Associations between Workers' Health and Working Conditions: Would the Physical and Mental Health of Nonregular Employees Improve If Their Income Was Adjusted?

Precarious employment can negatively affect health, but workers may be healthy if they earn enough income. This study uses equivalent disposable income and examines the interaction between income classes and employment types to clarify whether workers’ health improves as the income classes rise. In Japan, nonstandard workers, called nonregular employees, have remained high since 2013. Therefore, using data from the national cross-sectional Comprehensive Survey of Living Conditions 2013, an official survey performed in Japan, we targeted a sample of employees aged 18 to 45 who graduated during the economic recession. Our final sample included 8282 employees (4444 males and 3838 females). The health (general and mental) status indicators used the dichotomized self-rated health and scores of the K6 questionnaires scored in the national survey. The association between income and health was almost proportional. Female workers tended to improve their health as their income class increased; however, this tendency was not observed in male workers, especially nonregular employees. Although the associations were weakened by added income information on the regression models, nonregular employees always showed inferior health to regular employees. The health status of nonregular employees, especially female nonregular employees, is statistically significantly lower than that of regular employees, even when the economic class is similar. In conclusion, improving low incomes for nonregular employees could improve health challenges, but income alone may not result in the same health status for regular and nonregular employees.

Effects of Serving as a State Functionary on Self-Rated Health: Empirical Evidence From China

Purpose

There is a strong link between occupation and self-rated health. Existing research has revealed the effects of occupation on self-rated health outcomes and the corresponding mechanisms. However, there is a lack of research on the effects of state services on self-rated health in China. Therefore, this study focuses on exploring the effects of serving as a state functionary in China on self-rated health to enrich research in related fields.

Method

Based on the data of 14,138 individuals collected from the 2016 China Labour-Force Dynamics Survey, the logit model was used to investigate the effects of serving as a state functionary on self-rated health and the difference in the effects across different populations.

Results

The results show that (1) serving as a state functionary has a significant positive effect on self-rated health; (2) self-rated health of elderly state functionaries is higher than that of younger state functionaries; (3) self-rated health of state functionaries in non-eastern regions is higher than that of state functionaries in eastern regions; and (4) state functionaries with lower education have higher self-rated health than highly-educated state functionaries; (5) Higher self-rated health of state functionaries is achieved primarily through better work time, better work environment and lower relative deprivation.

Conclusion

Serving as a state functionary in China has a significant positive correlation with self-rated health, with differences across populations of state functionaries. This study expands the current literature on the effects of occupation on self-rated health in the context of China.

Socioeconomic status and health behaviors as predictors of changes in self-rated health among older persons in Israel

There is a considerable body of scientific knowledge about factors associated with self-rated health (SRH), a common measure of health status. However, less is known about the factors associated with changes in SRH over time. In order to fill this gap, the aim of the current study was to examine a combination of socioeconomic, psychosocial, and health behaviour variables in explaining changes in SRH among older adults. The study used data from two time periods in Israel of the Survey of Health, Aging and Retirement in Europe (SHARE) to analyse the predictive contribution of Time 1 socioeconomic, psychosocial and behavioural variables and changes in these variables over time to changes in SHR. The sample included 1,549 older persons interviewed at baseline (years 2009-2010) and four years later (year 2013). Using bivariate and multivariate regression models, the findings show that 26 percent and 23 percent of the participants reported either improvement or a deterioration in their SRH, respectively. Decline in SRH was predicted by a combination of Time 1 socioeconomic (subjective assessment of a household's ability to make ends meet), psychosocial (QoL and in trust in people), and behavioural factors (moderate physical activity) and decline in these factors over time. The findings demonstrate that changes in those variables make an additional significant contribution for explaining changes in SRH. The findings suggest that in addition to identification of low SES, poor psychosocial and behavioural factors as risk factors to poor SRH changes in these factors should be monitored among older populations.

