All part of the job? The contribution of the psychosocial and physical work environment to health inequalities in Europe and the European health divide

Investigating the influence of working status changes on physical activity and non-communicable diseases in Korean middle-aged and older adults: insights from a longitudinal panel study

BACKGROUND

Non-communicable diseases (NCDs) are a major global health challenge and occupational status is a critical determinant influencing NCD development, yet many cross-sectional studies have only linked current occupational status with specific diseases, overlooking broader temporal factors. The primary aim of the present study was to comprehensively elucidate the intricate interplay between alterations in working status, NCDs, and physical activity (PA) among Korean middle-aged and older adults, employing a longitudinal panel study design.

METHODS

This study utilized longitudinal data from the Korean Longitudinal Study of Aging, covering the period from 2006 to 2020, with a median follow-up duration of 10 years. (n = 5101 participants aged 45 years and older). Changes in working status were categorized, focusing on (1) yes-yes (e.g., indicative of sustained employment), (2) yes-no (e.g., denoting a transition from employment to non-employment), (3) no-yes (e.g., representing a shift from non-employment to employment), and (4) no-no (reflecting a continual non-employment status). PA was defined as the total minutes of moderate-to-vigorous PA per week and categorized into two groups: <150 min/week and ≥ 150 min/week. Confounding factors included age, gender, marital status, education level, and body mass index. Relative risk ratios (RRR) with 95% confidence intervals (CI) were calculated using random-effect multinomial logistic regression.

RESULTS

Individuals who were currently employed (adjusted RRR = 0.688, 95% CI = 0.656-0.722, p < 0.001) or who transitioned to employment (adjusted RRR = 0.755, 95% CI = 0.707-0.807, p < 0.001) had a reduced risk of physical inactivity. However, employed individuals had an increased risk of cardiovascular diseases (yes-yes: adjusted RRR = 1.653, 95% CI = 1.547-1.766, p < 0.001; no-yes: adjusted RRR = 1.168, 95% CI = 1.100-1.240, p < 0.001) and diabetes (yes-yes: adjusted RRR = 1.535, 95% CI = 1.464-1.610, p < 0.001; no-yes: adjusted RRR = 1.124, 95% CI = 1.078-1.173, p < 0.001). Additionally, current workers exhibited higher risks of cancer (yes-yes: adjusted RRR = 1.871, 95% CI = 1.721-2.035, p < 0.001; no-yes: adjusted RRR = 1.089, 95% CI = 1.018-1.166, p = 0.014) and chronic respiratory diseases (yes-yes: adjusted RRR = 1.467, 95% CI = 1.307-1.648, p < 0.001; no-yes: adjusted RRR = 1.121, 95% CI = 1.011-1.242, p = 0.029).

CONCLUSION

This longitudinal study revealed that individuals engaged in or transitioning to employment displayed a reduced likelihood of regular PA. Moreover, those with work history, transitioning, or consistently working, exhibited increased vulnerability to all NCDs compared to those without work experience.

Occupational determinants of physical activity at work: Evidence from wearable accelerometer in 2005-2006 NHANES

Occupation determines workers' physical activity (PA) in the workplace, an important health behavior contributing to health outcomes. However, self-reported measure limits our understanding of how occupational tasks differentiate workers' PA in terms of the type, frequency, intensity, and duration. In addition, accurate estimation of occupation-based PA during workers' actual working hours requires precise work schedule information. To address these limitations, this study employs data on accelerometer-monitored PA and work schedule from the 2005-2006 National Health and Nutrition Examination Survey (NHANES). It asks two questions: How do occupations determine PA among regular daytime workers in the United States? Second, how large a share of PA difference between two occupations is attributable to differences in the implicit occupational tasks, relative to workers' demographic, health preconditions, and socioeconomic attributes? Calculating PA during the 9-to-5 period among daytime regular workers on weekdays and conducting Blinder-Oaxaca decomposition analysis, we yield insights into the occupational determinant of both PA volume (total activity counts) and fragmentation (bouts of activities). Worksite health promotion can utilize the objective occupation-PA link and design occupation-tailored interventions, which is currently underdeveloped in the United States. Moreover, our findings shed light on the physical nature of occupation, suggesting a fruitful step to reconcile the documented mixed findings on occupation-based PA and health outcomes in future studies.

