A capital-based approach to understand health inequalities: empirical explorations

Background

The persistence of health inequalities may not be merely driven by education and income, but also by other economic and non-economic factors. In this study we investigated how the association between single-dimensional health and socioeconomic status (SES) changes when including health-related person capital, economic capital, social capital, cultural capital and non-health related person capital.

Methods

The present study proposes a capital-based approach to understand health inequalities. It presumes intertwined relationships between a wide notion of health (‘health-related person capital’) and embodied resources (‘non-health related person capital’) on the one hand, and non-person capital, i.e. economic, social, and cultural resources on the other. We used cross-sectional data on 152,592 participants from the Dutch Lifelines cohort study. Correlations between capital constructs were estimated using partial least squares structural equation modelling.

Results

The correlation between health-related person capital and SES (r = 0.15) was higher than the correlations between single-dimensional health (physical and mental health) and SES (r = 0.12, r = 0.04, respectively). Non-person capital, combining economic, social and cultural capital, showed a correlation of 0.34 with health-related person capital. This was higher than the correlation between health-related person capital and economic capital alone (r = 0.19). Lastly, the correlation between health-related person capital and non-person capital increased when non-health (personality and attractiveness) and health related person capital were combined into person capital construct (from r = 0.34 to r = 0.49).

Conclusions

This exploratory observational study shows the empirical interconnectedness of various types of resources. Our findings corroborate the idea of considering health as a multidimensional concept, and to extend conventional SES indicators to a broader measurement of economic and non-economic resources.

Key messages

Job resources do not mitigate the impact of job demands for workers with depression

Introduction

Jobs characterized by low to moderate job demands and high job resources are associated with better work outcomes among healthy workers, yet it remains unclear whether this is the case for workers with depression. This study examined whether depression moderates the relationship between job demands, job resources, and maintaining employment.

Methods

Data from the longitudinal population-based Lifelines cohort study were matched with register data on employment status from Statistics Netherlands (n = 55,950). The two-way interaction between job demands and depression and the three-way interaction between job demands, job resources and depression were examined in a zero-inflated Poisson regression model with path 1 including a binary employment outcome and path 2 a count variable including months out of employment.

Results

The interaction effect of job demands and depression on being employed was significant (b=-0.22, 95% CI: -0.44; 0.01), showing that workers without depression were more likely to be employed whereas workers with depression were less likely to be employed if they had high job demands. The three-way interaction between job demands, job resources, and depression was significant for months out of employment (b = 0.15, 95% CI: 0.01; 0.29), indicating that workers with depression had more months out of employment when reporting high job demands and high job resources compared to workers without depression.

Discussion

Although increasing resources to prevent negative work outcomes may be beneficial for workers without depression, this approach might be limited for the vulnerable subgroup of workers with depression.

Key messages

The impact of changes in working conditions, health behavior and BMI on work ability and health

Background

Research on how to improve work ability and health of workers is essential for prolongation of working lives. Therefore, this study assessed the impact of 1) within-individual improvements, and 2) within-individual deteriorations in working conditions, health behavior and BMI on changes in work ability and self-rated health among workers.

Methods

The Dutch Study on Transitions in Employment, Ability and Motivation (STREAM) was used to identify participants whose working conditions, health behavior, and BMI improved (N = 14,045) or deteriorated (N = 14,066) at least once during 7 year follow-up (2010-2017). The impact of within-individual improvements and deteriorations in health behavior (moderate- and vigorous physical activity, smoking status), BMI, psychosocial (psychological- and emotional job demands, autonomy, social support) and physical working conditions in a given year on changes in work ability (0-10 scale) and self-rated health (1-5 scale) in the same year were analyzed with fixed-effects regression models.

Results

Workers with deteriorated physical or psychosocial working conditions decreased in work ability (β's:-0.21 (95%CI: -0.25;-0.18) to -0.28 (95%CI: -0.33;-0.24)) and health (β's:-0.07 (95%CI: -0.09;-0.06) to -0.10 (95%CI: -0.12;-0.08)), whereas improvements were to a lesser extent associated with increased work ability (β's: 0.06 (95%CI: 0.02;0.09) to 0.11 (95%CI: 0.06;0.16)) and health (β's: 0.02 (95%CI: 0.00;0.03) to 0.04 (95%CI: 0.02;0.06)). Decreased physical activity and increased BMI were associated with reduced work ability and health. Workers whose BMI decreased or vigorous physical activity increased improved in health, but those with increased moderate or vigorous physical activity reduced in work ability. Quitting smoking was associated with reduced work ability and health.

Conclusions

Preventing deteriorations in working conditions and health behavior could be of importance for sustainable employability.

Key messages

Modification of working conditions and health promotion might contribute to sustained employability. Preventing deteriorations in working conditions might be of particular importance for prolongation of working lives.

The courses of objective physical activity and the association with sleepiness during a 2-week-on/2-week-off offshore shift rotation: an observational repeated-measures study

BACKGROUND

Offshore workers are assumed to have poor health behaviours, but no studies have yet examined physical activity (PA) during a full offshore shift rotation period, including both work and at home periods. Furthermore, the relationship of PA with sleepiness, a prevalent safety hazard offshore, is not known. This study aimed to examine (1) the courses of objectively measured PA in offshore workers during pre-, offshore and post-offshore periods, and (2) the association between PA and self-reported sleepiness.

METHODS

An observational repeated measures study was conducted among 36 offshore workers during a full 2-week on/2-week off offshore shift rotation. Objective PA was assessed using Daytime Activity Averages (DAA) from actigraph recordings. Sleepiness was assessed using next-morning Karolinska Sleepiness Scale (KSS) scores. The courses of PA over time were analysed with Linear Mixed Models (LMM). Parallel LMM were used to assess the longitudinal relationship between PA and sleepiness, both on a between-person and within-person level.

RESULTS

The courses of PA were not significantly different between the pre-, offshore, and post-offshore periods. In addition, between-person trends of PA and sleepiness were not associated (p ranges between 0.08─0.99) and PA did not affect next-morning sleepiness on a within-person level (p = 0.15).

CONCLUSIONS

PA levels during the offshore working period were not different from PA levels at home. Furthermore, PA was not associated with next-morning sleepiness. Further research should focus on different levels of PA including its intensity level.