The European Journal of Public Health Advance Access originally published online on July 1, 2009
The European Journal of Public Health 2009 19(5):458-463; doi:10.1093/eurpub/ckp095
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Socioeconomic Inequalities |
Physical and psychosocial working conditions as explanations for occupational class inequalities in self-rated health
Risto Kaikkonen1,2, Ossi Rahkonen2, Tea Lallukka2 and Eero Lahelma2
1 Department of Living conditions, Health and Well-being, National Institute for Health and Welfare, PO Box 30, 00271 Helsinki, Finland
2 Department of Public Health, University of Helsinki, PO Box 41, 00014 University of Helsinki, Finland
Correspondence: Risto Kaikkonen, Department of Living conditions, National Institute of Health and Welfare, PO Box 30, 00271 Helsinki, Finland, tel: +358 20 610 8176, fax: +358 20 610 5760, e-mail: risto.kaikkonen{at}thl.fi
Received March 10, 2009 , accepted June 4, 2009
Background: Socio-economic health inequalities are well documented, but efforts to explain health inequalities are less. However, previous studies suggest that working conditions provide potential explanations for inequalities in health. Methods: Cross-sectional questionnaire survey data, collected from municipal employees of the City of Helsinki, aged 40–60 years (n = 8960, response rate 67%) in 2000–02, were examined using binomial regression analysis. Socio-economic position was measured by six occupational social classes ranging from top managers to manual workers, and the outcome was self-rated health (SRH). Key physical and psychosocial working conditions and work arrangements were included as explanatory factors for inequalities in health. Results: Occupational class inequalities in SRH were clear among women [prevalence ratio (PR) 1.89, 95% confidence interval (CI) 1.54–2.32] and men (PR 1.78, 95% CI 1.40–2.25). Heavy physical workload explained a half of the health inequalities among women and almost one-third among men. Physical and chemical exposures at work explained one-fifth of the health inequalities among women and a half among men. Job control explained 24% of the men's and 40% of women's inequalities, whereas job demands widened the inequalities by 13–14%. The effects of shift work and working hours were negligible. In the fully adjusted model, 60% of the women's and 32% of the men's inequalities in SRH were explained. Conclusion: Physical working conditions explained a large part and job control, a somewhat smaller part of socio-economic inequalities in SRH. Improving physical working conditions and increasing job control provide potential routes to reduced inequalities in health among employees.
Keywords: physical working conditions, psychosocial factors, self-rated health, socio-economic position, work arrangements