On the Biopsychosocial Costs of Alienated Labor

Data from the national, longitudinal Mid-Life in the US (MIDUS) study were used to examine work alienation and its relationship to biological health as well as psychological and social functioning. The alienation measure focuses on the autonomy and creativity the work provides. We hypothesized that alienated work would have negative associations with each of the three domains: in biology, higher 'allostatic load' (biological dysregulation); in psychology, poorer cognitive performance; and socially, negative impacts on family life. The outcomes are generally as predicted, though there are notable differences for men and women.

The contribution of employment and working conditions to occupational inequalities in non-communicable diseases in Europe

BACKGROUND

Social inequalities in non-communicable diseases (NCDs) are evident across all European regions. Employment and working conditions are important determinants of NCDs, however, few comparative studies have examined how these conditions contribute to health inequalities. This study therefore examines the association of non-standard employment and poor working conditions with occupational inequalities in multiple NCDs and whether there are differences by gender and across European regions.

METHODS

We used cross-sectional data from 20 European countries for women and men aged 25-75 (n = 19 876), from round 7 of the European Social Survey. Data were analyzed for self-rated health (SRH) and 9 NCDs: heart/circulatory problems, high blood pressure, arm/hand pain, breathing problems, diabetes, severe headaches, cancer, obesity and depression. We used logistic regression models, stratified by gender, and adjusted rate ratios to examine whether occupational inequalities in NCDs were reduced after adjusting for non-standard employment and poor working conditions, across European regions.

RESULTS

After adjustment, occupational inequalities were significantly reduced across all regions of Europe. Reductions were particularly large among the lowest occupational group and for poor-SRH, depression and obesity. For these conditions, reductions were in the range of 60-99%.

CONCLUSIONS

Employment and working conditions are important determinants of occupational inequalities in NCDs. Labour market regulations should therefore be considered in the formulation of NCD prevention strategies.

Envisioning the future of work to safeguard the safety, health, and well-being of the workforce: A perspective from the CDC's National Institute for Occupational Safety and Health

The future of work embodies changes to the workplace, work, and workforce, which require additional occupational safety and health (OSH) stakeholder attention. Examples include workplace developments in organizational design, technological job displacement, and work arrangements; work advances in artificial intelligence, robotics, and technologies; and workforce changes in demographics, economic security, and skills. This paper presents the Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health's Future of Work Initiative; suggests an integrated approach to address worker safety, health, and well-being; introduces priority topics and subtopics that confer a framework for upcoming future of work research directions and resultant practical applications; and discusses preliminary next steps. All future of work issues impact one another. Future of work transformations are contingent upon each of the standalone factors discussed in this paper and their combined effects. Occupational safety and health stakeholders are becoming more aware of the significance and necessity of these factors for the workplace, work, and workforce to flourish, merely survive, or disappear altogether as the future evolves. The future of work offers numerous opportunities, while also presenting critical but not clearly understood difficulties, exposures, and hazards. It is the responsibility of OSH researchers and other partners to understand the implications of future of work scenarios to translate effective interventions into practice for employers safeguarding the safety, health, and well-being of their workers.

The Unequal Burden of Self-Reported Musculoskeletal Pains Among South Korean and European Employees Based on Age, Gender, and Employment Status

Background

The objective of this study was to elucidate the relationships musculoskeletal pains with combined vulnerability in terms of age, gender, and employment status

Methods

The fifth European Working Conditions Survey (EWCS) in 2010 (43,816 participants aged 15 years and over) analyzed for European employees and the third Korean Working Conditions Survey (KWCS) in 2011 (50,032 participants aged 15 years and older) analyzed for Korean employees. In this study, three well known vulnerable factors to musculoskeletal pains (older age, female gender, and precarious employment status) were combined and defined as combined vulnerability. Associations of musculoskeletal pains with combined vulnerability were assessed with prevalence ratios (PRs) and 95% confidence intervals (CIs) estimated by Poisson regression models with robust estimates of variance.

Results

The prevalences of musculoskeletal pains were lower but the absolute and relative differences between combined vulnerabilities were higher among Korean employees compared with the European employees. Furthermore, the increased risk of having musculoskeletal pains according to combined vulnerability was modestly explained by socioeconomic factors and exposure to ergonomic risk factors, especially in Republic of Korea.

Conclusions

The results of this study showed that the labor market may be more unfavorable for female and elderly workers in Republic of Korea. Any prevention strategies to ward off musculoskeletal pains, therefore, should be found and implemented to mitigate or buffer against the most vulnerable work population, older, female, and precarious employment status, in Republic of Korea.

