Occupational class inequalities in health across employment sectors: the contribution of working conditions

Objective  While health inequalities among employees are well documented, their variation and determinants among employee subpopulations are poorly understood. We examined variations in occupational class inequalities in health within four employment sectors and the contribution of working conditions to these inequalities. Methods  Cross-sectional data from the Helsinki Health Study in 2000–2002 were used. Each year, employees of the City of Helsinki, aged 40–60 years, received a mailed questionnaire (n = 8,960, 80% women, overall response rate for 3 years 67%). The outcome was physical health functioning measured by the overall physical component summary of SF-36. The socioeconomic indicator was occupational social class. Employment sectors studied were health care, education, social welfare and administration (n = 6,557). Physical and mental workload, and job demands and job control were explanatory factors. Inequality indices from logistic regression analysis were calculated. Results  Occupational class inequalities in physical health functioning were slightly larger in education (1.47) than in the other sectors (1.43–1.40). Physical workload explained 95% of inequalities in social welfare and 32–36% in the other sectors. Job control also partly explained health inequalities. However, adjusting for mental workload and job demands resulted in larger health inequalities. Conclusion  Inequalities in physical health functioning were found within each employment sector, with minor variation in their magnitude. Physical workload was the main explanation for these inequalities, but its contribution varied between the sectors. In contrast, considering psychosocial working conditions led to wider inequalities. Improving physical working conditions among the lower occupational classes would help reduce health inequalities within different employment sectors.     

Disabling working environments and mental health: A commentary

Employment is a fundamental Social Determinant of Health known to have large impacts on mental health and other health outcomes. Across many countries of the world, people with disabilities are much more likely to be unemployed and looking for work than those without disabilities. The deprivation of employment opportunities is likely to have notable impacts on the health of people with disabilities. In this commentary, we outline the concept of “disabling working environments,” which are defined as the range of experiences that affect the likelihood of people with disabilities in obtaining and maintaining quality employment which may then affect a disabled person's health. Disabling working environments are comprised of the following three mutually reinforcing components: 1) Differential selection into work; 2) Selection into certain types of jobs and exposure to poor psychosocial working environments when in employment, and; 3) Differential selection out of work (e.g., leaving employment at an earlier age than those who do not have a disability). We argue that policy and intervention design should consider the life course effects of employment on the mental health of people with disabilities.     

2019—2021年淄博市重点职业病监测与职业健康风险分析

目的 分析淄博市2019—2021年重点职业病监测和工作场所职业病危害因素监测结果,为制定和调整本市重点职业病防治策略提供技术参考。方法 通过相关监测信息系统收集淄博市2019—2021年重点职业病监测和工作场所职业病危害因素监测数据,用率、构成比和χ²检验进行描述性分析重点监测职业病危害作业劳动者体检情况、企业现场危害因素检测情况、职业病报告情况。结果 2019—2021年淄博市存在重点监测的职业病危害因素的企业24 384家,监测接害劳动者457 899人次,接受职业健康检查331 706人次,实检率为72.44%(331 706/457 899),其中疑似职业病检出率为0.03%(92/331 706),各职业病危害因素可能导致的疑似职业病检出率差异有统计学意义(χ²危害=271.400,P_危害<0.001),但年度变化趋势不显著(趋势χ²年度=0.000,P_年度=0.991);职业禁忌证检出率为2.20%(7 308/331 706),各职业病危害因素接触劳动者禁...     

北京市大兴区开展基本职业卫生服务工作情况分析

目的及时总结基本职业卫生服务（BOHS）试点工作开展情况,为今后全面推广BOHS提供借鉴。方法对北京市大兴区开展基本职业卫生服务工作情况从组织机构和管理体系、职业健康监护、宣传与培训、监督管理等方面进行总结和分析。结果大兴区已建立覆盖区镇两级的基本职业卫生服务和监督体系并在有条件的乡镇卫生院开展了职业健康监护工作,通过广泛开展职业卫生宣传和培训,加大监督执法力度,职业健康监护率和作业场所职业病危害因素检测率分别比试点前提高了11.67%-267.37%和80.68%-100.23%。结论大兴区通过开展基本职业卫生服务试点工作,使其基本职业卫生服务覆盖率和服务能力得到了提升,为以劳务吸纳地和流动人群的基本职业卫生服务探索出一条可借鉴的模式。     

