Employmentweb_low

EMploYMEnt, work, And hEAlth inEquAlitiEs - a global perspective
4
The first step in our alternative approach to this investigation is the
development of a theoretical model which delineates the causal
pathways we describe in this book. Given the complexity of the
phenomenon treated, the use of theoretical models helps us
organise and explain large quantities of scientific data in several
ways (Muntaner, 1999). First, these models help us understand the
complex links between employment relations, employment
conditions and the health of workers. Additionally, they suggest
further observation and testing of hypothetical causal pathways not
covered in this review. Finally, theoretical frameworks help identify
the main "entry-points" (i.e., exogenous factors) through which to
implement policies and interventions to reduce health inequalities.
Towards this end, we have developed two frameworks based on
a single overarching theoretical model. The resulting graphs and
flow charts serve two key purposes. First, they show the origins and
consequences of different employment relations. Second, they trace
the connection between employment relations and economic and
political factors, working conditions, and health inequalities. Put
simply, they are a way of visualising in context the many factors that
contribute to inequalities in health. The macro-structural
framework traces the effects of political power struggles on health
inequalities through the important mediating role of the welfare
state and labour market policies. The micro-structural framework
traces the effects of employment and working conditions on health
inequalities.
Some methodological caution needs to be exerted. First, the
main focus of both frameworks is on factors related to employment
relations and conditions, not on social determinants of health in
general or other public health factors. Second, neither framework
pretends to be a fully-pledged confirmed theory. Rather, they are
heuristic devices used to help simplify a complicated set of
relationships and point out the most important pathways. Finally, it
is also necessary to mention that both frameworks are "static" and
should also be considered from a historical point-of-view as well as
from a dynamic life-course perspective.
4.1. MACRO STRUCTURAL FRAMEWORK
The macro-structural framework (Figure 2) situates employment
relations in their larger institutional context, which is determined by
social institutions and relations that ultimately respond to a global
division of production and the situation of each country into the
world-system (Wallerstein, 1974). This framework explains the
30