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Through sustainable development goals 3 and 8 and other policies, countries have committed to protect and promote workers' health by reducing the work-related burden of disease. To monitor progress on these commitments, indicators that capture the work-related burden of disease should be available for monitoring workers' health and sustainable development. The World Health Organization and the International Labour Organization estimate that only 363 283 (19%) of 1 879 890 work-related deaths globally in 2016 were due to injuries, whereas 1 516 607 (81%) deaths were due to diseases. Most monitoring systems focusing on workers' health or sustainable development, such as the global indicator framework for the sustainable development goals, include an indicator on the burden of occupational injuries. Few such systems, however, have an indicator on the burden of work-related diseases. To address this gap, we present a new global indicator: mortality rate from diseases attributable to selected occupational risk factors, by disease, risk factor, sex and age group. We outline the policy rationale of the indicator, describe its data sources and methods of calculation, and report and analyse the official indicator for 183 countries. We also provide examples of the use of the indicator in national workers' health monitoring systems and highlight the indicator's strengths and limitations. We conclude that integrating the new indicator into monitoring systems will provide more comprehensive and accurate surveillance of workers' health, and allow harmonization across global, regional and national monitoring systems. Inequalities in workers' health can be analysed and the evidence base can be improved towards more effective policy and systems on workers' health. Par le biais des objectifs de developpement durable 3 et 8 ainsi que d'autres mesures, plusieurs pays se sont engages a proteger et promouvoir la sante des travailleurs en reduisant l'impact des maladies liees au travail. Mais pour evaluer leurs progres en la matiere, il convient de mettre en place des indicateurs estimant l'impact des maladies liees au travail afin de placer le developpement durable et la sante des travailleurs sous surveillance. D'apres l'Organisation mondiale de la Sante et l'Organisation internationale du Travail, seulement 363 283 (19%) des 1 879 890 deces lies au travail dans le monde en 2016 decoulaient de blessures, tandis que 1 516 607 (81%) d'entre eux etaient causes par des maladies. La plupart des systemes de surveillance qui s'interessent a la sante des travailleurs ou au developpement durable, comme le cadre mondial d'indicateurs pour les objectifs de developpement durable, comportent un indicateur relatif a l'impact des accidents de travail. Cependant, rares sont ceux qui possedent un indicateur concernant l'impact des maladies professionnelles. Pour combler cette lacune, nous devoilons un nouvel indicateur mondial: le taux de mortalite du aux maladies attribuables a certains facteurs de risque professionnels classe par maladie, facteur de risque, sexe et categorie d'age. Nous exposons le motif politique de l'indicateur, decrivons l'origine des donnees et les methodes de calcul, et communiquons et analysons l'indicateur officiel pour 183 pays. Nous fournissons egalement des exemples de la facon dont l'indicateur peut etre utilise dans des systemes nationaux de surveillance de la sante des travailleurs et soulignons ses forces et faiblesses. Nous concluons en affirmant que l'integration de ce nouvel indicateur dans les systemes de surveillance offrira un suivi plus complet et precis de la sante des travailleurs et ouvrira la voie a une harmonisation des systemes mondiaux, nationaux et regionaux. Il est possible d'analyser les inegalites en matiere de sante des travailleurs et d'en ameliorer les bases factuelles afin d'etablir des politiques et systemes plus efficaces dans ce domaine. A traves de los objetivos de desarrollo sostenlble 3 y 8 y de otras politicas, los paises se han comprometido a proteger y promover la salud de los trabajadores reduciendo la carga de morbilidad relacionada con el trabajo. Para supervisar los avances en el cumplimiento de estos compromisos, deberia disponerse de indicadores que reflejen la carga de morbilidad relacionada con el trabajo, a fin de controlar la salud de los trabajadores y el desarrollo sostenible. La Organizacion Mundial de la Salud y la Organizacion Internacional del Trabajo estiman que solo 363 283 (19%) de las 1 879 890 muertes relacionadas con el trabajo a nivel mundial en 2016 se debieron a lesiones, mientras que 1 516 607 (81%) muertes se debieron a enfermedades. La mayoria de los sistemas de vigilancia centrados en la salud de los trabajadores o el desarrollo sostenible, como el marco de indicadores mundiales para los objetivos de desarrollo sostenible, incluyen un indicador sobre la carga de las lesiones laborales. No obstante, pocos de estos sistemas cuentan con un indicador sobre la carga de las enfermedades relacionadas con el trabajo. Para subsanar esta carencia, presentamos un nuevo indicador mundial: la tasa de mortalidad por enfermedades atribuibles a factores de riesgo laborales seleccionados, por enfermedad, factor de riesgo, sexo y grupo de edad. Describimos la justificacion politica del indicador, describimos sus fuentes de datos y metodos de calculo, e informamos y analizamos el indicador oficial para 183 paises. Tambien proporcionamos ejemplos del uso del indicador en los sistemas nacionales de vigilancia de la salud de los trabajadores y destacamos las ventajas y las limitaciones del indicador. Concluimos que la integracion del nuevo indicador en los sistemas de vigilancia proporcionara una vigilancia mas exhaustiva y precisa de la salud de los trabajadores, y permitira la armonizacion entre los sistemas de vigilancia mundiales, regionales y nacionales. Se podran analizar las desigualdades en la salud de los trabajadores y se podra mejorar la base de evidencias para lograr politicas y sistemas mas eficaces en materia de salud de los trabajadores., Introduction Countries have made policy commitments through the sustainable development goals (SDGs) to ensure health and promote decent work for all. (1) SDG targets 3.9 and 8.8 are to 'substantially [...]