Health expectancies in the European Union: same concept, different methods, different results

BACKGROUND

Healthy life expectancy (HLE) is a population health measure that combines mortality and morbidity, which can be calculated using different methods. In this study, we aimed to assess the correlation, reliability and (dis)agreement between two estimates monitored in the European Union (EU), that is, the European Commission's HLE based on self-perceived health (SPH-HLE) and the Institute for Health Metrics and Evaluation's HLE based on disability weight (DW-HLE), by sex, and comparing these results with LE and proportion of life spent in good health (%GH).

METHODS

We performed a retrospective study in the EU28 countries, between 2010 and 2017. The HLE methods differ in definition, measurement and valuation of health states. While SPH-HLE relies directly on one question, DW-HLE relies on epidemiological data adjusted for DW. Spearman's r, intraclass correlation coefficient, information-based measure of disagreement and Bland-Altman plots were used to assess reliability, correlation and disagreement in HLE resulting from both methods and in LE or %GH measured by both institutions.

RESULTS

Correlation and reliability between SPH-HLE and DW-HLE were good (better for males), with low disagreement, and were even better for LE between both institutions. The HLE Bland-Altman plots suggest a variability range of approximately 6 years for both sexes, higher for females. There was also an increasing HLE difference between methods with higher average HLE for both sexes.

CONCLUSION

We showed wide variations between both methods with a clear and different high impact on female and male HLE, showing a tendency for countries with higher health expectancies to yield larger gaps between SPH-HLE and DW-HLE.

Occupational health profile of Canadian Maritimes truck drivers

BACKGROUND

There are over 12,000 professional truck drivers in the Canadian Maritime provinces, with the majority being in New Brunswick and Nova Scotia. Previous studies have focused on the health of Canadian and American truck drivers but the occupational health status of truck drivers in the Maritime Provinces remains undocumented.

OBJECTIVE

The objective of this cross-sectional study was to provide a general, occupational health and demographic characteristics description of professional truck drivers in the Maritimes.

METHODS

One-hundred and four male truck drivers from the Canadian Maritime Provinces volunteered for this study. Nine occupational health indicators were measured (seven were self-reported via questionnaire and two were physical measurements). Participants self-reported their age, years of truck driving experience and education.

RESULTS

Only one-quarter of the current sample had no health conditions. In contrast, more than half were obese, one third had back problems, and one-sixth had a high risk of developing cardiovascular disease (CVD). The group comparison analysis showed that the group without health condition was younger and more educated than the group with multiple health conditions. For this study, age and low rate of education were associated with an increased number of health conditions.

CONCLUSIONS

Similar to health profiles of other populations of North American truck drivers, this study suggests that the majority of truck drivers in the Canadian Maritime Provinces have at least one poor indicator of occupational health.

Associations between occupational factors and self-rated health in the national Brazilian working population

BACKGROUND

The literature remains seldom on the topic of self-rated health (SRH) among the national working populations of emerging countries. The objectives of the study were to examine the associations of occupational factors with SRH in a national representative sample of the working population in Brazil.

METHODS

This study relied on a cross-sectional sample of 36,442 workers, 16,992 women and 19,450 men. SRH was the studied health outcome. Sixteen occupational factors related to four topics were studied: employment characteristics, working time/hours, psychosocial work factors and physical and chemical work exposures. The associations between occupational factors and SRH were studied using logistic regression models with adjustment for sociodemographic characteristics (age, ethnicity and marital status). The analyses were performed for each gender separately and using weights.

RESULTS

The prevalence of poor SRH was 26.71%, this prevalence being higher among women (29.77%) than among men (24.23%). The following risk factors for poor SRH were found among men and women: working as a self-employed worker, clerk/service worker, manual worker, part-time (≤ 20 h/week), exposure to work stress, exposure to high physical activity and exposure to sun. The risk factors for poor SRH among women only were: working as a domestic worker and exposure to noise, and among men, working in the agriculture sector.

CONCLUSIONS

Our study suggested that occupational factors related to both physical and psychosocial work environment may be associated with SRH in the working population in Brazil. Improving working conditions may be beneficial for health at work in Brazil.