Worksite health promotion and social inequalities in health

It is well-documented that higher educated employees have better health than the lower educated. The workplace has been put forward as a contributor to this inequality. We extend previous work on workplace characteristics that could influence employee health by asking to what extent workplace health promotion (WHP) can account for the relation between education and health. Two ways in which WHP may relate to health inequalities are addressed: higher educated employees may be more likely to use WHP than lower educated employees and the effect of WHP on health may be stronger for higher educated than for lower educated employees. Using data from the European Sustainable Workforce Survey which contains information on over 11000 employees in 259 organisations, we test whether three types of WHP mediate or moderate the relation between education and health: healthy menus, sports facilities and health checks. We find that higher educated employees are in better health and that use of WHP positively relates to health. Use of healthy menus and sports facilities in the workplace can contribute to increasing health inequalities, as lower educated employees are less likely to make use of these. Health checks could contribute to diminishing health inequalities, as lower educated employees are more likely to use them compared to higher educated employees. The effect of WHP is not contingent on education. We advise stimulating lower educated employees to make more use of WHP, which can contribute to decreasing health inequalities.

Calloused hands, shorter life? Occupation and older-age survival in Mexico

BACKGROUND

Inequalities in mortality are often attributed to socioeconomic differences in education level, income, and wealth. Low socioeconomic status (SES) is generally related to worse health and survival across the life course. Yet, disadvantaged people are also more likely to hold jobs requiring heavy physical labor, repetitive movement, ergonomic strain, and safety hazards.

OBJECTIVE

We examine the link between primary lifetime occupation, together with education and net worth, on survival among older adults in Mexico.

METHODS

We use data from four waves (2001, 2003, 2012, and 2015) of the Mexican Health and Aging Study (MHAS). We estimate age-specific mortality rates for ages 50 and over using a hazards model based on a two-parameter Gompertz function.

RESULTS

Primary lifetime occupations have a stronger association with survival for women than men. Women with higher socioeconomic status have significantly lower mortality rates than lower status women, whether SES is assessed in terms of schooling, wealth, or occupation. Occupational categories are not jointly related to survival among men, even without controls for education and wealth. There are significant survival differences by wealth among men, but no disparities in mortality by education.

CONCLUSIONS

Consistent with recent studies of the Mexican population, we fail to find the expected gradient in the association between some measures of SES and better survival among men.

CONTRIBUTION

Our estimates extend this anomalous pattern among Mexican men to another dimension of SES, occupation. SES differentials in mortality are substantially larger for Mexican women, highlighting an important gender disparity.

Social inequalities in health: duration of unemployment unevenly effects on the health of men and women

Background

Employment status is an important determinant of health inequalities. The aim of this article is to analyze the association between duration of unemployment and the presence of cardiovascular risk factors, self-perception of health and presence of depression and anxiety, assessing differences in the effects of unemployment by sex and age.

Methods

The sample was composed of 12 123 people (52.4% men), 18 to 74 years old (mean age= 43.5 years, SD = 10.4). Logistic regression analyses were used to study the influence of duration of unemployment on health (‘0 days’, ‘≤11 months’ and ‘≥12 months’). Sex, age, level of education, employment status and time spent unemployed, as well as tobacco and alcohol use and physical activity, were considered. Morbidity variables were hypertension, hypercholesterolemia, diabetes, obesity, depression and anxiety, and a subjective health assessment.

Results

The results showed both unemployed men and women had worse outcome in health compared with their active counterparts. The risk of hypertension was presented in long-term unemployed men, which had 1.3 times more likely to suffer from hypertension. The risk of obesity was presented only in unemployed women, which had 1.5 times more risk of obesity, doubling the risk (OR= 2.2) among women under age 40. The unemployment had a protective effect against anxiety among younger women (OR = 0.53)

Conclusion

It has been observed a different influence of unemployment time on men and women’s health. The employment status should be considered in public health policy agendas with the purpose of reducing inequalities in health.

The social determinants of inequalities in self-reported health in Europe: findings from the European social survey (2014) special module on the social determinants of health

Background

Health inequalities persist between and within European countries. Such inequalities are usually explained by health behaviours and according to the conditions in which people work and live. However, little is known about the relative contribution of these factors to health inequalities in European countries. This paper aims to investigate the independent and joint contribution of a comprehensive set of behavioural, occupational and living conditions factors in explaining social inequalities in self-rated health (SRH).