BackgroundLife expectancy initially improves rapidly with economic development but then tails off. Yet, at any level of economic development, some countries do better, and some worse, than expected - they either punch above or below their weight. Why this is the case has been previously researched but no full explanation of the complexity of this phenomenon is available.New research networkIn order to advance understanding, the newly formed Punching Above Their Weight Research Network has developed a model to frame future research. It provides for consideration of the following influences within a country: political and institutional context and history; economic and social policies; scope for democratic participation; extent of health promoting policies affecting socio-economic inequities; gender roles and power dynamics; the extent of civil society activity and disease burdens.ConclusionFurther research using this framework has considerable potential to advance effective policies to advance health and equity.

Author(s): Kumanan Rasanathan 1,*, Sara Bennett 2, Vincent Atkins 3, Robert Beschel 4, Gabriel Carrasquilla 5, Jodi Charles 6, Rajib Dasgupta 7, Kirk Emerson 8, Douglas Glandon 2, Churnrurtai Kanchanachitra [...]

The Challenge Throughout the world, people who are vulnerable and socially disadvantaged have less access to health resources, get sicker, and die earlier than people in more privileged social positions. [...]

As in many other areas of social determinants of health, policy recommendations on employment conditions and health inequalities need to be implemented and evaluated. Case studies at the country level can provide a flavor of "what works," but they remain essentially subjective. Employment conditions research should provide policies that actually reduce health inequalities among workers. Workplace trials showing some desired effect on the intervention group are insufficient for such a broad policy research area. To provide a positive heuristic, the authors propose a set of new policy research priorities, including placing more focus on "solving" and less on "problematizing" the health effects of employment conditions; developing policy-oriented theoretical frameworks to reduce employment-related inequalities in health; developing research on methods to test the effects of labor market policies; generalizing labor market interventions; engaging, reaching out to, and holding onto workers exposed to multiple forms of unhealthy employment conditions; measuring labor market inequalities in health; planning, early on, for sustainability in labor market interventions; studying intersectoral effects across multiple interventions to reduce health inequalities; and looking for evidence in a global context. [ABSTRACT FROM AUTHOR]

Theoretical models are a way of visualizing, in context, the many factors that contribute to inequalities in health. This article presents a model showing the micro-level pathways relating employment and working conditions to health inequalities. A first important (indirect) pathway runs through the unequal distribution of harmful working conditions. Both employment and working conditions tend to be unequally distributed along the same social axes: social class, gender, ethnicity/race, immigration/migration status, territory, and so forth. Underlying mechanisms are exploitation, domination, and discrimination. Material deprivation and economic inequalities constitute a second direct pathway linking (nonstandard) employment conditions to health inequalities. In a third pathway, employment conditions may have an important effect on health inequalities via several psychosocial, behavioral, and physiopathological pathways. Although these several pathways are separated for analytical purposes, they are largely intertwined and, ideally, should be studied in an integrated way. The theoretical model presented in this article serves three main purposes: providing analytical clarity for organizing scientific data, encouraging further observation and causal testing, and identifying policy entry points. [ABSTRACT FROM AUTHOR]