The farm family perception of occupational health: a multistate survey of knowledge, attitudes, behaviors, and ideas

It is vitally important to integrate the views and concerns of the farm family into the process of policy development. If the input is not there, policy planners could implement programs that are philosophically separated from the farm families' concerns and attitudes. This would destroy credibility and future farmer support of any new program development. From May of 1988 to April of 1989, a phone and mail survey of approximately 1,500 farmers and spouses was conducted to assess knowledge, attitudes, and behaviors regarding agricultural safety and health. The survey was conducted in Iowa, New York, South Carolina, and Washington state. Preliminary results from Iowa and New York indicated that: 1) farmers value highly, and are concerned with, occupational health and safety issues; 2) farmers report that their major concerns include stress, trauma and respiratory problems; 3) farmers would like access to an occupational health and safety service; and 4) any new farm health and safety programs must include farmer input to ensure practicality, applicability, and acceptance.     

National working conditions surveys in Latin America: comparison of methodological characteristics

Background:

High-quality and comparable data to monitor working conditions and health in Latin America are not currently available. In 2007, multiple Latin American countries started implementing national working conditions surveys. However, little is known about their methodological characteristics.

Objective:

To identify commonalities and differences in the methodologies of working conditions surveys (WCSs) conducted in Latin America through 2013.

Methods:

The study critically examined WCSs in Latin America between 2007 and 2013. Sampling design, data collection, and questionnaire content were compared.

Results:

Two types of surveys were identified: (1) surveys covering the entire working population and administered at the respondent''s home and (2) surveys administered at the workplace. There was considerable overlap in the topics covered by the dimensions of employment and working conditions measured, but less overlap in terms of health outcomes, prevention resources, and activities.

Conclusions:

Although WCSs from Latin America are similar, there was heterogeneity across surveyed populations and location of the interview. Reducing differences in surveys between countries will increase comparability and allow for a more comprehensive understanding of occupational health in the region.     

深圳市福田区2006—2010年企业职业病危害因素申报情况

目的了解深圳市福田区企业职业病危害申报情况和职业病危害因素的变化趋势,以采取针对性的职业病防治措施,更好地开展基本职业卫生服务。方法将2006—2010年福田区企业职业病危害的申报资料录入Excel建立数据库,进行统计分析。结果福田区存在职业病危害因素企业数呈逐年减少趋势,申报的大中型企业构成比逐年减少,作坊式小型企业构成比逐年增加;不同经济类型企业中,有限责任公司构成比增加,其他类型企业构成比趋于减少;除电子、汽修、印刷行业外,其余行业企业构成比逐年下降;申报存在的三氯乙烯、二氯甲烷、铅、镉等职业病有害因素企业百分比逐年减少,而存在苯系物、正己烷、其他化学物质,粉尘,物理性职业病危害因素的企业百分比逐年增加。结论推进福田区基本职业卫生服务工作,保护劳动者职业健康,需要政府、职业卫生服务机构、企业等各方面的配合与落实,福田区职业病防治工作需根据辖区经济特点开展针对性的专项工作,促进企业主动进行职业病危害因素申报,并加强对小型企业职业病危害因素的检测,特别是加强对物理因素、粉尘的检测;对于其他化学物质,需重点了解其毒性及分类,以针对性地采取职业病防治控制措施。     

深圳市光明新区职业卫生现状调查与分析

目的 了解深圳市某区职业卫生现状,为职业病防治提供依据。 方法 对深圳某区392家企业的行业类型、职业病危害因素监测、劳动者接触危害及职业健康检查情况等进行调查分析。 结果 该地区的主要行业为电子、印刷、五金塑胶和化工;存在的主要职业病危害因素为化学毒物、粉尘和噪声;不同规模、不同经济类型企业从业人员的接触危害比例不同,差异有统计学意义(P<0.01),小型和私营企业接触危害比例较高,分别是16.70%和12.14%;噪声危害检测合格率较低,仅为42.51%,且接触噪声危害劳动者在岗期间疑似职业病及职业禁忌检出率较高,分别为3.76%,1.46%。 结论 小型和私营企业是该地区职业卫生重点关注对象,预防和控制职业性噪声危害则是该地区当前和今后职业卫生工作的重点。     