The impact of financial crisis and austerity policies in Andalusia, Spain: disentangling the mechanisms of social inequalities in health through the perceptions and experiences of experts and the general population

Background

Andalusia has been one of the regions most damaged by the economic crisis in Spain. A qualitative study of the effects of the economic crisis and austerity policies in this region has been conducted within the framework of the IMPACT-A project. This research seeks to analyse the perceived impact of the crisis upon the health of the Andalusian population through the first-hand discourses of professionals from the health and social sectors on the one hand, and citizens of different socioeconomic status (SES) on the other.

Methods

A total of five focus groups and ten semi-structured interviews were conducted and analysed following an inductive process based on Grounded Theory (GT).

Results

Our results show a general perception among professionals: the financial crisis has either directly or indirectly affected population health in Andalusia, though mostly impacting low-income individuals who were already at risk of social exclusion. Professionals’ perceptions have been confirmed through the discourses of citizens of a lower SES, which differ from those of middle and upper SES.

Conclusion

Findings reveal some of the most salient consequences on the socially vulnerable groups and people at risk of social exclusion. In particular, our study highlights the importance of addressing three areas of priority action: mental health, unmet (basic and medical) needs, and decline in the health system.

[Association between exposure to second-hand smoke and health status in children]

OBJECTIVE

This study aimed to estimate the association between second-hand smoke (SHS) exposure in children and asthma, wheezing and perceived health.

METHOD

A cross-sectional study based on a telephone survey was performed on a representative sample of 2411 children under 12 years old in Spain. Exposure to SHS in private and public settings, and the prevalence of asthma, wheezing and perceived poor health were described. The association between health indicators and SHS exposure was analyzed using multivariate Poisson regression models with robust variance according to age and educational level.

RESULTS

The prevalence of SHS exposure in children was 29.2% in private settings and 42.5% in public settings. There was no association between SHS exposure and asthma, wheezing and perceived poor health in children ≤5 years. In children aged 6-11 years with parents with primary/secondary education, presenting asthma (adjusted prevalence ratio [aPR]: 2.1; 95% confidence interval [95%CI]: 1.2-3.8) and worse perceived health (aPR: 1.6; 95%CI: 1.1-2.1) were positively associated with SHS exposure in private settings. In children with parents with university studies, a negative association between SHS exposure and asthma (aPR: .3; 95%CI: 0.1-0.7) and wheezing (aPR: 0.3; 95%CI: 0.1-0.8) was observed.

CONCLUSIONS

There are differences in the association between SHS exposure and asthma, wheezing and poor perceived health according to educational level. Interventions with an equity perspective aimed at reducing SHS exposure in childhood should be implemented.

Investigating self-reported health by occupational group after a 10-year lag: results from the total Belgian workforce

Background

Belgium lacks a systematic overview of health differences by occupation. This is the first study to examine self-reported health among 27 occupational groups in Belgium with a lag time of 10 years.

Methods

Individual data are derived from an anonymous linkage between the 1991 and 2001 Belgian census. The total working population (25–55 years) is selected from the 1991 Belgian census. Self-reported health (1 = fair or (very) bad health; 0 = (very) good health) was obtained from the 2001 census. Logistic regression analysis was used to analyse the health of 1.5 million men and 1.0 million women by occupational group in 1991. The active sex-specific population in 1991 and 2001 was the reference group. Controls include age, activity status and housing status at the time of 2001 census.

Results

Both male and female workers in physically demanding occupations were more likely to report poor health. The three occupations with the highest age-adjusted Odds Ratios (OR) were extraction and building trade workers (OR_male 2.08 95% Confidence Interval (CI) 2.05–2.10; OR_female 2.15 CI 1.93–2.40); services elementary workers (OR_male 2.06 CI 2.03–2.10; OR_female 2.37 CI 2.34–2.41); and labourers in construction, manufacturing and transport (OR_male 1.90 CI 1.86–1.93; OR_female 2.21 CI 2.12–2.29). Men and women in teaching, scientific, health-related and managerial positions had the lowest age-adjusted ORs for poor self-reported health. The pattern in occupational health differences remained the same after controlling for activity status and socio-economic position.

