Social Policy and Prevention Research Department, Centre for Addictions and Mental Health, Toronto.
Int J Health Serv. 2010;40(2):281-95. doi: 10.2190/HS.40.2.h.
The study explores the pathways and mechanisms of the relation between employment conditions and health inequalities. A significant amount of published research has proved that workers in several risky types of labor--precarious employment, unemployment, informal labor, child and bonded labor--are exposed to behavioral, psychosocial, and physio-pathological pathways leading to physical and mental health problems. Other pathways, linking employment to health inequalities, are closely connected to hazardous working conditions (material and social deprivation, lack of social protection, and job insecurity), excessive demands, and unattainable work effort, with little power and few rewards (in salaries, fringe benefits, or job stability). Differences across countries in the social contexts and types of jobs result in varying pathways, but the general conceptual model suggests that formal and informal power relations between employees and employers can determine health conditions. In addition, welfare state regimes (unionization and employment protection) can increase or decrease the risk of mortality, morbidity, and occupational injury. In a multilevel context, however, these micro- and macro-level pathways have yet to be fully studied, especially in middle- and low-income countries. The authors recommend some future areas of study on the pathways leading to employment-related health inequalities, using worldwide standard definitions of the different forms of labor, authentic data, and a theoretical framework.
本研究探讨了就业条件与健康不平等之间关系的途径和机制。大量已发表的研究证明，处于几种高风险劳动类型（不稳定就业、失业、非正规劳动、童工和债役劳动）中的劳动者，面临着导致身心健康问题的行为、心理社会和生理病理途径。将就业与健康不平等联系起来的其他途径，与危险的工作条件（物质和社会剥夺、缺乏社会保护和工作不稳定）密切相关，工作要求过高且难以实现，权力和回报微薄（在工资、福利或工作稳定性方面）。由于各国的社会背景和工作类型存在差异，因此存在不同的途径，但总体概念模型表明，员工和雇主之间的正式和非正式权力关系可以决定健康状况。此外，福利国家制度（工会化和就业保护）可以增加或降低死亡率、发病率和职业伤害的风险。然而，在多层次背景下，这些微观和宏观层面的途径仍有待充分研究，特别是在中等收入和低收入国家。作者建议使用不同劳动形式的全球标准定义、真实数据和理论框架，针对导致与就业相关的健康不平等的途径开展一些未来的研究。