2010年忻州市企业职业病危害现状及防治管理情况调查

[目的]了解忻州市职业卫生现状及存在的问题,为职业卫生监督工作重点提供依据。[方法]2010年2~11月,采取现场检查、听取汇报、查看资料等方式,对忻州市辖区内存在职业危害的企业、职业病防治管理机构进行调查。[结果]调查851家企业,接触职业病危害因素的职工占总职工数的64.18%;43.95%建立健全了职业病防治管理机构,40.31%制定了职业病防治管理制度,25.85%配备了专兼职的职业卫生管理人员,33.37%开展了职业健康体检工作,25.85%进行作业场所有毒有害因素监测;接害职工体检率为45.15%;存在的主要职业危害因素是粉尘的占78.3%,是噪声的占19.6%,是苯、甲苯等毒物的占16.22%,是二氧化硫、硫化氢等刺激性气体的占14.45%。1998~2010年,累计报告职业病病人2 379例,其中尘肺占78.98%,血液系统疾病占3.15%,振动病占2.02%,噪声性耳聋占8.24%。累计死亡330例,其中尘肺病死亡占86.36%,血液病占9.70%。调查职业健康检查机构15家,2009~2010年合计检查5 654人,职业病检出率为2.18%(其中尘肺占26.02%、噪声性听力障碍占39.84%、电光性眼炎占21.95%、血象异常占5.69%)。[结论]忻州市职业卫生现状严峻,职业病防治管理漏洞较多。     

Associations of psychosocial working conditions with self-rated general health and mental health among municipal employees

Objectives: To examine associations of job demands and job control, procedural and relational organizational fairness, and physical work load with self-rated general health and mental health. In addition, the effect of occupational class on these associations is examined. Methods: The data were derived from the Helsinki Health Study baseline surveys in 2001–2002. Respondents to cross-sectional postal surveys were middle-aged employees of the City of Helsinki (n=5.829, response rate 67%). Associations of job demands and job control, organizational fairness and physical work load with less than good self-rated health and poor GHQ-12 mental health were examined. Results: Those with the poorest working conditions two to three times more, often reported poor general and mental health than those with the best working conditions. Adjustment for occupational class weakened the associations of low job control and physical work load with general health by one fifth, but even more strengthened that of high job demands. Adjustment for occupational class clearly strengthened the associations of job control and physical work load with mental health in men. Mutual adjustment for all working conditions notably weakened their associations with both health measures, except those of job control in men. All working conditions except relational organizational fairness remained independently associated with general and mental health. Conclusions: All studied working conditions were strongly associated with both general and mental health but the associations weakened after mutual adjustments. Of the two organizational fairness measures, procedural fairness remained independently associated with both health outcomes. Adjustment for occupational class had essentially different effects on the associations of different working conditions and different health outcomes.     

The contribution of maternal working conditions to socio-economic inequalities in birth outcome

The aims of this study were to examine the association between maternal working conditions and birth outcomes, and to determine the extent to which these contributed to class inequalities in six birth outcomes. We used an existing job exposure matrix developed from survey data collected in 1977 and 1979 to apply occupational-level information on working conditions to the national Swedish Registry, including approximately 280,000 mothers and 360,000 births during the period 1980--1985. Data were analysed using multivariate logistic regressions. Low levels of job control, high levels of physical demands and job hazards were more common in manual compared to non-manual classes. The self-employed had intermediate levels of such exposures. Job exposures, particularly low levels of job control, were generally and significantly associated with higher risks for low birthweight, very low birthweight, small for gestational age, all preterm, very preterm and extremely preterm births, but not with mortality. Compared to middle non-manuals (the reference group), lower non-manual and manual classes had higher risks for all birth outcomes, and these risks were nearly all significant. The highest odds ratios were found for skilled and unskilled manual workers in the manufacturing sector, with ratios between 1.35 and 2.66 (all significant). Job control explained a considerable proportion of inequalities in all birth outcomes. Job hazards contributed particularly to very low birthweight and extremely preterm birth, and physical demands to low birthweight and all preterm births. In conclusion, class differences in maternal working conditions clearly contributed to class differences in low birthweight (explained fraction 14-38%), all preterm births (20-46%), very (14-46%) and extremely (12-100%) preterm births. For very low birthweight and small for gestational age, there was a similar contribution in the manufacturing sector only. For all birth outcomes, class differences could still be detected after working conditions were taken into consideration.     

