EPH 2022 Lifestyle, Work and Health in the EU Case summary
Case 1 Summary: Inequalities in working and behaving healthy
Learning goals:
1. How do socio-economic factors influence health? - How is lifestyle related to health
a. Lifestyle
b. Work
c. SES
d. Mental health
2. Different levels of exposure related to work and lifestyle (micro, meso, macro)
3. How do inequalities between socio-economic factors influence health?
4. How does one's occupation influence health outcomes?
a. Work characteristics - hazard, risk, and occupational/work-related diseases, job strain
b. SES and its relation to work characteristics (job-strain)
5. How to address the inequalities between SES and working conditions → health promotion (not important rn)
a. Companies
b. EU
c. Member States
1. How do socio-economic factors influence health? - How is lifestyle related to health?
a. Lifestyle
b. Work
c. SES
d. Mental health
a. Lifestyle
- behaviour/ lifestyle major contributors to the noncommunicable disease burden and mortality
o causal linkages are more or less clear
simple causal linkages: action causes health outcome (vaccination lower risk)
complex causal linkages: repetition or certain timing, other factors intervene (PA, diet,
smoking)
- Lifestyle = complex behavior
→ combinations of interrelated practices and their environmental contexts, reflecting patterns of living
influences by the family and social history of individuals.
o Discrete behaviors: can be influenced directly with education
o Complex behavior: changes more slowly → requires combination of education, organization,
economical and environmental intervention
- Determinants of behavior
o Predisposing factors → reside in individuals: attitudes, values, beliefs, perception of need etc.
Shaped over time by cultural and social exposure
Provide rationale, motivation or drive for an individual’s behavior
o Enabling factors → conditions of the environment that facilitate or impede the performance of a
predisposition or motivated action
Availability, accessibility, and affordability of healthcare & community resources
Built environment: bicycle lanes, sidewalks, housing etc.
o Reinforcing factors → consequence of action that determine whether actor receives positive
feedback and is supported socially and financially after it occurs
Social support, peer influences, benefits and costs of action, culture, etc.
Example: self-efficacy, chronic pessimism
1
,EPH 2022 Lifestyle, Work and Health in the EU Case summary
b. Work
- Three occupational aspects:
o employment relations
o employment conditions
Employment
Precarious employment
Unemployment
Informal employment and informal jobs
Child labor
Slavery/bonded labor
o and working conditions
- low SES & lower education
o lower level occupational roles and poor working conditions
o associated with dangerous work and with work-related exposure
Gender differences
- Horizontal segregation = gender stereotype cause restriction in feminized or masculinized sectors of
activity
- Vertical segregation → men tend to have jobs in higher occupational hierarchy than women
- unequal distribution of working conditions as well as exposure to different physical and psychological risks
between sexes
- Women are also more likely to have part-time or temporary contracts than men
Job stressors
- = physical, social, organizational or economic conditions at work that contribute to stress. Can result from
Job itself → heavy workloads, low input into decision making
Social and organizational context in which the job is performed → poor communication,
interpersonal conflict)
2 Models of job stress
- Demand-Control-Support (DCS):
o high stain jobs = most unhealthy
A lot of demand, but low latitude
- Effort-Reward Imbalance (ERI)
o High costs, low gain conditions
2. Different levels of exposure related to work and lifestyle (micro, meso, macro)
- Stress at work
2
,EPH 2022 Lifestyle, Work and Health in the EU Case summary
o Micro: individual level → how an individual copes with stressful events and conditions (could be
healthy or unhealthy)
o Meso: interface between individual and organization (company, society) → relationships
between boss and employees + exposure to hazards
o Macro: physical, organizational, economic and environments that can produce stress →
governments and policies (less specific for individuals)
- Interventions
o Micro: teaching someone relaxation techniques, time management, setting goals → personal
intervention
o Meso: in the company itself, that takes care of hazards and provides beneficial conditions to
employees
o Macro: national level or EU level making policies, larger changes
3. How do inequalities between socio-economic factors influence health?
- People with low SES have less healthy lifestyles and live and work more in disadvantaged conditions than
people with high SES mediation effect
- the effects of unhealthy lifestyle and living/working condition on health is larger in those with low SES →
moderating effect
- social gradient: health inequalities affect everyone, it’s a
gradient → people near the top have poorer health than
those at the very top but better than people behind them
in the health gradient scale
- SES inequalities on a global scale
o Hard to harmonize policies to prevent higher
income countries of taking advantage of lower
income countries (low costs of production)
o Need for international coordination of
occupational health protection for workers increasing globalization of the world economy
Harmonization of health, safety, and environmental standards
o Governments and multinational corporations must be prepared to share advances in control
technology, expertise, and resources
o international systems should be established to ensure complete notification of potential hazards,
including labelling the contents of raw materials and products
4. How does one's occupation influence health outcomes?
a. Work characteristics - hazard, risk, and occupational/work-related diseases, job strain
b. SES and its relation to work characteristics (job-strain)
- Diseases in which occurrence may be associated with workplace factors, but these need not be the only
risk factor in each case.
