Employment relations, social class and health: a review and analysis of conceptual and measurement alternatives.

Employment relations, as a theoretical framework for social class, represent a complementary approach to social stratification. Employment relations introduce social relations of ownership and control over productive assets to the analysis of inequalities in economic (e.g., income), power (occupational hierarchy), and cultural (e.g., education) resources. The objectives of this paper are to briefly clarify the theoretical background on socio-economic indicators used in social epidemiology and to conduct a review of empirical studies that adopt relational social class indicators in the socio-epidemiological literature. Measures of employment relations in social determinants of health research can be classified within two major conceptual frameworks: 1) "Neo-Weberian", like the National Statistics Socio-Economic Classification (NS-SEC) which is widely used in the United Kingdom; and 2) "Neo-Marxian", like Erik O. Wright's social class indicators, which are being used by social epidemiologists in the Americas and Europe. Our review of empirical findings (49 articles found) reveals that the relation between employment relations and health does not necessarily imply a graded relationship. For example, small employers can exhibit worse health than highly skilled workers, and supervisors can display worse health than frontline workers. The policy implications of employment relations research are therefore different, and complement those of income or education health gradient studies. While the latter studies tend to emphasize income redistribution policy options, employment relations implicate other factors such as workplace democracy and social protection. Our analysis confirms that the current transformation of employment relations calls for new social class concepts and measures to explain social inequalities in health and to generate policies to reduce them.