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C urrent research topics include

Social determinants of health - how are inequalities expressed in working life ? Susanna Toivanen Presentation at ENSP/Fiocruz Aug 21 st , 2013. C urrent research topics include. working life and health among the self-employed

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C urrent research topics include

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  1. Social determinants of health- how are inequalities expressed in working life?Susanna ToivanenPresentation at ENSP/FiocruzAug 21st, 2013

  2. Current research topics include • working life and health among the self-employed • foreign born persons' working conditions and health in Sweden • future workplaces (offices), working life and health • social determinants of health and health inequalities in working populations • gender and health

  3. Social Inequalities in Health “Inequalities in health are systematic differences in health between different socio-economic groups within a society. As they are socially produced, they are potentially avoidable and widely considered unacceptable in a civilized society.” Margaret Whitehead, 2007 Source: Whitehead, M. J Epidemiol Community Health. 2007;61:473-478

  4. Social Determinants of Health “The circumstances in which people grow, live, work, and age, and the systems put in place to deal with illness. The conditions in which people live and die are, in turn, shaped by political, social, and economic forces”. Source: http://www.who.int/social_determinants/en/

  5. WHO Commission on Social Determinants of Health “Reducing health inequities is an ethical imperative. Social injustice is killing people on a grand scale”. Source: http://www.who.int/social_determinants/en/

  6. The Commission’s overarching recommendations

  7. Marmot M. Status syndrome: how your social standing directly affects your health and life expectancy. London: Bloomsbury; 2004. Wilkinson RG, Pickett K. The spirit level: why more equal societies almost always do better. London: Allen Lane; 2009.

  8. Work and employment relations are important factors in explaining the health and quality of life of populations. http://www.euro.who.int/document/e81384.pdf

  9. Welfare state Labour market macro Organizations Health meso Work places Workers micro Levelsofworkfactors in relation tohealth

  10. Non-employed • or worklessness • Unemployed • Welfare recipients Employed Professionals Managerial and technical Skilled non-manual Skilled manual Unskilled manual Self-employed Industrial sector Size of enterprise Legal form Socio-economic groups in the formal labour market Age Gender Ethnicity

  11. Gender discrimination in the labour market - Obesity, Unemployment, and Earnings • Effects of obesity (BMI≥30) on unemployment • Obese women had a significantly higher risk of unemployment than not obese women • Obese women’s weaker labour market attachment translated to lower earnings • Similar results were not found among men www.nordicwl.dk Source: Härkönen et al, Nordic Journal of Working Life Studies 2011;1:23-38

  12. Life expectancy at 30 years of age according to educational level, men and women in Sweden 1986-2007 +3,2 +4,5 +2,3 +4,1 +0,7 +3,1 Women Men Source: Fritzell, J et. at. Health and inequalities in Sweden: long and short-term perspectives. In J. Fritzell & O. Lundberg (Eds.), Health inequalities and welfare resources.(pp. 19-41). Bristol: The Policy Press.

  13. Employed Professionals Managerial and technical Skilled non-manual Skilled manual Unskilled manual Mediation or moderation? Social inequalities in health – the contribution of adverse work conditions Sources: Hoven H, SiegristJ. OccupEnvironMed 2013;70:663–669. Landsbergis, P.A. Am J Ind Med 2010;53:95-103 Toivanen, S.Am J Ind Med 2011;54:780-90 Toivanen, S & Hemström, Ö. Int J Behav Med 2006;13:89-100

  14. Organizations and workers health • Lean production, a management model to increase efficiency and quality of production • In many cases work intensification is reported influencing workers wellbeing and health • New Public Management Sources: -Toivanen, S. & Landsbergis, P. [Lean and workerhealth] in Sederblad, P (Ed.) [Lean in workinglife]. Stockholm: Liber, 2013 -Landsbergis, P. et al. The impact of lean production and related new systems of work organisation on worker health. J Occup Health Psychol. 1999;4:108-130. -Noblet, A. et al. Organizational change in the public sector: Augmenting the demand control model to predict employee outcomes under New Public Management. Work & Stress, 2006;20:335-352

  15. Job strain and coronary heart disease • Meta-analyses from the IPD-Work Consortium, including 13 European cohort studies http://www.ncbi.nlm.nih.gov/pubmed/?term=IPD-Work+Consortium • Coronary heart disease: HR for job strain 1,23 versus no strain • The population attributable risk for job strain was 3,4% Source: Kivimäki et al. Job strain as a risk factor for coronary heart disease: a collaborative meta-analysis ofindividualparticipant data, Lancet 2012;380:1491–97 • The population attributable risk for CVD for job strain was 4,5 % Source: Niedhammeret al. Fractions of cardiovascular diseases and mental disorders attributable to psychosocial work factors in 31 countries in Europe, Int Arch OccupEnviron Health. 2013

  16. Job strain and CVD risk factors • Meta-analyses from the IPD-Work Consortium, including 8 European cohort studies • Job strain was linked to adverse lifestyle and diabetes • No association between job strain, clinic blood pressure or blood lipids Source: Nyberg ST, et al. Job Strain and Cardiovascular Disease Risk Factors: Meta-Analysis of Individual-Participant Data from 47,000 Men and Women. PLoS ONE 2013;8:e67323 • Single exposure to job strain in cross-sectional studies was associated with higher work systolic and diastolic ABP • Job strain is a risk factor for blood pressure elevation Source: Landsbergis, P. et al. Job strain and ambulatory blood pressure: A meta-analysis and systematic review, American Journal of Public Health. 2013;103:e61-e71

  17. A model of causal pathways (I-V) from society context and the social position of individuals to health. Mechanisms I Social stratification II Differential exposure III Differential susceptibility IV Differential consequences V Impact of consequences Source: Diderichsen, F. et. al. The social basis of disparities in health. In Evans, T. et. al. Challenging inequities in health – from ethics to action. New York: Oxford University Press, 2001

  18. Contact susanna.toivanen@chess.su.se +46 723 223 889

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