Sociopolitical values and social institutions: Studying work and health equity through the lens of political economy

Abstract

Work contributes to health and health inequity in complex ways. The traditional exposure-disease framework used in occupational health research is not equipped to address societal contexts in which work is embedded. The political economy approach to public health directly examines macro-level societal contexts, but the attention to work in this literature is mostly on unemployment. As a result, we have limited understanding of work as a social determinant of health and health inequity. To fill this gap, we propose a conceptual framework that facilitates research on work, health, and health equity in institutional contexts. As an illustration of different social institutions creating different work-related health, we present characteristics of work and health in the United States and the European Union using the 2015 Working Conditions Surveys data. The results also highlight limitations of the traditional exposure-disease approach used in occupational health research. Applying the proposed framework, we discuss how work and health could be investigated from a broader perspective that involves multiple social institutions and the sociopolitical values that underpin them. Such investigations would inform policy interventions that are congruent with existing social institutions and thus have the potential for being adopted and effective. Further, we clarify the role of research in generating knowledge that would contribute to institutional change in support of population health and health equity.

Keywords: European union; Occupational safety and health; Political economy; Social determinants of health; United States; Welfare regime.

Fig. 1

A framework for adressing population health from the perspective of work. Solid lines indicacte mechanisms that create health-damaging and health-enhancing conditions. Dotted lines indicate mechanisms that place people in health-damaging and health-enhancing conditions.

Fig. 2

Age-adjusted prevalence of poor health indicators among working men and women in the US and EU28, 2015. All differences between the two regions are statistically significant at the 0.05 level unless noted as “n.s.”

Fig. 3

Age-adjusted prevalence of selected occupational hazard exposure among working men in the US and EU28, 2015. All differences between the two regions are statistically significant at the 0.05 level unless noted as “n.s.”

Fig. 4

Age-adjusted prevalence of selected occupational hazard exposure among working women in the US and EU28, 2015. All differences between the two regions are statistically significant at the 0.05 level unless noted as “n.s.”