- They occur more commonly than pure ‘occupational diseases’, and the term is also used to refer to
aggravation of a pre-existing medical condition by workplace factors.
- Occupational illnesses
o Physical outcomes
lung and skin conditions
3
, EPH 2022 Lifestyle, Work and Health in the EU Case summary
hearing loss
infections
injuries (amputations, burns)
occupational cancer (benzene, asbestos, radiation etc.)
lung, bladder, skin and liver cancer
heart disease (hypertension)
Occupational reproductive disorders (mental compounds, astrogenic agents, certain
gases, ionizing radiation etc.)
o Mental outcomes
Occupational stress: chronic exposure (working overload) can lead to depression,
anxiety, immune deficiency disorder → can cause multiple illnesses
- Occupational and work disease not quite recognized
o Hard to find cause and effect relationships → takes a long time
o Lack of research → lot of chemicals used, only few tested for toxicity
o Health practitioners’ lack of knowledge
o Lack of medical awareness of workers
o Conflict of interest (employers may be reluctant to recognize the work-relatedness of a disorder,
especially in cases where personal habits or non-occupational pursuits are possible contributory
factors (financial reasons)
- Results in:
o Large economic costs
o Loss of working days
o Medical care
o Rehabilitation and compensation
o Productivity for the organization
5. How to address the inequalities between SES and working conditions Health promotion (not important rn)
a. Companies
b. EU
c. MS
- Primary: before disease occurs eliminate causal factors + make workplace safer
- Secondary detect overexposure to hazards
- Tertiary minimize the consequences
- Public Health strategies
o Educational strategies: inform and educate public
Direct communication → mass media, schools, worksites, etc
Indirect communications → parents, teachers, peers etc.
Community organization, political activation and training
o Automatic-protective strategies: directed at controlling environmental variables
Minimize need for individual decisions in structuring behavior
Infant immunization, water fluoridation
o Coercive strategies: legal and other formal sanctions to control individual behavior
Required immunizations for school entry
Mandatory TB testing
o Examples:
4
Case 1 Summary: Inequalities in working and behaving healthy
Learning goals:
1. How do socio-economic factors influence health? - How is lifestyle related to health
a. Lifestyle
b. Work
c. SES
d. Mental health
2. Different levels of exposure related to work and lifestyle (micro, meso, macro)
3. How do inequalities between socio-economic factors influence health?
4. How does one's occupation influence health outcomes?
a. Work characteristics - hazard, risk, and occupational/work-related diseases, job strain
b. SES and its relation to work characteristics (job-strain)
5. How to address the inequalities between SES and working conditions → health promotion (not important rn)
a. Companies
b. EU
c. Member States
1. How do socio-economic factors influence health? - How is lifestyle related to health?
a. Lifestyle
b. Work
c. SES
d. Mental health
a. Lifestyle
- behaviour/ lifestyle major contributors to the noncommunicable disease burden and mortality
o causal linkages are more or less clear
simple causal linkages: action causes health outcome (vaccination lower risk)
complex causal linkages: repetition or certain timing, other factors intervene (PA, diet,
smoking)
- Lifestyle = complex behavior
→ combinations of interrelated practices and their environmental contexts, reflecting patterns of living
influences by the family and social history of individuals.
o Discrete behaviors: can be influenced directly with education
o Complex behavior: changes more slowly → requires combination of education, organization,
economical and environmental intervention
- Determinants of behavior
o Predisposing factors → reside in individuals: attitudes, values, beliefs, perception of need etc.
Shaped over time by cultural and social exposure
Provide rationale, motivation or drive for an individual’s behavior
o Enabling factors → conditions of the environment that facilitate or impede the performance of a
predisposition or motivated action
Availability, accessibility, and affordability of healthcare & community resources
Built environment: bicycle lanes, sidewalks, housing etc.
o Reinforcing factors → consequence of action that determine whether actor receives positive
feedback and is supported socially and financially after it occurs
Social support, peer influences, benefits and costs of action, culture, etc.