新疆职业人群精神心理健康与职业紧张研究

目的 了解新疆克拉玛依地区职业人群的心理健康水平和职业紧张程度,并分析影响因素.方法 采用多阶段整群随机抽样的方法,在新疆克拉玛依地区抽取2 200名年龄≥18岁的职业人群(主要包括工人、教师、军人、公务员及医务人员),应用一般健康问卷(GHQ-20)和及症状自评量表(SCL-90)进行流行病学调查.结果 SCL-90各因子得分与全国常模比较,强迫症状(1.69±0.58)分、恐怖(1.36±0.64)分,均高于全国常模(P <0.001),躯体化(1.33±0.55)分、人际关系敏感(1.44±0.46)分、抑郁(1.42±0.66)分、精神病性(1.23±0.48)分,均低于全国常模(P <0.001);SCL-90阳性组在不同职业人群心理健康总分、各因子得分差异有统计学意义(P <0.001);GHQ-20的阳性检出率为27.5%,SCL-90的阳性检出率为25.0%,GHQ-20和SCL-90在不同职业人群上阳性检出率差异均有统计学意义(P <0.05),两量表有较高的一致性;不同职业紧张组在一般健康问卷阳性和阴性组间差异有统计学意义.结论 新疆地区职业人群的职业紧张情况较为严重,精神心理健康相对较差,应对其提供有效的干预措施.     

Integrating occupational health services and occupational prevention services

BACKGROUND: Despite the human and monetary costs of occupational injury and illness, occupational health care has focused more on treatment than prevention, and prevention is not part of many clinical occupational health practices. This represents a failure of occupational health care to meet the health care needs of the working patients. METHODS: MEDLINE searches were conducted for literature on occupational medical treatment and the prevention of occupational injury and illness were reviewed to for linkages between prevention and treatment. Policy discussions which identify examples of programs that integrated prevention and treatment were included. RESULTS: Although examples of the integration of clinical and preventive occupational health services exist, there are challenges and barriers to such integration. These include inaction by clinicians who do not recognize their potential role in prevention; the absence of a relationship between the clinician and an employer willing to participate in prevention; economic disincentives against prevention; and the absence of tools that evaluate clinicians on their performance in prevention. CONCLUSIONS: Research is needed to improve and promote clinical occupational health preventive services.     

2006—2010年广州市接触职业病危害因素人群职业健康状况分析

目的掌握广州市职业病危害因素接触工人健康状况。方法对广州市职业病防治院2006年1月1日—2010年12月31日受理的282家企业46162名接触粉尘、噪声、苯系物等职业病危害因素的工人,按照《职业健康监护技术规范》GBZ 188进行评价和分类整理。结果共发现疑似职业病937人,检出率为2.03%;职业禁忌证125人,检出率为0.27%。结论广州市职业健康状况仍然不容乐观,职业病危害因素暴露人群的职业健康状况应该引起有关部门的高度重视。     

Sources and level of information about health issues and preventive services among young-old persons in Switzerland

Summary Objectives: to describe the sources of health information in young-old persons, and how they feel informed about preventive services. Methods: 1,567 randomly selected persons aged 65–69 years were asked where they did get information about health, and whether they felt sufficiently informed about recommended preventive services. Results: Most participants (over 90 %) cited their physician as a source of health information, while only 4 % cited the Internet. Level of information was low for several preventive services, including colon cancer screening (55 % felt sufficiently informed) and immunization against pneumonia (27 % sufficiently informed). Conclusions: Promotion of preventive services in older populations should take into account the preponderant role of physicians as a source of information and advice. Submitted: 4 July 2006, Revised: 20 March 2007, Accepted: 29 March 2007     

Advent of occupational health services research

After lagging behind health services research in general health care, research is now examining health services provided to workers suffering occupational injuries and illnesses. The National Institute for Occupational Safety and Health, the Robert Wood Johnson Foundation Workers' Compensation Health Initiative, the Agency for Health Care Policy and Research (now the Agency for Healthcare Research and Quality), and the Canadian Institute for Work and Health co-sponsored a June, 1999, conference to explore research needs in this area. Fundamental tenets for advancing occupational health services research include: adopting the goal of improving occupational health care, including better integration of preventive and curative care; creating standardized interstate occupational health care data sets that include medical, economic, and patient perspectives; better defining quality in occupational care and developing appropriate performance measures; in addition to medical costs, assessing social, economic, medical and functional outcomes of care; considering the connections between work and health, including general health services; and addressing the need to train qualified occupational health services researchers. Am. J. Ind. Med. 40:291-294, 2001. Published 2001 Wiley-Liss, Inc.     

