How Society Shapes the Health Gradient: Work-Related Health Inequalities in a Comparative Perspective

Abstract

Analyses in comparative political economy have the potential to contribute to understanding health inequalities within and between societies. This article uses a varieties of capitalism approach that groups high-income countries into coordinated market economies (CME) and liberal market economies (LME) with different labor market institutions and degrees of employment and unemployment protection that may give rise to or mediate work-related health inequalities. We illustrate this approach by presenting two longitudinal comparative studies of unemployment and health in Germany and the United States, an archetypical CME and LME. We find large differences in the relationship between unemployment and health across labor-market and institutional contexts, and these also vary by educational status. Unemployed Americans, especially of low education or not in receipt of unemployment benefits, have the poorest health outcomes. We argue for the development of a broader comparative research agenda on work-related health inequalities that incorporates life course perspectives.

Labor markets and health: an integrated life course perspective

“…Labor market experiences related to the availability and nature of work are embedded within a labor market and social context (7). Four contextual levels are defined: workplace/organizational, labor market, societal, and supranational (see table 2).…”

“…Transitions are significant changes in physiological, psychological, social or material states (7,21). Transitions (ie, health status, life course and labor market transi tions) have the potential for short and longterm health and labor market outcomes.…”

“…Social epidemiology has considered theoretical models of exposure broadly focused on the socio ecological causes of health (6,7), social triggers of biological events (8), the social structuring of work exposures (9), the role of social context in affect ing unemployment (10), and precarious employment contracts (11). While social epidemiological theory has advanced our broad conceptualization, a more integrated approach is needed that considers the work ing life course (as represented in the example in the box on the following page) from the schooltowork toretirement transitions and the impact of work on retirement (12).…”

Receiving Unemployment Benefits May Have Positive Effects On The Health Of The Unemployed

“…Rodriguez used data from the United States, Germany and Britain and found that unemployed workers receiving different types of government entitlement benefits (including unemployment benefits) reported similar health status as full-time employed workers, suggesting that such support programs can buffer the health effects of job loss (Rodriguez 2001). Other studies have reported protective effects of government entitlement benefits for depression symptoms among unemployed women (25); poor self-rated health among minimum and medium skill level jobs (21); and poor mental health among unemployed workers in Spain (26). While most of these studies find a positive association between unemployment benefits and health, a key limitation is the lack of attention to selection.…”

“…While some studies suggest that unemployment benefits may ameliorate some of the negative health effects of job loss (19)(20)(21), prior studies have not accounted for preexisting differences between benefit recipients and nonrecipients. A potential concern is therefore that benefit recipients are a priori in comparatively better health than their non-recipient counterparts.…”