Method

Data from 21 countries was obtained from the 2014 European Social Survey and examined for respondents aged 25-75. Adjusted rate differences (ARD) and adjusted rate risks (ARR), generated from binary logistic regression models, were used to measure health inequalities in SRH and the contribution of behavioural, occupational and living conditions factors.

Result

Absolute and relative inequalities in SRH were found in all countries and the magnitude of socio-economic inequalities varied considerably between countries. While factors were found to differentially contribute to the explanation of educational inequalities in different European countries, occupational and living conditions factors emerged as the leading causes of inequalities across most of the countries, contributing both independently and jointly with behavioural factors.

Conclusion

The observed shared effects of different factors to health inequalities points to the interdependent nature of occupational, behavioural and living conditions factors. Tackling health inequalities should be a concentred effort that goes beyond interventions focused on single factors.

Occupational inequalities in self-rated health and non-communicable diseases in different regions of Europe: findings from the European Social Survey (2014) special module on the social determinants of health

Background

Socioeconomic inequalities in the prevalence of non-communicable diseases (NCDs) are evident across European populations. Several previous studies have addressed the question of whether occupational inequalities in health differ across European regions. It is uncertain however, the degree to which occupational inequalities in NCDs are similar or dissimilar across different European regions.

Methods

Using 2014 European Social Survey data from 20 countries, this article examines occupational inequalities in poor self-rated health (SRH) and 14 self-reported NCDs separately for women and men, by European region: heart/circulatory problems, high blood pressure, back pain, arm/hand pain, foot/leg pain, allergies, breathing problems, stomach/digestion problems, skin conditions, diabetes, severe headaches, cancer, obesity and depression. Age-controlled adjusted risk ratios were calculated and separately compared a working class and intermediate occupational group with a salariat group.

Results

Working class Europeans appear to have the highest risk of reporting poor SRH and a number of NCDs. We find inequalities in some NCDS to be the largest in the Northern region, suggesting further evidence of a Nordic paradox. Like some previous work, we did not find larger inequalities in poor SRH in the Central/East region. However, we did find the largest inequalities in this region for some NCDs. Our results do not align completely with previous work which finds smaller health inequalities in Southern Europe.

Conclusions

This work provides a first look at occupational inequalities across a range of NCDs for European men and women by region. Future work is needed to identify the underlying determinants behind regional differences.

Links between Primary Occupation and Functional Limitations among Older Adults in Mexico

Social inequalities in health and disability are often attributed to differences in childhood adversity, access to care, health behavior, residential environments, stress, and the psychosocial aspects of work environments. Yet, disadvantaged people are also more likely to hold jobs requiring heavy physical labor, repetitive movement, ergonomic strain, and safety hazards. We investigate the role of physical work conditions in contributing to social inequality in mobility among older adults in Mexico, using data from the Mexican Health and Aging Survey (MHAS) and an innovative statistical modeling approach. We use data on categories of primary adult occupation to serve as proxies for jobs with more or less demanding physical work requirements. Our results show that more physically demanding jobs are associated with mobility limitations at older ages, even when we control for age and sex. Inclusion of job categories attenuates the effects of education and wealth on mobility limitations, suggesting that physical work conditions account for at least part of the socioeconomic differentials in mobility limitations in Mexico.

In-Work Poverty and Self-Rated Health in a Cohort of Working Germans: A Hybrid Approach for Decomposing Within-Person and Between-Persons Estimates of In-Work Poverty Status

In this study, we investigated whether self-rated health (SRH) can be predicted by in-work poverty and how between-persons and within-person differences in the poverty status of people who are working contribute to this relationship. We used a logistic random-effects model designed to test within-person and between-persons differences with data from a nationally representative German sample with 19 waves of data collection (1995-2013) to estimate effects of between-persons and within-person differences in working poverty status on poor SRH. Interactions by age and sex were tested, and models controlled for sociodemographic, socioeconomic, and work-related characteristics. We found significant differences in SRH between individuals with different working poverty status but no evidence that within-person differences in working poverty status are associated with poor SRH. The association between in-work poverty and SRH was significantly stronger for women but did not differ significantly by age. All findings were robust when including sociodemographic, socioeconomic, and working characteristics. In this sample of German adults, we found a polarization of poor SRH between the working nonpoor and the working poor but no causal association of within-person differences in working poverty status with SRH.