Example: self-efficacy, chronic pessimism
1
,EPH 2022 Lifestyle, Work and Health in the EU Case summary
b. Work
- Three occupational aspects:
o employment relations
o employment conditions
Employment
Precarious employment
Unemployment
Informal employment and informal jobs
Child labor
Slavery/bonded labor
o and working conditions
- low SES & lower education
o lower level occupational roles and poor working conditions
o associated with dangerous work and with work-related exposure
Gender differences
- Horizontal segregation = gender stereotype cause restriction in feminized or masculinized sectors of
activity
- Vertical segregation → men tend to have jobs in higher occupational hierarchy than women
- unequal distribution of working conditions as well as exposure to different physical and psychological risks
between sexes
- Women are also more likely to have part-time or temporary contracts than men
Job stressors
- = physical, social, organizational or economic conditions at work that contribute to stress. Can result from
Job itself → heavy workloads, low input into decision making
Social and organizational context in which the job is performed → poor communication,
interpersonal conflict)
2 Models of job stress
- Demand-Control-Support (DCS):
o high stain jobs = most unhealthy
A lot of demand, but low latitude
- Effort-Reward Imbalance (ERI)
o High costs, low gain conditions
2. Different levels of exposure related to work and lifestyle (micro, meso, macro)
- Stress at work
2
,EPH 2022 Lifestyle, Work and Health in the EU Case summary
o Micro: individual level → how an individual copes with stressful events and conditions (could be
healthy or unhealthy)
o Meso: interface between individual and organization (company, society) → relationships
between boss and employees + exposure to hazards
o Macro: physical, organizational, economic and environments that can produce stress →
governments and policies (less specific for individuals)
- Interventions
o Micro: teaching someone relaxation techniques, time management, setting goals → personal
intervention
o Meso: in the company itself, that takes care of hazards and provides beneficial conditions to
employees
o Macro: national level or EU level making policies, larger changes
3. How do inequalities between socio-economic factors influence health?
- People with low SES have less healthy lifestyles and live and work more in disadvantaged conditions than
people with high SES mediation effect
- the effects of unhealthy lifestyle and living/working condition on health is larger in those with low SES →
moderating effect
- social gradient: health inequalities affect everyone, it’s a
gradient → people near the top have poorer health than
those at the very top but better than people behind them
in the health gradient scale
- SES inequalities on a global scale
o Hard to harmonize policies to prevent higher
income countries of taking advantage of lower
income countries (low costs of production)
o Need for international coordination of
occupational health protection for workers increasing globalization of the world economy
Harmonization of health, safety, and environmental standards
o Governments and multinational corporations must be prepared to share advances in control
technology, expertise, and resources
o international systems should be established to ensure complete notification of potential hazards,
including labelling the contents of raw materials and products
4. How does one's occupation influence health outcomes?
a. Work characteristics - hazard, risk, and occupational/work-related diseases, job strain
b. SES and its relation to work characteristics (job-strain)
- Diseases in which occurrence may be associated with workplace factors, but these need not be the only
risk factor in each case.
- They occur more commonly than pure ‘occupational diseases’, and the term is also used to refer to
aggravation of a pre-existing medical condition by workplace factors.
- Occupational illnesses
o Physical outcomes
lung and skin conditions
3
, EPH 2022 Lifestyle, Work and Health in the EU Case summary
hearing loss
infections
injuries (amputations, burns)
occupational cancer (benzene, asbestos, radiation etc.)
lung, bladder, skin and liver cancer
heart disease (hypertension)
Occupational reproductive disorders (mental compounds, astrogenic agents, certain
gases, ionizing radiation etc.)
o Mental outcomes
Occupational stress: chronic exposure (working overload) can lead to depression,
anxiety, immune deficiency disorder → can cause multiple illnesses
- Occupational and work disease not quite recognized
o Hard to find cause and effect relationships → takes a long time
o Lack of research → lot of chemicals used, only few tested for toxicity
o Health practitioners’ lack of knowledge
o Lack of medical awareness of workers
o Conflict of interest (employers may be reluctant to recognize the work-relatedness of a disorder,
especially in cases where personal habits or non-occupational pursuits are possible contributory
factors (financial reasons)
- Results in:
o Large economic costs
o Loss of working days
o Medical care
o Rehabilitation and compensation
o Productivity for the organization
5. How to address the inequalities between SES and working conditions Health promotion (not important rn)
a. Companies
b. EU
c. MS
- Primary: before disease occurs eliminate causal factors + make workplace safer
- Secondary detect overexposure to hazards
- Tertiary minimize the consequences
- Public Health strategies
o Educational strategies: inform and educate public
Direct communication → mass media, schools, worksites, etc
Indirect communications → parents, teachers, peers etc.
Community organization, political activation and training
o Automatic-protective strategies: directed at controlling environmental variables
Minimize need for individual decisions in structuring behavior
Infant immunization, water fluoridation
o Coercive strategies: legal and other formal sanctions to control individual behavior
Required immunizations for school entry
Mandatory TB testing
o Examples:
4