The authors develop a macro-social theoretical framework to explain how employment and working conditions affect health inequalities. The theoretical framework represents the social origins and health consequences of various forms of employment conditions. The emphasis is thus on determinants and consequences of employment conditions, not on social determinants of health in general. The framework tries to make sense of the complex link between macro-social power relations among employers, government, and workers' organizations, labor market and social policies, employment and working conditions, and the health of workers. It also suggests further testing of hypothetical causal pathways not covered in the literature. This macro-social theoretical framework might help identify the main "entry points" through which to implement policies and interventions to reduce employment-related health inequalities. The theoretical framework should be approached from a historical perspective. [ABSTRACT FROM AUTHOR]

Standard full-time permanent employment—providing a minimal degree of stability, income sustainability, workers' empowerment, and social protection—has declined in the high-income countries, while it was never the norm in the rest of the world. Consequently, work is increasingly affecting population health and health inequalities, not only as a consequence of harmful working conditions, but also because of employment conditions. Nevertheless, the health consequences of employment conditions are largely neglected in research. The authors describe five types of employment conditions that deviate from standard full-time permanent employment—precarious employment, unemployment, informal employment, forced employment or slavery, and child labor—and their health consequences, from a worldwide perspective. Despite obvious problems of measurement and international comparability, the findings show that, certainly in the low-income countries, these conditions are largely situated in informality, denying any possible standard of safety, protection, sustainability, and workers' rights. Considerable numbers of the world's working people are affected in geographically and socioeconomically unequal ways. This clearly relates nonstandard employment conditions to health equity consequences. In the future, governments and health agencies should establish more adequate surveillance systems, research programs, and policy awareness regarding the health effects of these nonstandard employment conditions. [ABSTRACT FROM AUTHOR]

The association between certain increasingly pervasive employment conditions and serious health inequalities presents a significant policy challenge. A critical starting point is the recognition that these problems have not arisen in a policy vacuum. Rather, policy frameworks implemented by governments over the past 35 years, in conjunction with corporate globalization (itself facilitated by neoliberal policies), have undermined preexisting social protection policies and encouraged the growth of health-damaging forms of work organization. After a brief description of the context in which recent developments should be viewed, this article describes how policies can be reconfigured to address health-damaging employment conditions. A number of key policy objectives and entry points are identified, with a summary of policies for each entry point, relating to particular employment conditions relevant to rich and poor countries. Rather than trying to elaborate these policy interventions in detail, the authors point to several critical issues in relation to these interventions, linking these to illustrative examples. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Many intrinsically related determinants of health and disease exist, including social and economic status, education, employment, housing, and physical and environmental exposures. These factors interact to cumulatively affect health and disease burden of individuals and populations, and to establish health inequities and disparities across and within countries. Biomedical models of health care decrease adverse consequences of disease, but are not enough to effectively improve individual and population health and advance health equity. Social determinants of health are especially important in Latin American countries, which are characterised by adverse colonial legacies, tremendous social injustice, huge socioeconomic disparities, and wide health inequities. Poverty and inequality worsened substantially in the 1980s, 1990s, and early 2000s in these countries. Many Latin American countries have introduced public policies that integrate health, social, and economic actions, and have sought to develop health systems that incorporate multisectoral interventions when introducing universal health coverage to improve health and its upstream determinants. We present case studies from four Latin American countries to show the design and implementation of health programmes underpinned by intersectoral action and social participation that have reached national scale to effectively address social determinants of health, improve health outcomes, and reduce health inequities. Investment in managerial and political capacity, strong political and managerial commitment, and state programmes, not just time-limited government actions, have been crucial in underpinning the success of these policies. INSETS: Panel 1: Domains of intersectoral actions.;Panel 2: Achieving intersectoral action to address social.... [ABSTRACT FROM AUTHOR]

The objective of this study was to analyze the association between social class and psychosocial occupational risk factors and self-rated health and mental health in a Chilean population. A cross-sectional study analyzed data from the First National Survey on Employment, Work, Quality of Life, and Male and Female Workers in Chile (N = 9,503). The dependent variables were self-rated health status and mental health. The independent variables were social class (neo-Marxist), psychosocial occupational risk factors, and material deprivation. Descriptive and logistic regression analyses were performed. There were inequalities in the distribution of psychosocial occupational risk factors by social class and sex. Furthermore, social class and psychosocial occupational risk factors were associated with unequal distribution of self-rated health and mental health among the working population in Chile. Occupational health interventions should consider workers' exposure to socioeconomic and psychosocial risk factors.