders, fatigue, psychological ill-health,<br />

unhealthy behaviours and outcomes related to cVd (Van der hulst,<br />

2003; caruso & Waters, 2008). self-employment may also be seen<br />

as a form of precarious employment, although there are many<br />

internal differences, for instance, between independent contractors<br />

and (small) business owners (Prottas & Thompson, 2006). supposed<br />

advantages of greater autonomy are often counteracted by higher<br />

work pressure and longer hours. a study on self-employed workers<br />

in north carolina found elevated occupational fatality rates,<br />

especially in retail and transportation industries. furthermore, poor<br />

work organisation, poor hygiene, ergonomic hazards, dangerous<br />

hand tools and exposure to chemicals were reported (Mirabelli,<br />

loomis, & richardson, 2003).<br />

Workers employed in the informal economy or informally<br />

employed workers in formal sectors often lack control over their<br />

working conditions. They can be deployed in the most dangerous<br />

activities, imposing a high risk of occupational injuries and diseases,<br />

while at the same time they are legally under-protected and<br />

vulnerable to firing and high exploitation (ilo, 2006). awkward<br />

postures and exposure to toxic chemicals, excessive noise, poor<br />

sanitation, high workload, pesticides, violence and sexual assault<br />

(iriart et al., 2006) are commonly observed in informal economy<br />

settings, along with little training and supervision and limited<br />

access to protective equipment.<br />

forced labourers and slaves are exposed to the worst hazards.<br />

They are forced into these adverse working conditions by the overexploitative<br />

nature of the employer-worker relation (fassa, 2003;<br />

Who, 2002). however, the invisibility of forced labour makes it a<br />

difficult area to investigate. a greater effort should be made to<br />

document working conditions in these settings. unacceptable<br />

working conditions are one of the worst features of child labour.<br />

exposure to hazards in the workplace is especially harmful for<br />

children due to their increased vulnerability to biological and toxic<br />

agents as a consequence of their immature immune system, <strong>low</strong>er<br />

bone elasticity, strength, and capacity to support heavy workloads.<br />

furthermore, tools and other equipment are often not designed to<br />

be used by children. children working in agriculture are particularly<br />

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