Does the pattern of occupational class inequalities in self-reported health depend on the choice of survey? A comparative analysis of four surveys and 35 European countries

Background

Despite increasing overall life expectancy, substantial differences in health between socioeconomic groups persist. Research on inequalities in health often draws on data from different, single surveys. An important question that arises is whether these surveys reflect health and inequalities in the same way. When occupational class is utilized, data are often not analysed for women. The aim of this study therefore is to investigate whether patterns of occupational class inequalities in self-reported health differ across sex and country, between four major European surveys.

Methods

Data on self-reported health and occupational class are taken from the European Social Survey (ESS), the EU Statistics on Income and Living Conditions (EU-SILC), the European Working Conditions Survey (EWCS) and the International Social Survey Programme (ISSP). Data from 35 countries for men and women aged 25–65 years are analysed. Occupational class is measured according to manual and non-manual workers. Age-standardized prevalence rates, and prevalence ratios (PR) between non-manual and manual workers and likelihood ratio (LR) tests are estimated to determine occupational class inequalities in self-rated health in Europe.

Results

Results show that prevalence rates of less than good health differ noticeably between countries and surveys. Furthermore, occupational class inequalities in health differ between countries. In some countries inequalities are larger for women than for men. This is especially true in Eastern, Central and Baltic European countries. Besides that no regional patterns, consistent over all surveys, in inequalities could be detected. Inequalities differed significantly between surveys.

Conclusion

The magnitude of inequalities in all countries depend on the survey used in the analysis. When undertaking a comparative analysis of inequalities in health, or other determinants, these differences have to be taken into account, as results might differ according to the data source used.

Risk and resilience: health inequalities, working conditions and sickness benefit arrangements: an analysis of the 2010 European Working Conditions survey

In this article we ask whether the level of sickness benefit provision protects the health of employees, particularly those who are most exposed to hazardous working conditions or who have a little education. The study uses the European Working Condition Survey that includes information on 20,626 individuals from 28 countries. Health was measured by self-reported mental wellbeing and self-rated general health. Country-level sickness benefit provision was constructed using spending data from Eurostat. Group-specific associations were fitted using cross-level interaction terms between sickness benefit provision and physical and psychosocial working conditions respectively, as well as those with little education. The mental wellbeing of employees exposed to psychosocial job strain and physical hazards, or who had little education, was better in countries that offer more generous sickness benefit. These results were found in both men and women and were robust to the inclusion of GDP and country fixed effects. In the analyses of self-reported general health, few group-specific associations were found. This article concludes that generous sickness benefit provision may strengthen employee's resilience against mental health risks at work and risks associated with little education. Consequently, in countries with a generous provision of sickness benefit, social inequalities in mental health are smaller.

Comparison of socio-economic indicators explaining inequalities in Healthy Life Years at age 50 in Europe: 2005 and 2010

BACKGROUND

The first estimates of Healthy Life Years at age 50 (HLY50) across the EU25 countries in 2005 showed substantial variation in healthy ageing. We investigate whether factors contributing to HLY50 inequalities have changed between 2005 and 2010.

METHODS

HLY50 for each country and year were calculated using Sullivan's method, applying the age-specific prevalence of activity limitation from the European Union Statistics on Income and Living Conditions (EU-SILC) survey to life tables. Inequalities in life expectancy at age 50 (LE50) and HLY50 between countries were defined as the difference between the maximum and minimum LE50 or HLY50. Relationships between HLY50 and macro-level socio-economic indicators were investigated using meta-regression. Men and women were analysed separately.

RESULTS

Between 2005 and 2010 HLY50 inequalities for both men and women in Europe increased. In 2005 and 2010 HLY50 inequalities exceeded LE50 inequalities, particularly in the established EU15 countries in 2010 where HLY50 inequalities (men: 10.7 years; women: 12.5 years) were four times greater for men and three times for women than LE50 inequalities (men: 2.4 years; women: 4.1 years). Only material deprivation significantly explained variation in EU25 HLY50 in both years with, additionally, long-term unemployment in 2010.

CONCLUSIONS

Our results suggest that inequalities in HLY50 across Europe are large, increasing and partly explained by levels of material deprivation. Moreover long-term unemployment has become more influential in explaining variation in HLY50 between 2005 and 2010.