Conclusions

Occupational health inequalities are apparent after a lag time of 10 years. The identification of types of workers in poor health provide valuable insights to future health promotion strategies in the Belgian workforce.

Influence of changes in the Spanish labor market during the economic crisis (2007-2011) on perceived health

PURPOSE

We analyze the influence of the dramatic changes in the Spanish labor market during the crisis on the perceived health of the Spanish population.

METHODS

We use the longitudinal Living Conditions Survey database and multilevel longitudinal logistic models between 2007 and 2011, before and during the economic crisis in one of the European countries most affected by its consequences.

RESULTS

Unemployment (OR 1.75; p < 0.001), job insecurity (OR 1.38; p < 0.001), and being part of a household with severe material deprivation (OR 1.87; p = 0.004) increase the risk of having worsened perceived health. Available income, on the other hand, is a protective factor (OR 0.72; p < 0.001). Public expenditure policies have little impact on the perceived health. Labor market reforms reducing the degree of job insecurity and unemployment, together with income transfers to those at greater risk of social deprivation, can be more effective in improving the health of the population than the increase of aggregated social or health care expenditure.

CONCLUSIONS

This study provides evidence of the influence that unemployment, job insecurity, and poverty exert on the perceived health of individuals, with data collected in Spain after the onset of the financial crisis. In addition, after analyzing public social expenditure, only expenditure on FPS seems to influence self-reported health, although to a very limited degree.

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.

Long term unemployment, income, poverty, and social public expenditure, and their relationship with self-perceived health in Spain (2007-2011)

BACKGROUND

There is scant research that simultaneously analyzes the joint effects of long-term unemployment, poverty and public expenditure policies on poorer self-perceived health during the financial crisis. The aim of the study is to analyze the joint relationship between long-term unemployment, social deprivation, and regional social public expenditure on one side, and self-perceived health in Spain (2007-2011) on the other.

METHODS

Longitudinal data were extracted from the Survey on Living Conditions, 2007-2010 and 2008-2011 (9105 individuals and 36,420 observations), which were then used to estimate several random group effects in the constant multilevel logistic longitudinal models (level 1: year; level 2: individual; level 3: region). The dependent variable was self-perceived health. Individual independent interest variables were long and very long term unemployment, available income, severe material deprivation and regional variables were per capita expenditure on essential public services and per capita health care expenditure.

RESULTS

All of the estimated models show a robust association between bad perceived health and the variables of interest. When compared to employed individuals, long term unemployment increases the odds of reporting bad health by 22% to 67%; very long-term unemployment (24 to 48 months) increases the odds by 54% to 132%. Family income reduces the odds of reporting bad health by 16% to 28% for each additional percentage point in income. Being a member of a household with severe material deprivation increases the odds of perceiving one's health as bad by between 70% and 140%. Regionally, per capita expenditure on essential public services increases the odds of reporting good health, although the effect of this association was limited.

CONCLUSIONS

Long and very long term unemployment, available income and poverty were associated to self-perceived bad health in Spain during the financial crisis. Regional expenditure on fundamental public services is also associated to poor self-perceived health, although in a more limited fashion. Results suggest the positive role in health of active employment and redistributing income policies.

Recession, employment and self-rated health: a study on the gender gap

OBJECTIVES

Employment status and economic recession have been associated with negative effects on self-rated health, and this effect differs by gender. We analysed the effects of the Spanish economic recession in terms of self-rated health, its differential effect among genders and its influence on gender gap.

STUDY DESIGN

Repeated cross-sectional study using Spanish health surveys (2001-2014).

METHODS

Logistic regression models were conducted to explore the association between self-rated health and employment status and its evolution over time and gender. To test the impact of the economic recession, pooled data regression models were conducted.

