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BEDREHELSE-Bedre helse og livskvalitet

The European burden of disease of psychosocial stress and physical risk factors at work

Awarded: NOK 1.9 mill.

Social determinants of health pertain to the economic and social situation of an individual and can influence personal health. Working conditions are a known social determinant of health. Unfavorable working conditions, especially those related to the psychosocial working environment (i.e. high demands and low control), have been found to increase the risk of coronary heart disease, obesity, musculoskeletal pain, poor mental health and mortality. The aims of this project are to study unfavorable working conditions and population health across Europe using two distinct methodological approaches. First, in this project we are the first in the world to examine if the associations between both psychosocial and physical working conditions and population health vary by European welfare-state regime within both men and women. In our reserach we ascertained that physical working conditions contributed substantially to health inequalities across Europe, with women in manual occupations, especially those who live in Central and Eastern Europe being particularly vulnerable. Our findings indicate that more research is needed concerning physical working conditions to explain and potentially reduce occupational inequalities in health. The results of this study are published with high priority in the International Journal of Health Services (2014) and are entitled. All part of the job. The contribution of the psychosocial and physical work environment to health inequalities in Europe and the European health divide. Second, we are also the first in the world to assess the potential for reduction of all-cause mortality within Europe by improving unfavourable psychosocial working conditions within men. This manuscript is currently in progress and the preliminary findings are promising. Thus far it seems that raising unfavourable working conditions within manual workers to that of non-manual workers appear to reduce inequalities within all examined countries. It also seems that if unfavorable psychosocial working conditions were lowered to that of Denmark, we may also achieve a slight reduction in deaths around Europe. Although at this stage results are tentative and further analysis will be carried out in the upcoming year to enrich our preliminary findings, it appears that our study may provide a first-step for policy makers motivated to reduce inequalities in mortality.This project has produced interesting results. We expect that once this project is completed that we might be able to provide useful evidence based information that will help in the quest to decrease occupational inequalities in mortality within Europe.

It is well established that work is an important social determinant of health and health inequalities. Hazardous physical working conditions, stressful psychosocial work environments, and some elements of the organisation of working life have all been ass ociated with adverse health outcomes. Previous European research in this field has been largely based on single country studies, and has often focused on only one particular aspect of working conditions, most notably the psychosocial work environment or j ob insecurity. The extent to which adverse psychosocial and physical working conditions contribute to mortality and morbidity in a larger European perspective is currently unknown. However, we know that socioeconomic position is a key factor in understan ding the occurence of the European health burden because people in the lower strata are overrepresented among those experiencing adverse working conditions. The current project will apply the largest (21 countries) and most recent (the period 2000-2005) European data on mortality and link these to data on psychosocial and physical working conditions, that are causally related to mortality, from the European Survey of Working Conditions (ESWC). Population Atributable Fractions will be used to calculate th e saved deaths and potential reduction of socioeconomic inequalities that could be obtained provided that the the exposure to known psychosocial and physical risk factors at work would be reduced to an alternative level. The alternative levels will be id entified as counterfactual scenarios, which will be derived from the intervention evaluation literature as well as from observed variations between countries, between men and women and between socioeconomic groups. A separate study will use the data obt ained from the ESWC to assess the contribution of psychosocial and physical working conditions to socioeconomic inequalities in self-reported health in 27 European countries for men and women separately.

Funding scheme:

BEDREHELSE-Bedre helse og livskvalitet