Occupational health and safety policy and psychosocial risks in Europe: The role of stakeholders’ perceptions

Introduction

Psychosocial risks are now largely acknowledged throughout Europe as important challenges in occupational health and safety. However, there appear to be wide gaps in perception between experts and the general population on the nature and the relevance of psychosocial risks that have a potential impact on policy development and implementation in this area.

Methods

This study investigated the level of knowledge among European stakeholders, of legislation on occupational safety and health, focusing particularly on psychosocial risk factors. 75 members of employers’ associations, trade unions and government institutions from 21 countries in the European Union (EU) participated in the study. In addition, to further elaborate the findings of the survey, focus groups were organised during a 2-day stakeholder workshop.

Results

The level of application of European Directive 89/391 for the assessment and management of psychosocial risks and work-related stress was largely reported by the stakeholders as inadequate. This opinion was more marked in the new EU27 countries than the older EU15, and the difference was significant as regards the impact of the Directive on the assessment and management of psychosocial risks. Overall, psychosocial risks and work-related stress were reported to be important occupational health and safety concerns; however there were important differences among stakeholders in different countries.

Conclusions

Despite the development of knowledge and activities on both the policy and practice levels in recent years, further work is still needed to harmonize stakeholder perceptions in this area in the various EU member states.     

北京市怀柔区职业健康状况调查

目的全面了解怀柔区存在职业病危害因素企业的基本情况和防治现状,探讨存在的问题并提出建议,推动怀柔区职业病防治工作的开展,保护劳动者的身体健康,为政府制定职业病防治政策提供依据。方法采用横断面调查方法,使用统一的调查表,分级、分批培训调查员,统一要求、方法和标准;于2011年8月—2012年12月对怀柔区存在职业病危害因素的企业进行现场调查,由疾病预防控制中心专业技术人员审核后录入职业健康状况信息管理系统,并撰写调查报告,对职业健康现状进行描述性分析。结果怀柔区存在职业病危害因素的企业共297家,主要分布在杨宋镇、北房镇、雁栖开发区、庙城镇、雁栖镇和怀柔镇6个镇乡及开发区,以金属制品业、印刷业和交通运输设备制造业为主,小型、私营企业所占比例最高。存在职业病危害因素59种,主要为粉尘、噪声、苯系物等。有生产工人22 597人,接触职业病危害工人8 051人,接触职业危害因素比例为22.9%;企业职业健康检查覆盖率：上岗前为24.6%,离岗时为7.1%,在岗期间为61.3%;企业职业病危害因素检测覆盖率为77.1%。5年内重点职业病发病17人,主要为尘肺和噪声聋,占职业病发病总数的76.5%。结论怀柔区职业健康监护率、职业病危害因素检测率、职业卫生管理达标率均有待提高,提示相关部门应加强对小型、私营企业的监管,加大宣传和培训力度,提高企业的自身法律意识和广大劳动者的自我防范意识。     

中国职业卫生与职业病研究的进展

近年来中国职业卫生与职业病研究取得了长足的发展,以职业暴露人群为研究中心,针对职业病的病因、发病机制、人群易感性生物标志物以及风险评估等方面开展了大量的研究,填补了中国甚至世界范围内诸多职业卫生与职业病方面的空缺,具有重要的公共卫生意义。目前中国处于高速发展阶段,大批新兴的、创新的技术正应用于各个领域,推动着中国的产业结构、生产方式和生产技术发生巨大变革,新兴领域的高速发展对职业卫生提出了新的挑战,表现为传统的职业性有害因素带来的职业卫生问题逐渐减少,新的问题不断出现。职业卫生和职业医学也迫切需要将医学科学的新理念、新技术应用于本学科,建立新型健康风险评价体系,进而满足职业人群健康监护和职业病诊断治疗的需求。