RESULTS

In this study, we considered 104,577 subjects. During the last 15 years, women have entered the labour market, leading to wide changes in the Spanish traditional family roles. Instead of an increasing proportion of women workers, gender employment differences persist. Therefore, in 2014, the prevalence of workers was 55.77% in men, whereas in women, it was 44.01%. Self-rated health trends during the economic recession differ by gender, with women improving slightly their self-rated health from a low self-rated health prevalence of 38.76% in 2001 to 33.78% in 2014. On the contrary, men seem more vulnerable to employment circumstances, which have led to substantial reduction in the gender gap.

CONCLUSIONS

Although a gender gap persists, the change in socio-economic roles seems to increase women's self-rated health, reducing this gap. It is important to promote women's labour market inclusion, even in economic recession periods.

Job Characteristics Associated With Self-Rated Fair or Poor Health Among U.S. Workers

INTRODUCTION

Approximately 60% of the U.S. adult population is employed. Many aspects of a person's job may influence health, but it is unclear which job characteristics are most strongly associated with health at a population level. The purpose of this study was to identify important associations between job characteristics and workers' self-rated health in a nationally representative survey of U.S. workers.

METHODS

Data from the 2010 National Health Interview Survey were used to calculate weighted prevalence rates for self-reported fair/poor health for five categories of job characteristics: occupation; pay/benefits (economic); work organization; chemical/environmental hazards; and psychosocial factors. Backward elimination methods were used to build a regression model for self-reported health with the significant job characteristics, adjusting for sociodemographic variables and health behaviors. Data were collected in 2010 and analyzed in 2012-2016.

RESULTS

After adjusting for covariates, workers were more likely to have fair/poor health if they were employed in business operations occupations (e.g., buyers, human resources workers, event planners, marketing specialists; adjusted prevalence ratio [APR]=1.85, 95% CI=1.19, 2.88); had no paid sick leave (APR=1.35, 95% CI=1.11, 1.63); worried about becoming unemployed (APR=1.43, 95% CI=1.22, 1.69); had difficulty combining work and family (APR=1.23, 95% CI=1.01, 1.49); or had been bullied/threatened on the job (APR=1.82, 95% CI=1.44, 2.29).

CONCLUSIONS

Occupation, lack of paid sick leave, and multiple psychosocial factors were associated with fair/poor health among U.S. workers at the population level in 2010. Public health professionals and employers should consider these factors when developing interventions to improve worker health.

Financial fraud and health: the case of Spain

OBJECTIVE

To examine whether financial fraud is associated with poor health sleeping problems and poor quality of life.

METHODS

Pilot study (n=188) conducted in 2015-2016 in Madrid and León (Spain) by recruiting subjects affected by two types of fraud (preferred shares and foreign currency mortgages) using venue-based sampling. Information on the monetary value of each case of fraud; the dates when subjects became aware of being swindled, lodged legal claim and received financial compensation were collected. Inter-group comparisons of the prevalence of poor physical and mental health, sleep and quality of life were carried according to type of fraud and the 2011-2012 National Health Survey.

RESULTS

In this conventional sample, victims of financial fraud had poorer health, more mental health and sleeping problems, and poorer quality of life than comparable populations of a similar age. Those who had received financial compensation for preferred share losses had better health and quality of life than those who had not been compensated and those who had taken out foreign currency mortgages.

CONCLUSION

The results suggest that financial fraud is detrimental to health. Further research should examine the mechanisms through which financial fraud impacts health. If our results are confirmed psychological and medical care should be provided, in addition to financial compensation.

Change in self-rated general health is associated with perceived illness burden: a 1-year follow up of patients newly diagnosed with type 2 diabetes

Background

Diabetic patients’ lifestyle adaptations to improve glycaemic control are not always followed by improvements in self-rated general health (SRH). The perceived impact of diabetes on patients’ daily lives may influence changes in their SRH. This paper examines the association of illness severity, treatment, behavioural, and coping-related factors with changes in SRH from diagnosis of type 2 diabetes until one year later, in a population-based sample of 599 patients aged 40 years or over who were treated in general practice.

Methods

Change in SRH was estimated by a cumulative probit model with the inclusion of covariates related to SRH (e.g. illness severity at diagnosis, behaviour, treatment, and the perceived impact of diabetes on patients’ daily lives one year later).

