Occupational class inequalities in health across employment sectors: the contribution of working conditions
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While health inequalities among employees are well documented, their variation and determinants among employee subpopulations are poorly understood. We examined variations in occupational class inequalities in health within four employment sectors and the contribution of working conditions to these inequalities.
Cross-sectional data from the Helsinki Health Study in 2000–2002 were used. Each year, employees of the City of Helsinki, aged 40–60 years, received a mailed questionnaire (n = 8,960, 80% women, overall response rate for 3 years 67%). The outcome was physical health functioning measured by the overall physical component summary of SF-36. The socioeconomic indicator was occupational social class. Employment sectors studied were health care, education, social welfare and administration (n = 6,557). Physical and mental workload, and job demands and job control were explanatory factors. Inequality indices from logistic regression analysis were calculated.
Occupational class inequalities in physical health functioning were slightly larger in education (1.47) than in the other sectors (1.43–1.40). Physical workload explained 95% of inequalities in social welfare and 32–36% in the other sectors. Job control also partly explained health inequalities. However, adjusting for mental workload and job demands resulted in larger health inequalities.
Inequalities in physical health functioning were found within each employment sector, with minor variation in their magnitude. Physical workload was the main explanation for these inequalities, but its contribution varied between the sectors. In contrast, considering psychosocial working conditions led to wider inequalities. Improving physical working conditions among the lower occupational classes would help reduce health inequalities within different employment sectors.
KeywordsOccupational class Physical functioning Inequalities Employment sector Working conditions
This study was supported by grants from the Academy of Finland: EL #205588; and ML #204894. We thank the City of Helsinki and members of the Helsinki Health Study group.
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