Results

At diagnosis, 11.6% of patients reported very good, 35.1% good, 44.6% fair and 8.5% poor SRH. Physical inactivity, many diabetes-related symptoms, and cardiovascular disease were related to lower SRH ratings. On average SRH improved by 0.46 (95% CI: 0.37; 0.55) during the first year after diagnosis without inclusion of covariates. Mental and practical illness burden was the only factor associated with change in SRH, independent of patients’ diabetes severity and medical treatment (p = 0.03, multivariate analysis). Compared to otherwise similar patients without illness burden, increase in SRH was marginally smaller among patients who expressed minor illness burden, but much smaller among patients with more pronounced illness burden.

Conclusions

Much as one would expect, many patients increased their SRH during the first year after diabetes diagnosis. This increase in SRH was not associated with indicators of illness severity or factors reflecting socio-demographic circumstances, but patients experiencing illness burden had a smaller increase than those who reported no illness burden. We suggest that during the diabetes consultation, general practitioners explore further how patients manage their illness burden. We further suggest that diabetes guidelines extend their current focus on clinical and social aspects of diabetes to include questions on patient’s perceived illness burden and SRH.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-015-1790-6) contains supplementary material, which is available to authorized users.

Material, psychosocial and sociodemographic determinants are associated with positive mental health in Europe: a cross-sectional study

OBJECTIVES

To investigate the association between psychosocial, sociodemographic and material determinants of positive mental health in Europe.

DESIGN

Cross-sectional analysis of survey data.

SETTING

34 European countries.

PARTICIPANTS

Representative Europe-wide sample consisting of 21 066 men and 22 569 women aged 18 years and over, from 34 European countries participating in the third wave of the European Quality of Life Survey (2011-2012).

OUTCOME

Positive mental health as measured by the WHO-5-Mental Well-being Index, while the lowest 25% centile indicated poor positive mental health.

RESULTS

The prevalence of poor positive mental health was 30% in women and 24% in men. Material, as well as psychosocial, and sociodemographic factors were independently associated with poor positive mental health in a Europe-wide sample from 34 European countries. When studying all factors together, the highest OR for poor positive mental health was reported for social exclusion (men: OR=1.73, 95% CI 1.59 to 1.90; women: OR=1.69, 95% CI 1.57 to 1.81) among the psychosocial factors. Among the material factors, material deprivation had the highest impact (men: OR=1.96, 95% CI 1.78 to 2.15; women: OR=1.93, 95% CI 1.79 to 2.08).

CONCLUSIONS

This study gives the first overview on determinants of positive mental health at a European level and could be used as the basis for preventive policies in the field of positive mental health in Europe.

Psychosocial working conditions and psychological well-being among employees in 34 European countries

PURPOSE

The aim of this study was to explore the associations between psychosocial working conditions and psychological well-being among employees in 34 European countries. Another objective was to examine whether these associations varied according to occupation and country.

METHODS

The study was based on data from the European Working Conditions Survey 2010 including 33,443 employees, 16,512 men and 16,931 women, from 34 European countries. Well-being was measured by the WHO-5 well-being index. Twenty-five psychosocial work factors were constructed including job demands, role stressors, work hours, job influence and freedom, job promotion, job insecurity, social support, quality of leadership, discrimination and violence at work, and work-life imbalance. The associations between these factors and well-being were examined using multilevel logistic regression analyses. Different models were performed including interaction tests.

RESULTS

When all 25 psychosocial work factors were studied simultaneously in the same model with adjustment variables, 13 showed a significant association with poor well-being among both genders: quantitative demands, demands for hiding emotions, low possibilities for development, low meaning of work, low role conflict, low quality of leadership, low social support, low sense of community, job insecurity, low job promotion, work-life imbalance, discrimination, and bullying. The association with low sense of community on poor well-being was particularly strong.

CONCLUSIONS

A large number of psychosocial work factors were associated with poor well-being. Almost no country and occupational differences were found in these associations. This study gave a first European overview and could be useful to inform cross-national policy debate.